NR 327 EDAPT PROCESS AND STAGES OF LABOR 2024

EDAPT PROCESS AND STAGES OF LABOR The process of labor and delivery is complex, yet mostly natural. Often, the results are positive without the need for intervention. However, multiple factors influence each other to make this happen. What is the highest priority after birth of the fetus? The priority after birth of the fetus is establishing the newborn’s airway. Typically, the nares and mouth are suctioned out after birth, and this may occur after placing the newborn on the client’s chest. The fetal occiput, the most rounded and smooth surface of the fetal head, is best at fitting through the pelvis and dilating the cervix when it is turned in a right anterior (ROA) position. The base is the most inferior area of the skull and not ideal for fitting through the pelvis. The sinciput is the front of the skull from the forehead to the crown and not ideal for fitting through the pelvis. The acromion process is not part of the skull. It is the bony process on the scapula. This part of the fetus will not descend into the pelvis. A pregnant client who is 39 weeks gestation reports that she is urinating a lot more lately and does not feel the baby up as high in her abdomen. What is the likely reason? Lightening is common at the end of pregnancy. The fetus feels like it has settled or dropped into the pelvis. Most often in first pregnancies, the woman has an increase in urinary frequency brought on by the pressure of the fetus settling in the pelvis and the pressure of the uterus. The woman feels it is easier to breathe once the fetus drops lower, which allows more room in the abdominal cavity for respirations. Braxton Hicks contractions are abdominal tightening that occurs in the later part of pregnancy that does not dilate the cervix. Internal rotation of the fetus occurs during labor when the occiput rotates to fit the diameter of the pelvic cavity for descent through the birth canal. Urinary tract infections may cause frequency of urination but are also accompanied by fever, urgency, and dysuria. Around 2 weeks before labor begins, the following signs may develop. 1. Lightening: The fetus feels like it has settled or dropped into the pelvis, most often in first pregnancies. 2. Increased Urinary Frequency: An increase in urinary frequency is brought on by the pressure of the fetus settling in the pelvis and the pressure of the uterus. 3. Relief of Pressure & Fetus “Drops”: It is easier to breathe once the fetus drops lower, which relieves pressure and allows more room in the abdominal cavity for respirations. 4. Leaking Amniotic Fluid in the Vagina: This may feel like leaking urine. Nitrazine paper is used at the bedside to determine the presence of amniotic fluid. If the paper turns blue, it is reactive and positive for amniotic fluid. If it does not change color, the fluid is probably urine. Typically, the amniotic fluid does not rupture or leak until after labor starts. It is important that the woman seeks medical attention if she believes her membranes are leaking or have ruptured. 5. Vaginal Examination: The exam performed by the healthcare provider late in pregnancy will find a cervix that is “ripening”, beginning to efface (thin), soften, shorten, and dilate (open). Mucousy, bloodtinged vaginal discharge (called bloody show): There is a mucous plug that blocks the cervical opening during pregnancy. As the vascular cervix ripens and labor approaches, this plug may become dislodged and also be mistaken for amniotic fluid. 6. Backaches: Backaches along with uterine contractions become more frequent and intense but may or may not be regular and painful. This can make it difficult to determine true versus false labor. True labor is determined by regular, rhythmic contractions that result in progressive cervical dilation and effacement. Contractions that do not meet this criteria are called Braxton Hicks contractions and are false labor. 7. Other signs: Nausea, diarrhea, bursts of energy with the desire to clean and prepare for the baby (called nesting) are common. The exact cause for the onset of labor, whether it is prompted by mechanical or hormonal changes, remains unknown. Some believe uterine stretching causes uterine contractions to start, but this is often not the case. Hormonal increases or decreases in either the mother or the fetus are also possible causes for the onset of labor.  Progesterone decreases in late pregnancy, allowing uterine contractions to strengthen.  Estrogen increases, making the uterus more sensitive to stimuli that cause contractions.  Oxytocin increases and stimulates uterine contractions.  Prostaglandins increase the strength of uterine contractions and further enhance oxytocin secretions. A pregnancy is considered full term beginning at 39 weeks 0 days until 41 weeks 6 days. As the pregnancy continues beyond 40 weeks and into post term (42 weeks gestation), the body goes through changes that affect the fetus. THE Ps OF THE LABOR AND DELIVERY PROCESS As a woman nears the end of pregnancy, specific clini