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A baby born in water...
Can be under water after birth without complications
Assessing "normal progress" of labor:
Friedman's Curve (1955)
Taught to doctors and
nurses
Used as guide to "managing" labor
Modern "Curves"
New research
New thoughts on modern management
More individual care focused on steady progress rather than a curve
"Normal progress": Active phase
-(4-7cm) slower dilation than Friedman
-4-10 cm took approximately 5.5 hours
-Before 7 cm: ok if no change over > 2 hours
-Wider variation of expectant management
,The Six P's of the laboring person and the Fetus
-Powers (contractions and pushing)
-Passage (pelvis)
-Passenger (fetus)
-Position
-Placenta
-Psyche
The Four P's of the Labor Support Person and Providers
-Patience
-Persistence
-Practice/Pain
relief Psyche
Passage
Pelvis & Soft Tissue -- Cervix, Vagina, Perineum
,Passenger
-Size of baby
-Number of babies
-Position of baby
-Presentation
-Lie
Position
-Think of mother and baby
-What is the best position of birth?
-What is the worst?
-What is the most common?
Placenta
-After delivery will detach on its own
-Must wait up to 30 minutes
-Contractions will continue
-Retained placenta create risk for bleeding
Psyche
-Progress of labor and birth can be adversely impacted by maternal fear,
anxiety or tension
-Norepi or epi may stimulate alpha and beta receptors of myometrium
-Interferes with rhythm of contractions
-Can also interfere with pain receptors
-Increasing need for analgesia and anesthesia
, Mechanisms of labor and delivery
-Engagement: presenting part at 0 station
-Descent: fetus moves down through pelvis
-Flexion: chin to chest due to pelvic pressure (largest diameter changes
from 11 to 9.5cm)
-Internal rotation: to bring head in line w/ opening
-Extension: pressure from pubic bone makes head extend up and out- head
born
-Restitution & internal rotation: head twists 45°
-Expulsion: anterior shoulder rotates under pubic bone then posterior
shoulder and rest of baby
1st stage
-Contractions and dilation
-From start of labor through 10cms dilated
What happens at the first stage?
-Uterine contractions
-Cervical dilation
-Cervical effacement
-Fetal Station
-ROM.....
2nd stage
Pushing and delivery of the baby