NRSG3302 Exam 3 Winter 2024/2025 Northeastern University

Module 9: Nursing care during labor and delivery

- Five P’s of labor
o Powers (contractions)
 Responsible for dilating and effacement of the cervix
 Dilation: the enlargement or opening of the cervix
o 0-10 cm
 Effacement: softening, shortening, and thinning of the cervix
o 0-100%
 Described in two ways
 Frequency: time form beginning of one contraction to the beginning of
another
 duration: time from beginning of a contraction to the end of a
contraction
 intensity: strength of contraction
o measured by palpation or intrauterine pressure catheter (IUPC)
o Mild (nose)
o Moderate (chin)
o Strong (forehead)
 Two categories
 Involuntary contractions resulting in dilation and effacement of cervix
 Voluntary expulsive efforts of the birthing woman during second stage
of labor
o Passageway
 Types of bony pelvis
 Gynecoid: most common type; optimal for child bearing
 Android: heart-shaped; may make vaginal birth more difficult
 Anthropoid: oval shaped; inadequate for childbirth
 Platypelloid: least common: makes childbirth more difficult
 When moving down the birth canal: +3 is BELOW the ischial spine
o Passenger
 Fetal head is able to mold: ability to change shape to accommodate or fit
through the maternal pelvis
 Fetal attitude/posture
 Flexed
 Extended
 Deflexed
 Fetal lie
 Refers to the long axis (spine) of the fetus in relationship to long axis of
mom
o Longitudinal= spines are parallel; most common
o Transverse= spines are perpendicular; must be delivered
cesarean
 Presenting part

,  Cephalic = head first
 Breech= buttock or feet
 Transverse= shoulder
 Fetal position
 Refers to the relation of the reference point to the maternal pelvis in 3
letter abbreviations
o First letter referenced to presenting part of mom’s pelvis
 L is left; R is right
o Second letter designates the fetal presenting part
 O= occiput
 S = sacrum
 M = mentum
 A = shoulder
o Third letter is the relationship of presenting fetal part to mom’s
pelvis
 A = anterior
 P = posterior
 T = transverse
 WANT ROA or LOA
o Position
 Maternal positions in labor
 Freedom of movement
 During first stage of labor patients that walk, stand, sit, or kneel decrease the
first stage
 During second stage of labor remain upright or lateral
 Upright increases pelvic diameter allowing the fetus to move through
the pelvis easier
o Psyche
 Focus on providing emotional support and information to empower the
woman’s decision making; feel cared-for and safe
 Management of labor discomfort
 Nonpharmacological
o Sensory stimulation strategies
 Aromatherapy
 Music
 Breathing techniques
 Imagery
o Cutaneous stimulation strategies
 counter pressure
 light massage
 hydrotherapy
o cognitive strategies
 child birth education
 hypnosis

,  biofeedback
 Pharmacological
o Analgesia: partial or full relief of painful sensations using
medication that decreases or alters the perception of pain
o Anesthesia: partial or complete loss of sensation with or without
loss of consciousness
 General anesthesia has a risk of potential fetal distress
o Systemic (analgesic) administration
 IV, IM, inhalation
 Nitrous oxide (inhaled), morphine, fentanyl
 Can slow down labor
 Can affect the fetus (crosses the placenta)
o Regional administration
 Epidural, spinal, combined spinal-epidural
 Watch for hypotension with epidural
 Risk for spinal headache with spinal
o Local nerve blocks
 Pudendal and paracervical blocks
 Most common complication is hypotension
 N/V, respiratory depression, and alterations of FHR can
also occur
- Stages and phases of labor
o Labor: process in which the fetus, placenta, and membranes are expelled through the
uterus and out the vagina
o True vs false labor
 True
 Regular contractions
 Progress into a pattern
 Contractions continue despite moving or changing positions
 False
 Irregular contractions
 No regular pattern
 Contractions might stop when you walk or rest
o First stage
 Initiation of true labor until full dilation and effacement
 Early labor (latent phase)
 Beginning of cervical dilation to 3cm
 Lasts hours to days
 Every 10-30 min; 20-40 seconds; progress every 3-7 minutes
 Painless to mildly uncomfortable
 Bag of water usually ruptures during this stage
 Mom feels excited and sociable
 Active phase
 4-7cm dilation