Cervical Changes—softens/ripens to allow stretching and dilation necessary for fetal passage Bloody show—small amount of blood loss that results from exposed capillaries that occurs when mucus plug is dislodged; pink -tinged secretions; impending labor: 24-48 hr ROM—labor usually occurs within 24 hr Sudden burst of energy =(nesting instinct)— cleans everything in sight because she has so much energy; warn women to not overexert themselves; instead preserve energy for impending labor (24-48hr) Other signs: o Weight loss of 0.5-1.4 kg (1-3 lb): changes in estrogen and progesterone levels cause fluid and electrolyte shifts o Increased backache and sacroiliac pressure (increase relaxin) o N/V/D, and indigestion Difference between true and false labor o True labor: contractions are at regular intervals, interval between contractions gradually shorten; contractions increase in duration and intensity; discomfort begins in back and radiates around the abd; intensity increases with walking; cervical dilation and effacement are progressive; contractions do not decrease with rest/warm bath o False labor: contractions are irregular, intervals between don’t change; abdominal discomfort; walking decreases or has no effect on discomfort; cervical dilation and effacement don’t change; rest/warm bath lessens contractions Stages of Labor and Birth=4 TQ First stage: initiated when true labor begins and ceases when cervix is dilated 10 cm o Latent phase: contractions have begun and continuously increase in frequency and intensity; duration: 5-8hrs; contractions lasting 20-40 seconds and occurring frequently 5-20 minutes apart; dilation is 0-4 cm. Pt. is anxious and excited; walk/talk; patient education should occur here. o Active phase: contractions progressively increase in intensity, cervix dilates 4-8 cm, and anxiety increases in relation to increasing pain and feeling a sense of loss of control; (Decreased coping/increased anxiety). Duration 4-6 hrs. (approx. 1-1.5 hrs. per cm.); contractions = closer together, more intense, last longer. o Transition phase: anxiety increases as does tiredness; contractions occur every 1.5-3 mins. ….last approx. 1.5 mins. and are intense; dilation is 8-10 cm; duration of this stage is 1-3 hrs. The woman may display restlessness evidenced by frequent changes in position (restlessness), difficulty understanding directions, lower back pain, hypersensitivity to touch, increased need for support person (anxiety/fear), increased
irritability, and crying and/or yelling (exhaustion). Hardest stage for the woman to handle=“hurricane hour” Second stage (10 cm – delivery!): initiated when cervix is fully dilated to 10 cm and ends when baby is delivery (15 mins– 2+ hrs.); contractions occur every 1 ½ to 2 minutes (close together) and are intense and last 60-90 seconds; the head of the fetus continues to descend in the pelvis and crowing occurs when the top of the baby’s head is visible at the external opening of the vagina; women begin to push during this stage to promote the advancement of the baby through the birth canal (only after full dilation=10cm).
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