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Full Text Access for Subscribers:Not a Subscriber?ONGOING COLUMNS: Hot Topics in Maternity Nursing Wisner, Kirsten MS, RNC, CNS Kirsten Wisner is a perinatal clinical nurse specialist at
Salinas Valley Memorial Hospital in Salinas, CA. She can be reached at [email protected] The author declares no conflict of interest. doi:
10.1097/NMC.0000000000000095  Related ArticlesLabor contractions are the periodic tightening and relaxing of the uterine muscle, the largest muscle in a woman's body. Something triggers the pituitary gland to release a hormone called oxytocin that stimulates the uterine tightening. It is difficult to predict when true labor contractions will begin. Contractions are often described as a cramping or tightening sensation that starts in the back and moves around to the front in a wave-like manner. Others say the contraction feels like pressure in the back. During a contraction, the abdomen becomes hard to the touch. In the childbirth process, the work of labor is done through a series of contractions. These contractions cause the upper part of the uterus (fundus) to tighten and thicken while the cervix and lower portion of the uterus stretch and relax, helping the baby pass from inside the uterus and into the birth canal for delivery. How Contractions are TimedContractions are intermittent, with a valuable rest period for you, your baby, and your uterus following each one. When timing contractions, start counting from the beginning of one contraction to the beginning of the next. The easiest way to time contractions is to write down on paper the time each contraction starts and its duration, or count the seconds the actual contraction lasts, as shown in the example below. Writing down the time and length of the contraction is extremely helpful for describing your contraction pattern to your physician, midwife or hospital labor and delivery personnel.
What Contractions Feel LikeMany mothers describe contractions that occur in early labor as similar to menstrual cramps, or as severe gas pains, which may be confused with flu symptoms or intestinal disorders. Imagine your contractions as looking like a wave. Each contraction will gradually gain in intensity until the contraction peaks, then slowly subside and go away. As your body does the work of labor, it is likely that the time in between contractions will become shorter. As the strength of each contraction increases, the peaks will come sooner and last longer. There should be some regularity or pattern when timed. Persistent contractions that have no rhythm but are five-to-seven minutes apart or less should be reported to your physician or midwife. Try to Visualize Contractions as Positive Think of each contraction as something positive—it is bringing you that much closer to the birth of your baby. Visualize what the contractions are accomplishing, the thinning and opening of the cervix and the pushing of the baby downward. Try to work with your body rather than against it by staying as relaxed as possible during the contractions. Typical Length or Duration A typical labor for a first time mother is eight-to-fourteen hours, and is usually shorter for a second or subsequent birth. For many women, rocking in a chair or swaying during a contraction assists them with this relaxation.
Overview of LaborWhat is labor?Labor is a series of continuous, progressive contractions of the uterus which help the cervix to open (dilate) and to thin (efface), allowing the fetus to move through the birth canal. Labor usually starts two weeks before or after the estimated date of delivery. However, no one knows exactly what triggers the onset of labor. What are the signs of labor?Signs of labor vary from woman to woman, as each woman experiences labor differently. Some common signs of labor may include:
If a woman feels unsure if labor is beginning, she should always call her doctor or midwife. What are the different stages of labor?Each labor is different. However, labor typically is divided into three stages:
Each labor experience is different and the amount of time in each stage will vary. However, labor in a first pregnancy usually lasts about 12 to 14 hours. Labor is generally shorter for subsequent pregnancies.
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Click Image to Enlarge Induction of laborIn some cases, labor has to be "induced," which is a process of stimulating labor to begin. The reasons for induction vary. Labor induction is not done before 39 weeks of pregnancy unless there is a problem. Some common reasons for induction include the following:
Some common techniques of induction include the following:
Care at the hospital during laborWhen a woman arrives at the hospital in labor, the nursing staff may perform a physical examination of the abdomen to determine the size and position of the fetus, and an examination of the cervix. In addition, the nursing staff may check the following:
Intravenous fluids are sometimes given during labor. The intravenous line, a thin plastic tube inserted into a vein (usually in the patient's forearm), can also be used to administer medications. Intravenous fluids are usually given once active labor has begun, and are also needed when a woman has epidural anesthesia. The fetus, too, is carefully monitored during labor. A monitor placed over the mother's abdomen will keep track of the fetal heart rate. What are pain management options during labor?A woman has many options for managing the discomforts that occur during labor and the birth of her baby. Generally, mothers and their doctors or midwives want to use the safest and most effective method of pain relief for both mother and baby. The choice will be determined by:
There are three main types of pain management for labor and birth:
How is the frequency of contractions measured?From the beginning of one contraction until the next one begins. You can also time how long the contractions last. Using a watch or clock, measure the frequency of your contractions by timing them from the beginning of one to the beginning of the next.
When determining the frequency of contractions the nurse would measure which of time?Frequency is timed from the start of one contraction to the start of the next. It includes the contraction as well as the rest period until the next contraction begins. This time is measured in minutes. It is not necessary to time your whole labor.
What is used to measure contractions?A pressure-sensitive device called a tocodynamometer is placed on the mother's abdomen over the area of strongest contractions to measure the length, frequency, and strength of uterine contractions.
How should the nurse determine the frequency of uterine contraction quizlet?To determine the frequency of uterine contractions,the nurse should note the time from the: Beginning of one contraction to the beginning of the next contraction. Excessive anxiety and fear during labor may result in an: Ineffective labor pattern.
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When determining the frequency of contractions the nurse would measure which of the following
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