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COVERS STAGE 1 ONLY!! LAST BOOK NOTES FOR EXAM #1!

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Chapter 19 Study Well!!!
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Table 19-1 pg 439 expected maternal progress in first stage of labor!

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FIG. 19-6 !Location of the fetal heart tones (FHTs). A, FHTs with fetus in right occipitoanterior
(ROA) position. B, Changes in location of point of maximal intensity of FHTs as fetus undergoes
internal rotation from ROA to OA and descent for birth. C, FHTs with fetus in left sacrum
posterior position.!

NURSING ALERT!
The umbilical cord may prolapse when the membranes rupture. The fetal heart rate and pattern should be
monitored closely for several minutes immediately after ROM to determine fetal well-being, and the
findings should be documented. (Lowdermilk 449)

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SIGNS OF POTENTIAL COMPLICATIONS: Labor!
Intrauterine pressure of 80 mm Hg (determined by intrauterine pressure catheter monitoring) or resting
tone of 20 mm Hg
Contractions lasting 90 seconds
More than five contractions in a 10-minute period (occur more frequently than every 2 minutes)
Relaxation between contractions lasting <30 seconds
Fetal bradycardia; tachycardia; absent or minimal variability not associated with fetal sleep cycle or
temporary effects of CNS depressant drugs given to the woman; late, variable, or prolonged FHR
decelerations
Irregular fetal heart rate; suspected fetal arrhythmias
Appearance of meconium-stained or bloody fluid from the vagina
Arrest in progress of cervical dilation or effacement, descent of the fetus, or both
Maternal temperature of 38 C
Foul-smelling vaginal discharge
Persistent bright or dark red vaginal bleeding (Lowdermilk 449)

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BOX 19-5 !COMMON MATERNAL POSITIONS DURING LABOR AND BIRTH!
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Semirecumbent Position (See Figs. 19-15, B; Fig. 19-16, B)!

With woman sitting with her upper body elevated to at least a 30-degree angle, place wedge or small
pillow under hip to prevent vena cava compression and reduce likelihood of supine hypotension (see Fig.
19-5).
The greater the angle of elevation, the more gravity or pressure is exerted that promotes fetal descent,
the progress of contractions, and the widening of pelvic dimensions.
Position is convenient for rendering care measures and for external fetal monitoring.

Lateral Position (See Figs. 19-12, B, and 19-15, A)!

Have woman alternate between left and right side-lying position, and provide abdominal and back support
as needed for comfort.
Removes pressure from the vena cava and back, enhances uteroplacental perfusion, and relieves
backache.
Facilitates internal rotation of fetus in a posterior position to an anterior position (woman should lie on
same side as fetal spine).
Makes it easier to perform back massage or counterpressure.
Associated with less frequent, but more intense, contractions.
Obtaining good external fetal monitor tracings may be more difficult.
May be used as a birthing position.
Takes pressure off perineum, allowing it to stretch gradually.
Reduces risk for perineal trauma.

Upright Position!
The gravity effect enhances the contraction cycle and fetal descent: the weight of the fetus places
increasing pressure on the cervix; the cervix is pulled upward, facilitating effacement and dilation;
impulses from the cervix to the pituitary gland increase, causing more oxytocin to be secreted; and
contractions are intensified, thereby applying more forceful downward pressure on the fetus, but they are
less painful.
Fetus is aligned with pelvis, and pelvic diameters are widened slightly.
Effective upright positions include:
Ambulation (see Fig. 19-10)
Standing and leaning forward with support provided by coach (see Fig. 19-11, A), end of bed, back of
chair, or birth ball; relieves backache and facilitates application of counterpressure or back massage
Sitting up in bed, chair, birthing chair, on toilet, or bedside commode (see Fig. 19-15, B)
Squatting (see Fig. 19-12, A, and Fig. 19-16, E)

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Hands-and-Knees PositionPosition for Posterior Positions of the Presenting Part (See Figs.
19-11, B; Fig. 19-13)!
Assume an all fours position or lean over an object (e.g., birth ball) while on knees in bed or on a
covered floor; allows for pelvic rocking.
Relieves backache characteristic of back labor.
Facilitates internal rotation of the fetus by increasing mobility of the coccyx, increasing the pelvic
diameters, and using gravity to turn the fetal back and rotate the head (NOTE: A side-lying position,
double hip squeeze, or knee squeeze can also facilitate internal rotation.)
Assess the effect of each position on the laboring woman's comfort and anxiety level, progress of labor,
and fetal heart rate and pattern. Alternate positions every 30 to 60 minutes, allowing the woman to take
control of her position changes. (Lowdermilk 455)

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Review Emergency Box on pg 459