Question

Name: ___________________________________

N241 Human Reproduction & Sexuality

Thinking Critically Worksheet

Answer the following questions. Please be descriptive in your answers.

1. (4 points)

During a prenatal class, you are going to teach the women and their partners about the process of labor and how it progresses. You decide the best approach is to discuss the Ps of labor. Describe what you will present related to the Ps.

2. (4 points)

Cindy is in early labor and has a few questions for the nurse about epidurals. Cindy asks, “Can I move around after I get an epidural? How good is the pain relief? I heard I might get itchy with an epidural. Is that true? Is it safe for the baby?” How should the nurse answer Cindy’s questions?

3. (2 points)

Ann is a primigravida. During a prenatal visit at 34 weeks gestation, she asks you the following questions regarding her approaching labor. Describe how you would respond.

“Are there things I should watch for that would tell me my labor is getting closer to starting?”

“How long can I expect my labor to last once it gets started?”

BONUS:

Apgar scoring is a method of newborn assessment used in the immediate post birth period, at 1 and 5 minutes. Indicate the Apgar score for each of the following newborns.

1. Baby boy at 1 minute after birth:
   1. Heart rate 160 beats/min
   2. Respiratory effort good, crying vigorously
   3. Muscle tone-active movement, well flexed
   4. Reflex irritability-cries with stimulus to soles of feet
   5. Color-body pink, feet and hands cyanotic

Score:

What is your interpretation?

2. Baby girl at 5 minutes after birth:
   1. Heart rate 102 beats/min
   2. Respiratory effort slow, irregular with weak cry
   3. Muscle tone-some flexion of extremities
   4. Reflex irritability-grimace with stimulus to soles of feet
   5. Color-pale

Score:

What is your interpretation?

Answer 1

1. Prenatal class about four P's

There are four major factors interact during normal childbirth: the four P's are interrelated and depend on each other for a safe delivery. They are,

• Powers
• Passageway
• Passenger
• Psyche

Powers: Uterine contractions are the forces that are expelling the fetus from the uterus. During the initial stage the structural changes in uterus such as shortening, thinning and enlargement of birth canal, and later the pushing efforts of a mother are the forces that lead to a safe delivery.

Passageway: The bodily structures in the mother's body that is related to the child birth include bony pelvis and soft tissues of cervix, pelvic floor, and external opening of birth canal.

Passenger: Fetus, membranes and placenta passes through the birth canal.

Psyche: The emotional status is an important factor that influences both physiological and psychological functioning. The women experience fear and anxiety related to pain during the delivery process and outcome of delivery.

2. Questions about Epidural.

a) Can I move around after getting epidural?

No, maintain a side-lying position and be relaxed. Epidural may cause fall in blood pressure, and the proper positioning will prevent the distended uterus from compressing the major blood vessel.

b) How good is the pain relief?

Epidural anesthesia relieves pain from contractions and makes the birth canal numb.

c) I heard i might get itchy with epidural, Is it true?

Epidural anesthesia has a side effect of itching. It will be observed after administering epidural and nothing to be worried about it as the possibility is less.

d) Is it safe for baby?

Yes, it is safe for baby.

3.a) Are there things I should watch for that would tell me my labor is getting closer to starting?

Observe for the presence of mild pain which occurs every 15-30 minutes and lasts for 15-30 seconds. The time interval between the occurrence of pain reduces and intensity will increase when the labor progresses.

b) How long can I expect my labor to last once it gets started?

It varies from individual to individual. Approximately it takes around 10-14 hours for a primigravida.

BONUS

1. Apgar score for baby boy at 1 minute after birth.

Indicator	Points
Heart Rate - 160 beats/min	2
Respiratory Effort - Good, vigorous cry	2
Muscle Tone - Active movement, well flexed	2
Reflex irritability - Cries with stimulus	2
Skin Color - Body pink, extremities cyanotic	1
SCORE	9

2. Apgar score for baby girl at 5 minutes after birth.

Indicator	Points
Heart Rate - 102 beats/min	2
Respiratory Effort - Slow, irregular, weak cry	1
Muscle Tone - some flexion of extremities	1
Reflex irritability - Grimace with stimulus	1
Skin Color - Pale	0
SCORE	5

3. Interpretation

First Baby - No intervention is required for the score 8-10.

Second Baby - The score is 5. Gently stimulate, rub infant's back, and administer oxygen to the newborn.