Contraction cause constriction of blood to the

● Contraction cause constriction of blood to the placenta, decreasing fetal oxygen supply
(155)
● True labor: Cervical changes show progressive dilation and effacement (157)
● False labor: Walking decrease the frequency or eliminates the contractions altogether
(157)
● Factors affect maternal psyche (Box 8-2; 158)
○ Culture influence: Acceptable responses to pain during labor
○ Current Pregnancy experience: Amount of difficulty conceiving
○ Culture influences: Shameful vs Joyful
○ Presence & Support of birth companion
● Cardinal movement (158-159)
○ Engagement (initial descent): Presenting part descends to the level of ischial
spines
○ Extension: Fetal head is well flexed with chin on the chest, reaches pubic arch
● Labor Phase (160) Table 8-3 page 161
○ Active Phase: Cervix dilate from 4-8 cm & contractions are 2-5 minutes apart
lasting 45-60 seconds
○ Second stage (birth): Maternal response of feeling of begging in control & less
irritable
○ Third stage: Ends with th delivery of placenta
● Average length of second stage for primparas: 1 hours (160)
● Indicate the placenta separating from the uterine wall (160)
○ Lengthening of the umbilical cord
○ Gush of blood
● Cephalohematoma: Collection of blood under the newborn scalp (163)
Chapter 9
● General concepts related to pain: Threshold & Tolerance (168)
● Physiologic factors that are directly related to the birthing process, affect the perception
of pain (168)
○ Mom reports more pain when experiencing abnormal labor
○ The longer the labor, mom more likely to report extreme pain
○ Mom injected with oxytocin report extremely strong, intense contractions
○ Mom with back labor report intense discomfort (back breaking in two)
● Example of non pharmacological comfort measures for a laboring mother (169)
○ Change liens that are solid with perspiration or body fluids
○ Give perineal care with warm water after mom uses the restroom
○ Keep lips hydrated with ice chips and lip balm
● Hydrotherapy: Exposure of water for the mom, either show, bath or whirlpool to increase
comfort (171)
● Patterned breathing technique, take slow deliberated breaths while focusing, approx. 6-
10 breaths per minute (Table 9-2; 171)
○ Slow-paced breathing
● Intradermal injection of sterile water can effectively relieve the pain of back labor (172)

● Anesthesia: Use of of medication to partially or totally block all sensation to an area of
the body (173)
● Analgesia: Use of medication to reduce sensation of pain
● Sedatives can produce neonatal respiratory depression if given 12-24 hours of birth
(Table 9-3; 174)
● Receiving an epidural before 5 cm dilation can increase the need for labor augmentation
with oxytocin (Table 9-3; 174)
● Barbiturates can cause respiratory & CNS depression in the newborn if given within 12-
24 hours of birth (175)
● Interventions prior to a client can get an epidural (176)
○ Informed consent is required
○ 500-20000 mL IV fluid bolus is given to reduce the risk of hypotension
○ IV line must be in place
● Side effects when narcotics are used with anesthetics (Table 9-3; 174)
○ Pruritus
● Disadvantages of epidural (Table 9-3; 175 & 176)
○ Increase need of labor augmentation if administered before 5 cm dilation
○ Impairs motor function, which decrease the ability to walk during labor
○ Vacuum assistance and forceps are more frequently required
● Spinal HA is suspected when the lady has an intense HA in the upright position, relieved
when lies down and is still (177)
● FALSE (176)
● After delivery appropriate interventions that are done for client with epidural (176)