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IntrapartumNotes - Chapter 12 Process of Birth I...

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Chapter 12: Process of Birth I. Physiologic Effects of the Birth Process A. Maternal response 1. Reproductive system a. Characteristics of contractions i. Coordinated – regular pattern of increasing frequency, duration, and intensity; begin in the fundus and spread downward ii. Involuntary – not under conscious control; anxiety diminished contractions, relaxation facilitates them iii. Intermittent – relaxation of the uterus allows resumption of placental blood flow and oxygen/nutrient exchange b. Contraction cycle (Figure 12-1, p. 240) i. Increment – period of increasing strength of uterine contraction ii. Peak (acme) – period of greatest strength of a uterine contraction iii. Decrement – period of decreasing strength of a uterine contraction iv. Frequency – period from the beginning of one contraction to the beginning of the next contraction v. Intensity – strength of a uterine contraction; described as mild, moderate, or strong on palpation vi. Duration – period of a uterine contraction from beginning to end vii. Interval – period from the end of one contraction to the beginning of the next contraction; when most exchange occurs viii. Uterine resting tone – degree of uterine muscle tension when the woman is not in labor or between contractions c. Uterine body (Figure 12-2, p. 241) i. Upper 2/3 contracts to push the fetus down ii. Cells become remain shorter at the end of each contraction; upper uterus becomes thicker iii. lower 1/3 remains passive to allow passage of the fetus; cells become longer, lower uterus becomes thinner iv. Physiologic reaction ring – marks the division between the upper and lower uterus v. Opposing forces cause the uterus to become more elongated and narrow, aligning the fetus directing it downward d. Cervical changes (Figure 12-3, p. 242) i. Effacement is thinning of cervix ii. 2cm long cylinder before labor iii. Contractions push the fetus against the cervix while pulling it upward iv. The cervix becomes shorter and thinner v. Effacement is estimated as a percentage; 100% is full effacement vi. Dilation is opening of cervix vii. Full dilation is approx. 10cm viii. Nullipara – completes most effacement early in the process of dilation ix. Parous woman – cervix is thicker at any point during labor 2. Cardiovascular system a. Changes during contractions i. Decreased placental blood flow causes a temporary relative increase in maternal blood volume ii. Increases in BP iii. Decrease in HR iv. Vitals should be taken between contractions b. Supine hypotension i. Compression of the inferior vena cava and aorta by the uterus; decreases blood return and placental blood flow ii. Encourage the woman to rest in positions other than supine 3. Respiratory system a. Increased rate and depth of respirations - especially if the woman is anxious b. Hyperventilation i. May lead to respiratory alkalosis – exhaling too much CO 2 ii. S/S – tingling in hands and feet, numbness, dizziness iii. Encourage the woman to slow her breathing, breathe into a paper bag or her cupped hands (raises CO
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IntrapartumNotes - Chapter 12 Process of Birth I...

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