Maternity chapter 16 labor and delivery STUDY GUIDE 2024
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RN - Registered Nurse
Institution
RN - Registered Nurse
Maternity chapter 16 labor and delivery STUDY GUIDE 2024
Maternity chapter 16 labor and delivery STUDY GUIDE 2024
Maternity chapter 16 labor and delivery STUDY GUIDE 2024
Maternity chapter 16: labor and delivery
STUDY GUIDE 2024
Venue Options
- Hospitals
o Most happen in the hospital
o Provides access to key personnel, equipment, pain
control option, and emergency services
- Home births
o 88% are intentional ; 12% precipitous
o Many chose this b/c of negative hospital experiences
o Women may feel more comfortable, empowered, and in
control at home
- Birthing centers
o Generally freestanding centers are not located in a hospital
o Midwives attend most births in birthing centers
o Cater to women w/ low-risk pregnancies
o Transfer agreements w/ local hospitals
5 P’s of Labor
- Power = uterine contractions, pushing reflex (Ferguson
reflex) and voluntary pushing efforts
- Passageway = anatomy of the mother’s bony pelvis and soft
tissues
- Passenger = fetal factors
- Psyche = maternal state of mind
- Position = maternal position
5P’s #1 = Power
- Primary powers (Involuntary uterine contractions, reflex to push
{Ferguson reflex})
o Involuntary uterine contractions
▪ Occur in upper 2/3 of uterus
▪ Apply pressure to fetus pressure to amniotic fluid,
lower portion of uterus & cervix cervix dilates and
effaces allows for passage of fetus, amniotic fluid,
membranes,
placenta
▪ How are cervical dilation & effacement measured?
• Cervical dilation = nurse putting fingers
inside woman’s vag. and using finger
lengths to see how
many cm’s
• Effacement = thinning of the cervix, measured
in %,
▪ Oxytocin (Pitocin) can be administered to
augment strength & frequency of
contractions
▪ Contractions & bearing down reflex
▪ Ferguson reflex: stimulated when presenting part of
fetus reaches pelvic floor (bear down reflex)
, ▪ 2nd stage of labor: time from complete dilation of
cervix to birth of fetus
- Secondary powers (voluntary action of pushing {maternal})
o Voluntary bearing down efforts of laboring woman
o Increases intraabdominal pressure potentiates
contractions
o When should secondary powers start?
▪ When she’s 10 cm dilated
5P’s #2 = Passageway
- Passageway = anatomy of the bony pelvis and soft tissue of
the pelvic floor muscles, vaginal canal & introitus (vaginal
opening)
o Pelvic joints (symphysis pubis & sacroiliac) become
mobile in pregnancy relaxin and estrogen
o Gynecoid pelvis shape provides the most ideal passageway
- Depends on the ability of soft tissue (vaginal canal) to stretch
o May be problematic if a woman has scar tissue from
gynecologic surgery
- Muscles of the pelvic floor help turn and orient the fetus
through the cardinal movements of delivery
- The relationship between the fetal presenting part and the
pelvis is assessed by fetal station
- Level of the ischial spines (narrowest part) is referred to as zero
station (look at slide 15 for stations)
- Fetus is engaged when the presenting part has reached zero
station
5P’s #3 = Passenger
- Important factors related to the fetus and labor are
1. Fetal head size
a. Typically the largest part of fetus
b. Unfused skull bones allow for head to
change in reference to birth canal
2. Fetal presentation
a. Part of the fetus that enters the pelvis 1st
(presenting part)
b. Majority of fetuses enter pelvis head first – AKA
cephalic presentation
c. Other presentations: breech (buttocks or
feet) & shoulder
3. Fetal attitude
a. Position of fetal body parts in relationship
to one another (flexion/extension)
b. Typical attitude = flexed neck, arms, legs &
rounded back – optimal!!
4. Fetal lie
a. Relationship of the long axis of the fetus to the
long axis of the mother
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