Critical Concept Review Learning Objectives Examine the five critical factors that influence labor. Concepts 1.

. Birth passage:

The ability of the pelvis and cervix to accommodate the passage of the fetus.

2. Fetus:

The ability of the fetus to complete the birth process.

3. Relationship between the passage and the fetus:

The position of the fetus in relation to the pelvis.

4. Physiologic forces of labor:

Characteristics of contractions and the effectiveness of expulsion methods.

5. Psychosocial considerations:

Understanding and preparing for the childbirth experience. Amount of support from others. Present emotional status. Beliefs and values.

Describe the physiology of labor.

1. Progesterone causes relaxation of smooth muscle tissue. 2. Estrogen causes stimulation of uterine muscle contractions. 3. Connective tissue loosens and permits the softening, thinning, and opening of the cervix. 4. Muscles of the upper uterine segment shorten and cause the cervix to thin and flatten. 5. Fetal body is straightened as the uterus elongates with each contraction. 6. Pressure of the fetal head causes cervical dilatation.

7. Rectum and vagina are drawn upward and forward with each contraction. 8. During the second stage, the anus everts. Discuss premonitory signs of labor. 1. Lightening:

Fetus descends into the pelvic inlet.

2. Braxton Hicks contractions:

Irregular, intermittent contractions that occur during pregnancy. Cause more discomfort closer to onset of labor.

3. Cervical changes:

Cervix begins to soften and weaken (ripening).

4. Bloody show:

Loss of the cervical mucous plug. Causes blood-tinged discharge.

5. Rupture of membranes:

If membranes rupture prior to the onset of labor, there is a good chance labor will begin within 24 hours.

6. Sudden burst of energy:

Known as nesting. Usually occurs 2448 hours before the start of labor.

7. Other signs:

Loss of 13 pounds. Diarrhea, indigestion, nausea, and vomiting may occur prior to the onset of labor.

Differentiate between false True labor is characterized by: and true labor. 1. Contractions that occur at regular intervals and increase in duration and intensity.

2. Discomfort that begins in the back and radiates to the front of the abdomen. 3. Walking intensifies contractions. 4. Resting or relaxing in warm water does not decrease the intensity of contractions. 5. Contractions that produce cervical dilatation. False labor is characterized by: 1. Irregular contractions that do not increase in duration or intensity. 2. Contractions that are not affected or lessened by walking, rest, or warm water. 3. Discomfort that is felt primarily in the abdomen. 4. Contractions that produce no effect on cervix. Describe the physiologic and 1a. Latent phase physiologic changes: psychologic changes Regular, mild contractions begin and increase in occurring in each of the intensity and frequency. stages of labor.

Cervical effacement and dilatation begins.

1b. Latent phase psychologic changes:

Relief that labor has begun. High excitement with some anxiety.

2a. Active phase physiologic changes:

Contractions increase in intensity, frequency, and duration. Cervical dilatation increases from 47 cm. Fetus begins to descend into the pelvis.

2b. Active phase psychologic changes:

Fear of loss of control.

Anxiety increases. Possible decrease in coping skills.

3a. Transition phase physiologic changes:

Contractions continue to increase in intensity, duration, and frequency. Cervix dilates from 810 cm. Fetus descends rapidly into the birth passage. Woman may experience rectal pressure. Woman may experience nausea, vomiting, or both.

3b. Transition phase psychologic changes:

Increased feelings of anxiety. Irritability. Eager to complete birth experience. Need to have support person or nurse at bedside.

4a. Second stage physiologic changes:

Begins with complete cervical dilatation and ends with the birth of the infant. Woman pushes due to pressure of fetal head on sacral and obturator nerves. Woman uses intra-abdominal pressure. Perineum begins to bulge, flatten, and move anteriorly as fetus descends.

4b. Second stage psychologic changes:

May feel a sense of purpose. May feel out of control, frightened, and irritable.

5a. Third stage physiologic changes:

Placental separation: uterus contracts and the placenta

begins to separate.

Placental expulsion: woman bears down and expels the placenta. Physician may put slight traction on the cord to assist the expulsion of the placenta.

5b. Third stage psychologic changes:

Woman may feel relief at the completion of the birth. Woman is usually focused on welfare of the infant and may not recognize that placental expulsion is occurring.

6a. Fourth stage physiologic changes:

Woman experiences increased pulse and decreased blood pressure due to redistribution of blood from uterus and blood loss. Uterus remains contracted and is located between umbilicus and symphysis pubis. Woman may experience a shaking chill. Urine may be retained due to decreased bladder tone and possible trauma to the bladder.

6b. Fourth stage psychologic changes:

May experience euphoria and be energized at birth of child. May be thirsty and hungry.

Summarize maternal systemic responses to labor.

1. Cardiovascular changes:

Increase in cardiac output.

2. Blood pressure:

Rises with each contraction. May rise further with pushing.

3. Respiratory system:

Increase in oxygen demand and consumption. Mild respiratory acidosis usually occurs by time of birth.

4. Renal system:

Increase in renin, plasma renin activity, and angiotensinogen. Edema may occur at base of bladder due to pressure of fetal head.

5. Gastrointestinal system:

Gastric motility decreased. Gastric emptying is prolonged. Gastric volume remains increased.

6. Immune system and other blood values:

WBC count increases. Blood glucose decreases.

7. Pain:

In the first stage: arises from dilatation of cervix, stretching of lower uterine segment, pressure, and hypoxia of uterine muscle cells during contractions. In the second stage: arises from hypoxia of contracting uterine muscle cells, distention of the vagina and perineum, and pressure. In the third stage: arises from contractions and dilatation of cervix as placenta is expelled.

Explore fetal responses to labor.

1. Labor may cause no adverse effects in the healthy fetus. 2. FHR may decrease as the head pushes against the cervix. 3. Blood flow decreases to the fetus at the peak of each contraction, leading to a decrease in pH. 4. Further decrease of pH occurs during pushing due to the

woman holding her breath.