NURS 3163 Child Health Summary

Chapter 16:
Issues for new nurses:
 pain associated with birth
 inexperience or negative experience
 unpredictability
 intimacy of the birth experience

Physiologic effects of birth process:
 Maternal response:
o Labor contractions are intermittent allowing placental blood flow and
exchange of O2
o Uterine contractions are NOT under conscious control
o Pushing is under conscious control
o Contractions do not make or change labor
o Labor= dilation & effacement (cervical changes)
o Upper uterus contracts actively during labor as it pushes the fetus down
o Best time to assess maternal VS is in between contractions
 During contractions there is an increased BP & decreased HR
o Labor pain can cause hyperventilation
 may feel dizzy, lightheaded, impaired thinking
 Breathe into brown paper bag, emesis bag, cover mouth with hands
while breathing in and out, oxygen mask w/o O2
 Fetal response:
o Placental circulation
 During contractions there is less blood flow to fetus
 3 protective mechanisms: (enough reserves to tolerate labor)
 Fetal hemoglobin (carry more O2)
 High hematocrit (more RBC)
 High cardiac output
 Pulmonary system:
 Fetal lung liquid production decreases and its absorption into
lung tissue increases during later pregnancy and labor

Components of birthing process:
 Powers:
o Uterine contractions (first stage of labor)
o Maternal pushing (second stage of labor)
 Passage: natural mechanisms of labor favor efficient passage of the fetus through
the mother’s pelvis
o Bones (maternal pelvis- inlet, mid-pelvis, outlet)

,  Most favorable is gynecoid
 Can also deliver baby with anthropoid
 Cannot deliver baby with android (men) & platypelloid
o Soft tissue (perineum)
 Softening of cartilage, hormone relaxin increases
 Passenger: fetus & placenta
o presentations & position further describe the relation of the fetus
(passenger) to the maternal pelvis
o 96% of the time fetus enters pelvis head first
o Fetal head
 2 frontal, 2 parietal, 1 occipital
 Bones of the head separated by sutures (strong but flexible fibrous
tissue)
 Sutures are flexible so they move and fetus can get through birth
canal
 Molding= sutures & fontanels allow fetal head bones to move
slightly to adapt to size & shape of maternal pelvis
o Fetal lie
 Orientation of long axis of fetus in relation to long axis of mother
 Longitudinal= vertical (parallel)
 Transverse= horizontal (perpendicular)
 Oblique= diagonal
o Attitude
 Relation of fetal parts to one another
 Normal is flexion, head flexed toward the chest and the arms &
legs flexed over thorax, back is curved in a convex C shape
o Presentation: part that enters the pelvis first
 Cephalic (head first)
 Vertex (favorable) where head is flexed and baby comes out
all tucked in
 Military- head is in a neutral position not flexed or extended
 Brow- fetal head partially extended
 Face- fetal head is fully extended
 Breech (butt first)- do NOT want to deliver vaginally
 Frank breech (most common); feet in face
 Complete (full) breech; baby all tucked in
 Footling breech; one or both feet come out
 Shoulder- CANNOT be delivered vaginally
o Position: presenting part in relation to the 4 quadrants of maternal pelvis
 Want ROA or LOA (right/left occiput anterior)

,  When baby is facing the floor it is easiest for fetus to slip out of the
pelvis
 Psyche: maternal mindset
o Marked anxiety, fear, or fatigue decreases woman’s ability to cope with
labor pain
o Relaxation boosts natural process of labor
o Maternal catecholamines are secreted in response to anxiety or fear
 Inhibit uterine contractility and placenta blood flow
 Position: mother’s position and how the pelvis is opening so baby can move
down; position of mother should allow pelvis to stay open
o Peanut ball (helps keep pelvis open)
o Creative positioning
 Put mother in different positions to try and change position of the
baby and get them head first into pelvis
o Maternal positioning is the most common measure to promote placental
function during normal labor

Normal labor:
 Theories of onset:
o Changes in maternal estrogen (increased) and progesterone (decreased)
o Prostaglandin secretion
o Increased section of oxytocin
o Oxytocin receptors increase
o Fetal role
o Stretching, pressure, irritation of the uterus

Premonitory signs of labor: warning signs that indicate labor could be starting
 Braxton hicks contractions (practice contraction)
 Lightening
o Mother feels “lighter” because baby moves off diaphragm and into pelvis
o Occurs closer to term (2-3 weeks before onset of labor)
 Increase in clear and nonirritating vaginal secretions
o Lose mucus plug
 “bloody show”
 Nesting (energy spurt)
 Small weight loss
o 1-3 pounds because of excretion of the fluid

True & False labor:

,  Difference between true & false labor is the progressive effacement and
dilation of the cervix
 Early labor feels like menstrual cramps
 False labor: (prodromal labor)
o Contractions are inconsistent in frequency, duration, intensity
 Change in activity does not alter contractions
o Discomfort
 Felt in abdomen and groin, more annoying than painful
o Cervix
 No significant change in effacement or dilation
 True labor:
o Contractions are consistent pattern of increasing intensity, duration,
frequency
 Walking increases intensity (this is key)
o Discomfort
 Begins in low back and wraps around to abdomen
o Cervix
 Effacement and dilation occurs; progressive changes

Mechanisms of labor: (aka cardinal movements)
1. Descent
2. Engagement of the presenting part
3. Flexion of the fetal head
4. Internal rotation
5. Extension of the fetal head
6. External rotation
7. Expulsion of fetal shoulders and body

Stages of labor:
 First stage- “stage of dilation”
o Latent phase
 Early onset
 Dilation of 0-3 cm
 Best time to get history, fill out forms, and educate patient
 Longest stage especially for primigravida
o Active phase
 Dilation of 4-7 cm
 Short, brief explanations
o Transition phase
 Dilation of 8-10 cm