Process of Labor

Alright, I'm gonna share my screen.
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Okay. Can you guys see that?
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Okay, perfect. All right, so a few different things here. We talk about this called the four ps. Um, and then something else, just like a pneumonic called out to help you remember everything. And then we're going to get into really how to identify what position that Ab is when it's being born. When you hear those terms at clinical, the doctor will say, oh, the baby with roa or loa or whatever it is. So we're gonna, um, talk about that. And that's where I'll show you those images that I think are super helpful. Okay. So these are our four ps. The powers, the passageway, the passenger and the psych, which is super confusing cause that P is silent. Um, so the powers are going to be, we have two different powers and those are going be, um, there's a voluntary power, which voluntary is going to be pushed because the mom has total control over that. Um, and then our involuntary power is going to be the contraction. So the contractions are that, um, uterus that is contracting and that is an involuntary, we have no control over it. Um, and that your uterus contracting, what it does is it pushes that baby down as that uterus contract, um, to get it delivered. So those are our powers. Our passageway is obviously, how's that ab coming out? Right? So the pelvis is really our, um, passageway. Um, oops.
Try that again. So the pelvis, so that opening, what's it looking like? Is there room for this big baby? If it's a big baby or whatever it may be. Um, is there a room for that baby to pass through? Um, that is going to be the pelvis. So then the passenger, we have two passengers here. Our main one is obviously the baby, right? Um, or babies, if there's more than one, and then the placenta is the other. But our main passenger that we're worried about is the baby. The placenta typically comes out, no problem. Um, so the baby is what we were worried about there as our passenger and then the psych. So this is just, um, the whole emotional piece and how the mom is like, if she is not coping well with what's going on with her body, um, or with the pain, then she's not going to be very good at these voluntary actions of pushing that we need her to be, to deliver that baby.
Um, so that's all that emotional piece. Alright, so down here that out. So this is what we talk about when we're trying to figure out the fetal position and all that. What's going on. So the first one here, you see his attitude. Um, so the attitude is going to be if the baby is flexed or extended. Um, and what this means, and I'll put here in case people are, um, taking screenshots. So it's gonna be really the chin. So is the chin to the chest which is going to be flexed or is it like facing up and extended? Um, we obviously want flex. That's going to be the best position. I shouldn't say obviously, but um, so flex is going to be the position we want because at that chin to the chest, then it's going to be able to pave its way out. Um, through, I wish you guys could see me too as I'm acting this out.
Um, but you can't see me. So then lie. Okay. So how's the fetal lie? Are we vertex that means head down. Are we breach? So that would be when we have, um, not head. So either butt or feet, um, that are breached. Transverse is going to be our other one and that means that we are across, so this lie has to do with um, how the baby is in comparison to the moms sign. So transfers, if you think of it just like that t so I don't want to capitalize. So if the mom's spine is up and down like this, um, and then the baby's spine crosses it. So that's transfers. And then our presentation. So presentation is like what's coming out. So we're either set phallic, so that, that, that would be the head, um, or the bed for breach. So presentation the baby.
And then presenting parts. So what is exactly coming out first? And there's a few different ones. Our main one is going to be the head hopefully, right? If everything is correct in line and the way it should be. But instead of calling this ahead, what we call it is the asa put, which if you guys remember that is that little bony part, um, or soft spot on the back of the fetal scalp. And if you remember that selects is supposed to be our position, right? So if you put your chin to your chest right now, you'll see that you're also put is going to be more facing out, like it's going to come out. Um, so that is the presenting part we typically want. Is that awesome put. So when we are describing our roa or loa for that positioning of the baby, this one is going to be labeled as, oh, and it's that middle letter and I'll get to the other ones, um, later, um, and show you those images and it will help everything pulled together.
Um, the other thing you might see is mentum, which is our chin. That one's going to be labeled as an m. This is a never good. That means that the baby's head is really hyperextended if that Chin is what's being delivered first. Um, we one time had a patient that was um, starting to deliver and they realized it was the chin was the presenting part. Um, and so they quickly had to push that baby back up there and do a c-section because that neck can snap. Um, not a good situation. So yes, m is going to be from mentum. There you could have a shoulder be as a presenting part and you would label that, um, as Scapula, which is sc, um, the scapula coming out. So those are typically the three main ones that you'll see. Um, obviously ask what's going to be the most common.
And usually that's going to be asked hopefully on a test. All right, our positions. So the position has to do with are we right or left? And this will make sense in just one second, I promise. So that is the presenting part in relationship to the mom's pelvis. And when I show you the image, it'll be easier. We'll go there right after that. And then if we are anterior or posterior, so this is where we get that first letter like r o and then either if the baby's anterior or here ear. So posterior means that the presenting part like the asa put is facing the back and anterior. It means the front of the mom. So this is all in relation to them. Mom, this station's, I'm going to come back to you and tell you guys what that is. First I want to go over this roa stuff and Loa and all that before I confuse you all and we lose where we are. So I am going to stop sharing real quick so that I can switch us over to the other screen. We'll go to [inaudible].
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Okay. Can you guys see this? Okay. Hopefully. Let me go back and make sure we're good. Okay, cool. Okay, so this image I, cause I'm a visual, I just want to show you, so this is the baby's also put back here and that is your posts here ear. So towards the backs of this baby's posts or Asafa is facing post carrier. Okay, that's our first thing to clear up. And then let's look at these. So these, this websites spinning babies, they have all these amazing images drawn and then they say what the position the baby is in. It's really a website that kind of helps moms get in positions to turn and spin their baby so that it's facing the way that it should. Um, but for learning purposes is awesome. So if you see this beautiful baby that's drawn on here, if you look are awesome.
Put so back here, right? Because this is the face. So our off the put is are going to be our presenting part and it is facing the mom's left side. So that's our first letter. If you look right here, so we have l o, h the left all supply and it's more anterior, right? It's turned more to the front cause the baby's facing more to the back. So Loa for this one in comparison, if you look here, this baby is n r o t because we have the asa Pi is on, is facing the mom's or right side of her pelvis and it is posterior. It's more towards that back side. Um, so I just think these images are really awesome. I'll get you guys these links at the end so you can look through, cause there's some other pictures as well. Um, so that's what you're gonna do when you get these questions.
The best to do is to um, draw what is being told to you in a question. So if, you know, they're pretty much going to say like that or support or the fetal head is coming first, which you would describe as awesome put. Um, and then which way it's facing. So I always draw it out so I can see and just remember it's the mom's left or right of her pelvis, whichever one. So not the doctors, cause that's usually saying it right? They're like this baby's coming out loa, you need to drop that. You can see it. At least that's how, what works for me. Okay. I wanna do station with you guys, but station's easier if I try it. Then using that little note thing. So, okay. Our fetal station, so this is, um, my pelvis picture that does not look like the pelvis.
I know. So the issue will spine. So let's say they're right here. This is known as zero station. Okay? So that is the issue of spines or zero. Okay. So the station tells us where the baby's located. As the baby gets closer to being delivered, it's going to be plus one plus two plus three. So usually a head that's like crowning or about crowning is going to be a plus three station. If the baby's floating way up high, you make your nurse to say that baby's that high, that's going to be labeled as minus one, minus two, minus three. Um, it's measured in centimeters. Um, but a guesstimate because it's based on when the nurse does her cervical exam. So that's how that's labeled. This is opposite of when people do the fundal check, right? That fundal check. You want the minus numbers as the fundus gets a lower, so just remember it, the station, it's a positive thing that that baby's getting close to delivering. So it's going to be our positive numbers. Um, so for our, it's your spine is going to be at zero station and then as the head gets closer to delivering, we'll be at those plus numbers. Um, so that's the Beatles station. What questions do you guys have about this? Well, I put some links in for Ya.
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You know, it takes some time to type the go ahead and it could be any ob related question. I'm happy to answer anything. Something you've seen at clinical or whatever it may be that you have questions about and these are those spinning baby websites that you can kind of really look at those images. Hopefully that kind of helps paint a picture. I'm just a very visual person so I find it super helpful. Um, and you should be able to click right on those. Um, crowning was just when you see the baby's head, correct? Yes. So crowning is when um, yeah, you see a good portion of the head coming out of the, um, vagina. So that is crowning where it's kind of staying there. So that'll be like your plus three station.
I mean the most. That's really the motional here is plus three. You're welcome. And then you guys have any other questions? Go ahead. Oh, interventions for EKG, you mean fetal heart rate changes? Okay, so let me start with you. Do you, so that, um, fetal heart rate changes. So if you have these sounds happening, then that's going to be um, where we are going to stop the potato center. Remember Pitocin, that drug that we give to contract the uterus. So we're going to stop that if it's going on, if it's being given, we are going to turn the patient. The left side is the best side, um, to turn her to the left side and that's gonna get the baby, that oxygen, profuse auctions, that baby. Um, and then also, um, give oxygen to the mom. If the Moms, um, oxygen light level is like reading 100%, it doesn't matter if you give oxygen, that extra oxygen is going to go to that baby.
Um, and that is going to help the fetal heart rate. So those are your big things that she'll do. Turn, give oxygen and stop the pitocin if you're getting any pitocin. And Briana station numbers are opposite about, oh, so the station numbers are opposite of when women get their fundal assessment done. So if you're a nurse and you're doing the fundal assessment after delivery, if you remember the fundal assessment is that top of the uterus. So that top of the uterus is starting to move down after delivery. And we want that to be a negative numbers is that uterus muse back into the pelvis. So it's opposite. I actually like people to get confused because it's one of those things that you can use easily. Does that make sense, Brianna?
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Yes. Okay. You're welcome. Um, that answered the negative numbers, making sure I'm getting everyone's questions. Yes, I can share the screen again. Isn't it? Above the umbilicus is positive and below negative. Um,
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oh, so who asked that? Austin. So Austin Fundal, yes. Negative is below that [inaudible] and it's measured in what we call finger breaths or centimeters. So if this is my umbilicus right there, okay. So if I'm pushing on the uterus and it's right here, that's u minus one. Okay. You minus two, you minus three. And so on. If her bladder school or her uterus isn't going down like it should or on, but like is here, we'd be at you plus one u plus two you plus three and so on for that. Um, so yes, that is true. Awesome for it. That's about the fundus. Um, negative means baby is still inside the stomach crowning when the baby's head is mere. Yes. So when we're talking about some station, the negative numbers means the baby's up floating up high and hasn't really engaged head into the pelvis. Then as it gets engaged into the pelvis, that's when we get the positive numbers. The closer we are to delivery meaning the closer the head is to coming out, the higher that positive number will be.
Um, okay. Scotty, real quick. Fetal desales are good during contractions, right? As long as they rebel. Not always. So hold on, let me get my other board so I can draw this. Sorry. It depends what type of DSL and actually on what they say the 21st at 7:00 PM central standard time we're doing fetal heart monitoring. So if you have a lot of questions on that, that'll be a good one for your people to go to. Okay. So let's say these are my contractions. Okay? So the fetal heart rate is being monitored, right? If we have a cell that happens here, go along and it happens again. So yes, it's rebounding. This is called an early deceleration and it is a mere image is often the term that you'll see used in a test question. The diesel, the dip happens with the contraction and recovers to baseline. By the end of the contraction, it's going to be the early b-cell. Um, these are okay. Early means we have head compression.
So that just means that the baby's head is engaged. It's getting compressed and squeezed because it's closer to being delivered. So it will have these decelerations. Now, the one that isn't that good, and I just want to make sure you know are going to be late decelerations. So these are the ones that are not good. So if these are contractions again the late, we have the heart rate going and that looks good. And then we dip. The dip happens after the contraction. Sometimes it recovers, which is good. Sometimes it doesn't, which is not good. But lates are never good lates mean that we have placental insufficiency. So that's just fancy for meaning that the placenta's not giving the baby the oxygen that it needs. Um, so placental insufficiency so it might recover and then it dips again. Um, so opposite of the earliest cause remember the earliest are mirror image. So these who are often, um, can be confused a lot or are compared and always going to be, uh, like in the same question for choices. Um, so I suggest with this also to dry it out as you're reading the description. So is it starting, is the dip starting with the contraction and returning by the end starting after the start of the contraction? Um, so after is kind of your key word there for that. So that is it on, um, those B cells. So late is not good. Earliest aren't good.
Okay. And I think, um, let me share my screen again cause somebody wanted to see that again in, and I'll answer your question in just one second.
Yeah.
Let me see.
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there are, can you guys see that or is that, I know you're also seeing the chat box, but that way I can see that too. And let me get it so we can try and get it all in one little thing.
There we go.
Can you guys see that? Okay. For those that want to see it. Okay. Um, on the EKG is that bottom you take? So fetal heart monitoring strips are totally different than what for an EKG, just so you don't get confused. And EKG is going to be where we're just monitoring our heart rhythm on a fetal monitoring strip. Um, you will have, the very bottom will be the contraction patterns. Those big leaps that I drew that are like that. And then the um, top part, the bottom number will be the mom and the top number. We'll be the baby. Yes. Does any, did you guys still need to see that screen or are you good?
You're welcome. Okay.
What other questions? Do you guys have any other questions?
Okay.
Oh shoot, I should have taken you in. Let's do this.
Okay.
So let's go in here to NRSNG and get processor Libor and I'll take you right in. Um, there's also mechanisms of labor, just a bunch of different things, but here is the lesson that, um, will give you the information in more detail and the video on what we talked about tonight.
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So I will put that in here for you all. Okay.
So that you can get right to that site. Um, and then those other ones for the spinning baby. Um, if you Google spinning baby, you can get there also. But the other links that I posted, Sheena, you can click right in there to see those images if you need to. So on the 21st we're doing the fetal heart monitoring tutoring session at seven and then at seven again on the 24th is talking about all the antepartum testing. Um, so like non-stress test and traction, stress tests, the blood sugar testing, um, all that kind of good fun stuff. So make sure you guys join me for that. If you can, I'd love to have you. Are there any other questions? Good. Awesome. Look forward to it. I love having repeat people. Alright, Scotty and all my people that are, I'm practicing for their in class and getting ready. Awesome.
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well, we'll go through it and hopefully make it clear that any part in testing, there's a lot of information. So I'm going to look at it and see what we are really big important things are. And then I'll make sure you guys have, um, a link to get into the lesson. You're welcome. No problem. I love doing this. All right guys, if you don't have anything else than I will hopefully see you guys on the 21st that per session, happy nursing.