Contractions 4-20 minutes, 15-40 seconds2. Active (4-8 cm); lasts 4-6 hoursContractions more intense3. Transition (8-10 cm); “hurricane hour”Shakes, N&V, flashes/chills, fears being left aloneContractions 1-3 minutes, 90 seconds long.B. Second Stage = dilation to delivery-Contractions 60-90 seconds, every 1-3 minutes-pushing, more control, fear tearingC. Third Stage = delivery of placenta within 30 minutesD. Fourth Stage = 1-4 hours after birth-Uterine involution- oxytocin, methergine-shakes/shivers-hungry, talkative, exhausted-250-500 mLs lost at birthOB Notes48
-decrease in b/p, increase in HRIV. Pain during laborA. Gate Control Theory- breathing, coaching, efflurageB. Causes:1.cervix dilation2. hypoxic uterine muscle3. stretching of muscle4. pressureV. Fetal Progression1. descent2. flexion3. internal rotation4. extension5. restitution6. external rotation7. expulsionBraxton Hicks: warm-up contractions, not as intense, Empty bladderDrink plenty of fluidsLightening—baby dropping into pelvis, occurs 2-4 weeks prior to labor, less pressure Flu-like systemNesting InstinctPassing of the mucous plugBreaking of waters—amniotic fluid in large or trickle of fluid, call caregiverUsually just water around baby’s headAmniotic sac breaks during labor Stage of laborStage one (early)oCervix thins and opens 3cmoLongest stage—14 hour aveoLast 30-40oFive minutes apartoLight activity oMore comfortable with position changeoExitedStage one (active)o3-7cm dilationo3-5 hours o45-60 mino3-5 minutes apartoneed more supportoShow—blood during normal progressive labor Stage one (transition)oUsually lasting between 30 minutes and 2 hourso60-90 second contractionso1 minute of restohot flahsesochillsonausea ovomitingOB Notes49
oincreasingly dependant on othersogiving upoirritableSecondoPushing and birthoCervix fully dilated o45-90 second contractionsobear down and pusho+4cm or +5cmoburning from stretching Third stageoDelivery of placentaoInvolutionUterus contracts to size of grapefruit Normal size 6 weeks after deliver Ch. 26- Childbirth at Risk: The Intrapartal PeriodI. Specific Risk FactorsA. Hypertonic Labor1. Increased frequency but decreased intensity of contractions2. occurs after labor has been initiated3. Associated with primapara mothers, in relation to anxiety and pain (hypoxia to uterus d/t tensing)4. risks: increased fatigue and discomfort, maternal dehydration, decreased coping, fetal distress5. Tx: rest and relaxation (breathing techniques, sedatives), fluids, comfort measures.B. Hypotonic Labor1. Regular contractions slow to <2-3 contractions in 10 minute period2. occurs after labor has been initiated3. Causesoverstretching of the uterus omultiplesohydramniosobowel and bladder distentionempty bladder to help contractions resume smoother contraction If water broke early onRisk of infection 4. risks: increase fatigue and length of labor, fetal distress, infection5. Tx: hydration (IV fluids)pitocinamniotomyencourage mom in coping, assess fetusC. Fetal malposition
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- Fall '12
- Nursing, progesterone, A., Late pregnancy, OB Notes