Overview
This lecture reviews key concepts and common questions on labor and delivery, focusing on maternal and fetal assessment, physiological changes, nursing interventions, and common clinical scenarios.
Normal Findings in Late Pregnancy
- Increased urination, easier breathing, lower back pain, and increased vaginal discharge in the third trimester are expected due to "lightening" (the fetus dropping into the pelvis).
- Edema of the lower extremities can also be normal in late pregnancy.
- Continued monitoring is appropriate when only expected third trimester changes are present and no complications are indicated.
Prostaglandins, Braxton Hicks, and Cervical Changes
- Increased prostaglandins near term cause reduced cervical resistance, myometrial contractions, and cervical softening/thinning.
- Braxton Hicks contractions help soften and ripen the cervix in preparation for labor and move the fetus anteriorly.
Differences in First vs. Subsequent Pregnancies
- Labor is usually longer in first-time pregnancies because cervical dilation to 10 cm takes 12–16 hours in primigravidas.
Labor Positions and Physiological Responses
- The kneeling position helps rotate a fetus in posterior position.
- Maternal responses to labor include increased heart rate, blood pressure, and respiratory rate; body temperature may rise slightly, and gastric emptying decreases.
Fetal Responses and Delivery
- During contractions, the nurse should monitor for decreased fetal circulation and perfusion.
- After placental expulsion, uterine massage is performed to constrict uterine blood vessels and prevent hemorrhage.
Stages of Labor and Admission Assessment
- The first stage of labor ends with cervical dilation to 10 cm.
- When a patient presents with abdominal pain at term, first determine if labor is true or false before other assessments.
- Essential admission information includes the estimated due date, contraction characteristics, and any vaginal bleeding.
Anesthesia and Medications in Labor
- Lorazepam may cause increased maternal sedation, an important adverse effect to monitor.
- General anesthesia is given for cesarean delivery in patients with a history of spinal injury.
Fetal Monitoring During Labor
- In the latent phase of labor, fetal heart rate is monitored every 30–60 minutes (every hour is appropriate).
- More frequent monitoring is needed in the active and transition phases.
Key Terms & Definitions
- Lightening — Descent of the fetus into the maternal pelvis before labor.
- Braxton Hicks contractions — Painless, irregular contractions that soften and ripen the cervix.
- Prostaglandins — Hormones increasing uterine contractions and cervical changes near labor.
- First stage of labor — Begins with onset of contractions and ends with full cervical dilation (10 cm).
- Uterine massage — Physical stimulation after placental delivery to prevent postpartum hemorrhage.
Action Items / Next Steps
- Review related audio lessons on labor and delivery from the instructor’s website.
- Practice distinguishing true vs. false labor and memorizing stages of labor.
- Continue following the instructor’s content on social media for daily practice questions.