OB

• True vs False Labor True Labor Regular and predictable contractions
• True vs False Labor True Labor Pain in the lower back radiating to the abdomen
• True vs False Labor True Labor Increase in frequency, increased duration, shortened interval
• True vs False Labor True Labor Pain is not relieved/more intense with ambulation
• True vs False Labor True Labor With cervical dilatation and effacement; rupture of membranes; bloody show/mucus plug expulsion
• True vs False Labor False Labor Irregular contractions
• True vs False Labor False Labor Pain is confined in abdomen
• True vs False Labor False Labor No increase in frequency, duration, and interval
• True vs False Labor False Labor Relieved by ambulation
• True vs False Labor False Labor Absent cervical changes (no effacement, no dilatation)
• 4Ps of Labor 1. Passenger: fetus 2. Passageway: pelvis, cervix, vagina 3. Power a. Primary: uterine contraction (stronger power, therefore do not bear down with contraction) b. Secondary: bearing down 4. Psyche: overall status of the mother (physical, emotional, psychological)
• Frequency start of one labor contraction to start of another
• Duration start of one laborcontraction to end of same contraction
• Interval end of one contraction to the start of another
• Cardinal Signs of Labor D – Descent = Lightening O – Opening of cervix = Dilatation S – softening of the cervix C – contraction is increased R – Rupture of Membranes (bag of water breaking) E – Effacement (cervix gets thinner and shorter) A – Apprehension M – Mucus plug expulsion (bloody show)
• Definitive diagnostics of true labor: Initiation of Labor
• Amniotic fluid Nitrazine test value: pH 7.0 – 7.5
• Vaginal fluid Nitrazine test value: pH 5.5. – 6.5
• Fetal position that causes back pain: LOP/ROP
• Back Pain Interventions for R/LOP 1. Apply counterpressure to the sacrum during contractions 2. Reposition the mother on her hands and knees with birthball 3. Encourage mother to change position every 30-60 minutes
• Stages of Labor Stage 1: Dilation & Effacement - longest stage Stage 2: Fetal Expulsion Stage 3: Placental Delivery Stage 4: Recovery
• 1st stage of labor typically last for 20 hours
• Phases of Stage 1 Latent 0-3 cm dilated, 0-30% effaced
• Phases of Stage 1 Latent mother is able to communicate; best time for health teachings
• Phases of Stage 1 Latent contractions are irregular, short, & far apart
• Phases of Stage 1 Latent Frequency: 5-30 min; Duration: 30 sec
• Priority for Latent Phase is to assess for late decelerations so the nurse must monitor for fetal hear rate
• Purpose of fetal monitor: Determine if the fetus is receiving enough oxygen
• Phases of Stage 1 Active 4-7 cm dilated
• Phases of Stage 1 Active contractions are stronger and longer; true labor begins
• Phases of Stage 1 Active breathing techniques and pain management
• IV narcotics during labor are only given slowly during peak of contractions to reduce sedation of the fetus
• Phases of Stage 1 Active focuses on pain; mother loses self control; no health teachings
• Phases of Stage 1 Transitional 8-10 cm dilated, fully effaced
• Phases of Stage 1 Transitional contractions are strongest and closer
• Phases of Stage 1 Transitional focus and staying in control
• Priority for Transition Phase is to assess for color of aminiotic fluid as it may indicate fetal distress or hypoxia
• When a patient is 10 cm dilated, document fetal HR every 15 minutes
• Phases of Stage 1 Transitional anxiety, vomiting, the need to have a bowel movement
• Stages of Labor 2nd: Fetal Expulsion denoted by significantly increased in contractions, Ferguson reflex, strong urge to bear down