Ch 26

Front 1

birthing choices. three primary options available:

Back 1

hospital

birthing center

home

Front 2

the combination unit is referred to as a ________ unit.

some facilities offer single-room services which the woman labors, delivers, and receives postpartum care in one area. this arrangement is referred to as ___________________.

Back 2

mother-baby unit

labor, delivery, recovery, postpartum (LDRP) unit

Front 3

a ________ offers childbirth outside of a hospital, but typically nearby to allow for easy access in the event of complications.

it is cost effective and is provided by nurse-midwives and physicians. eligibility for childbirth is limited to those women considered to be low risk for development of complications

Back 3

freestanding birthing center

Front 4

women interested in a more relaxed, family centered, and relatively low cost delivery experience may consider a _______. the risk of infection also is lower. only an option for a woman in good health with a reasonable expectation of a positive outcome for both mother and baby.

must be carefully considered by all parties and must be approved by the attending physician and nurse-midwife.

Back 4

home birth

Front 5

some of the more common (but sill unproven) onset labor theories relating to hormones are

Back 5

oxytocin stimulation

progesterone withdrawal

estrogen stimulation

fetal cortisol

Front 6

as early as 2 weeks before the onset of labor the woman may notice that the fetus seems to have settled, or "dropped" into the pelvis. this is called _______ and is seen most often in nulliparas.

once is has occurred, the woman often notices that urinary frequency returns. she may be able to breathe more normally because the abdominal cavity has more space.

Back 6

lightening

Front 7

sign of impending labor, occasionally a woman may have a seepage or sudden outflow of fluid from the vagina. this may be urine, or it may be amniotic fluid, indicating a rupture of the amniotic sac. a simple test with _______ can distinguish between these.

Back 7

nitrazine paper

Front 8

if the nitrazine paper reacts (turns blue), the discharge is probably ________. if the test is nonreactive, the membranes are probably ________.

Back 8

amniotic fluid

intact

Front 9

delivery should occur _______ hours after membranes rupture.

Back 9

18 to 24

Front 10

the amount of vaginal draining typically increases as term approaches, and blood-tinged mucus called _______ may be observed. this is the mucus that occluded the opening of the cervix during pregnancy.

Back 10

bloody shaw

Front 11

irregular tightening of the pregnant uterus that begins in the first trimester and increases in frequency, duration, and intensity as pregnancy progresses.

backache and contractions of the uterus

they remain irregular and do not dilate the cervix

Back 11

braxton hicks contractions

Front 12

true labor is marked by the onset of regular, rhythmic contractions that cause progressive cervcial dilation and ____________.

thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both.

Back 12

effacement

Front 13

contractions follow a regular pattern

contractions come closer, stronger, and tend to last longer

contractions get stronger with ambulation

contractions seem to start in the lower back and then travel to the lower abdomen

contractions are usually not stopped by controlled breathing, sedation, or other relaxation interventions

the cervix softens, effaces, and dilates

the fetus continues descent into the pelvis

Back 13

true labor

Front 14

contractions rarely follow a pattern

contractions vary in length and intensity

contractions frequently stop with ambulation or position change

contractions maybe felt in the back, but are most often noticed in the fundus

contractions eventually stop with relaxation interventions

the cervix may soften, but there is little or no change in effacement or dilation

there is not significant change in the fetal position

Back 14

false labor

Front 15

standard precautions during childbrith

Back 15

wash hands

don gloves when performing procedures in contact with woman's genitalia or body fluids

when assisting with birth, wear cover gown and mask with eye shield. weak cap and shoe covers for c-section births.

primary health care provider should wear sterile gown.

drape woman with sterile towels and sheets

help woman's partner put on coverings (mask, cap, gown, shoe covers)

wear gloves and gown when handling newborn

use an appropriate method to suction the newborn's airway

Front 16

process of labor and delivery the five Ps

Back 16

passageway: pelvis and soft tissue

passengers: the fetus and placenta

powers: contractions

position of mother: standing, walking, side lying

psyche: psychological response

Front 17

the superior position of the ______ supports the uterus and fetus during the late months of pregnancy.

Back 17

pelvis

Front 18

these bones aid in directing the fetus into the inferior (lower) portion of the pelvis, which is called the ________. the two sections are divided by an imaginary line called the _______, or pelvic inlet.

Back 18

true pelvis

linea terminalis

Front 19

the true pelvis is further divided into three segments:

Back 19

the inlet, the cavity or midpelvis, and the outlet.

Front 20

the primary care practitioner can use several methods for evaluating the size of the true pelvis:

Back 20

palpation, pelvimetry, ultrasonography

Front 21

during labor the ____, _____, ______, and _______ change is consistency and shape to allow passage of the fetus.

Back 21

uterus

cervix

vagina

muscles of the perineum

Front 22

at term the fetus often weighs

Back 22

7 pounds or more and is 20 to 21 inches long

Front 23

the ______ is usually the largest part of the body, so delivery of the head is of greatest concern. the bones are not rigidly joined. this allows the bony plates to move and overlap as they progress through the maternal pelvis.

Back 23

fetal skull

Front 24

reshaping of the skull bones in response to pressure against maternal pelvis is called

Back 24

molding

Front 25

the major bones of the skull are two frontal bones, the two parietal bones, the two temporal bones, and the occiput. They are joined by membranous spaces called ________.

Back 25

sutures

Front 26

where sutures meet, there are larger membranous areas called

Back 26

fontanelles

Front 27

the _______ is formed by four bones and thus tends to be larger and diamond shaped. the _______ is formed by three bones and is smaller and triangular.

Back 27

anterior fontanelle

posterior fontanelle

Front 28

the largest transverse diameter of the skull is the __________. if this is too large, the skill may not be able to enter the mother's pelvis

Back 28

biparietal measurement

Front 29

the relationship of the fetal body parts to one another is called

Back 29

attitude

Front 30

at term, the ideal attitude for the fetal body is

Back 30

flexion

Front 31

the back is bowed outward, the chin is touching the sternum, the arms are crossed on the chest, and the thighs are flexed on the abdomen. this is called the

Back 31

fetal position

Front 32

if the fetus does not have enough room because of too little fluid (oligohydramnios), multiple pregnancies, or anatomical variations in the mother, the attitude may be altered, leading to

Back 32

complications of labor or delivery

Front 33

the relationship of the cephalocaudal (head to buttocks) axis of the mother.

Back 33

fetal lie

Front 34

if the spine of the fetus is parallel to the spine of the mother, the lie is called

Back 34

longitudinal

Front 35

if the spine of the fetus is perpendicular to that of the mother, it is called ________

most common in women who have had many pregnancies, maternal pelvic contracture, or placenta previa

Back 35

transverse lie

Front 36

that part of the fetus that first enters the pelvis and lies over the inlet

describes the part that will be in contact with the cervix.

this is determined by both attitude and lie.

in about 96% of deliveries the presentation is cephalic

Back 36

fetal presentation

Front 37

cephalic presentation is divided into four types:

Back 37

vertex (region between the fontanelles), brow, face, and mentum (chin).

Front 38

three types of breech presentation are possible: _______, in which the buttocks present and the thighs are well flexed on the abdomen; _______, in which the buttocks present and the thighs are extended across the abdomen and chest; and ________, in which there is no flexion and one foot or two feet present.

Back 38

complete breech

frank breech

footling breech

Front 39

to decrease risks to the fetus, the majority of breech births are delivered

Back 39

surgically

Front 40

the relationship of the presenting fetal part to a quadrant of the maternal pelvis. can be determined by abdominal inspection and palpation, vaginal or rectal examination, auscultation of fetal heart tones, or ultrasound or x-ray exam. once determined, it is expressed in abbreviated form.

Back 40

fetal position

Front 41

the most common position for delivery is ______, in which the occiput of the fetus points toward the left anterior segment of the maternal pelvis. the _______ position is the next most common.

Back 41

left occiput anterior (LOA)

right occiput anterior (LOA)

Front 42

______ is dangerous because pressure on the vessels in the cord can restrict blood flow to the fetus

Back 42

cord prolapse

Front 43

the ______ is also referred to as a passenger. after the fetus is delivered by strong uterine contractions, it's attachment site is significantly smaller. this reduced size causes it to separate from its attachment.

Back 43

placenta

Front 44

positions to relieve pressure on cord

Back 44

modified sims, trendelenburg's, or knee-chest

Front 45

a placenta will not easily be freed from ______ uterus because the placental attachment site is not reduced in size.

Back 45

flaccid (relaxed)

Front 46

placental separation is indicated by the following signs

Back 46

firmly contracting fundus

change is uterus shapes

a sudden gush of dark blood

apparent lengthening of cord

a vaginal fullness noted

Front 47

The delivery of the placenta completes the ________ stage of labor. this stage lasts 15 to 30 minutes or longer if the health care practitioner waits for the mother to express the placenta herself.

Back 47

third stage

Front 48

after the placenta emerges, it is examined for _______ to be certain that no portion of it remains in the uterine cavity.

Back 48

intactness

Front 49

if the _____ is not firm, stimulate the uterine muscles to regain tone and to expel any clots before measuring the distance from the umbilicus. palpate the uterus gently only until it is _____; overstimulation causes uterine muscle fatigue and results in ________.

Back 49

fundus

firm

atonia (relaxation)

Front 50

the uterus can contract only if it is free of

Back 50

intrauterine clots

Front 51

________ combine to expel the fetus and the placenta from the uterus.

Back 51

involuntary and voluntary contractions

Front 52

signal the beginning of labor

originate at certain pacemaker points in the thickened muscle layers of the upper uterine segment. from the pacemaker points, contractions move downward over the uterus in waves, seperated by short rest periods.

called primary powers

responsible for the effacement and dilation

Back 52

involuntary uterine contractions

Front 53

_______ is the enlargement of the cervical opening and the cervical canal that occur once labor has begun. the diameter of the cervix increases from less than 1 cm to full dilation (approximately 10 cm) to allow birth of a term fetus.

occurs by drawing upward of the musculofibrous components of the cervix as a result of strong uterine contractions.

Back 53

dilation of the cervix

Front 54

full cervical dilation marks the end of the ____ stage of labor.

Back 54

first

Front 55

in the first and second stages of labor, increased intrauterine pressure caused by contractions places pressure on the ___________.

Back 55

descending fetus and the cervix

Front 56

stretch receptors in the posterior vagina cause release of exogenous oxytocin that triggers the maternal urge to bear down, or ________.

Back 56

ferguson's reflex

Front 57

uterine contractions may temporarily become less frequent and intense when the woman recieves

Back 57

narcotic analgesics or epidural analgesia early in labor

Front 58

as soon as the presenting part reaches the pelvic floor, the woman experiences an involuntary urge to push. she uses ________ (bearing down efforts) as she contracts her diaphragm and abdominal muscles, and pushes. result in increased intraabdominal pressure that compresses the uterus on all sides and increases the expulsive forces. have no effect on cervical dilation, but they are important in expelling the infant from the uterus and vagina after the cervix is fully dilated.

Back 58

secondary powers

Front 59

spontaneous bearing down efforts

closed glottis and prolonged bearing down

Back 59

valsalva's maneuver

Front 60

as the fetus moves through the maternal pelvis, several maneuvers are required. these turns and adjustments are called the

Back 60

mechanisms of labor

Front 61

occurs when the biparietal diameter of the fetal head crosses the pelvic inlet; the head is said to be fixed or engaged in the pelvis. in nulliparous women, this tends to occur early, often several days or weeks before labor begins. multiparous women may not experience this until labor has started.

Back 61

engagement

Front 62

_______ is the downward progress of the presenting part. the amount of progress is measured by comparing the lowest point of the present part to the ischial spines. this is referred to as the station and is measured in centimeters above or below the level of the spines.

Back 62

descent

Front 63

enables the fetal head to progress through the maternal pelvis. the largest diameter of the fetal head aligns with the largest diameter of the pelvis.

Back 63

internal rotation

Front 64

occurs when the occiput passes under the symphysis pubis. this bony structure acts as a stable point and provides leverage, enabling the head to leave the pelvis.

Back 64

extension

Front 65

as soon as the head is delivered, it moves to realign with the body and shoulders. this is referred toas

Back 65

restitution

Front 66

occurs as the shoulders and body move through the birth canal, using the same maneuvers as the head. the shoulders are delivered similarly to the head, with the anterior shoulder pressing under the symphysis pubis, which acts as a leverage point and assists in delivering the posterior shoulder.

Back 66

external rotation

Front 67

begins with the onset of regular contractions and ends with complete dilation of the cervix. generally the longest stage of labor, averaging 10 to 12 hours in nulliparas and 6 to 8 hours in multiparas. this stage is often divided into three phases: early latent stage, middle or active phase, and transitional phase.

Back 67

first stage: dilation

Front 68

begins with complete dilation at 10 cm and ends with the birth of the baby. lasts an average 30 minutes to 2 hours in nuliparas and 20 minutes to 90 minutes in multiparas. contractions continue to lasts 80 to 90 seconds or slightly less. the woman usually feels the urge to push and is anxious to do so. restin between contractions, if possible, is important to conserve energy. primary care provider may provide anesthesia and perform episiotomy.

Back 68

second stage: delivery of the fetus

Front 69

the _______ is a surgical incision of the perineum at the end of the second stage of labor to allow easier delivery and to avoid laceration of the perineum. the most common type is midline, or median, incision that seperates the tissues of the perineum at an anatomical junction.

Back 69

episiotomy

Front 70

after the shoulders are delivered, the delivery ends with ________, in which the body of the infant leaves the pelvis. delivery of the body occurs rapidly once the shoulders have been delivered.

Back 70

expulsion

Front 71

immediately after delivery the baby's ______ is established and the _______ is clamped with two clams and then severed between the clamps. if everything is normal, show baby to parents.

Back 71

airway

umbilical cord

Front 72

begins with the delivery of the infant and ends with the delivery of the placenta. the average for both primiparas and multiparas is 5 to 20 minutes. mother is less interested in the third stage; she is focused on the newborn. when placenta detaches from the uterine wall, blood suddenly pours out of the vagina. the cord protruding from the vagina lengthens, and the uterus becomes more rounded and firm. woman may again experience contractions. during this time, practitioner repairs the episiotomy if one was performed.

Back 72

third stage: delivery of the placenta

Front 73

total blood loss during labor is normally 200 to 300 ml; it is considered excessive if more than ______ of blood is lost during delivery.

Back 73

500 ml

Front 74

common drugs given during third stage of labor & delivery

Back 74

oxytocin (pitocin)

maleate (methergine)

Front 75

mother's body attempts to recover from the efforts of labor. the mother is monitored closely for 2 to 4 hours after delivery in the birthing room or in a recovery room. monitor physiologic changes closely. monitor vitals, uterine tone, vaginal drainage, and perineal tissue. during first hour perform 15 minute assessments. if observations are within normal limits, assessments are done every 30 minutes.

Back 75

fourth stage: stabilization

Front 76

_______ is a good indicator of the fetus condition.

Back 76

Fetal heart rate (FHR)

Front 77

the normal FHR range is ____ to _____ bpm. an increase or decrease of ______ bpm may indicate fetal distress and should be reported immediatley.

Back 77

120 to 160 bpm

30 bpm

Front 78

auscultate the FHR, using a ______ , every 15 to 30 minutes the first stage of labor and every 5 minutes during the second stage.

Back 78

fetoscope or doppler

Front 79

can detect subtle changes of condition before they can be recognized by auscultation.

Back 79

electronic fetal monitoring

Front 80

an ______ uses high frequency sound waves to reflect movement of the fetal heart ventricles.

Back 80

ultrasound transducer

Front 81

FHR is monitored in relation to the contractions. A decrease in FHR occurs in response to the contractions and is called a _________.

can be early, late, or variable.

Back 81

decelerations

Front 82

if the amniotic membranes have not ruptured, the primary care practitioner may use a sterile hook-shaped instrument to open the sac and allow the fluid to drain; this procedure is called an _________.

artificial rupture of the fetal membrane.

Back 82

amniotomy

Front 83

_____ are spoonlike device that fits around the fetal head to aid in expulsion. closely monitor the FHR.

Back 83

forceps

Front 84

is defined as labor that lasts less than 3 hours from the onset of contractions to the time of birth. may result from hypertonic uterine contractions that are tetanic-like in intensity. maternal and fetal complications can result.

Back 84

precipitous labor

Front 85

monitors uterine activity and records frequency and duration of contractions.

Back 85

tocotransducer