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Labor and birth process. Labor Process Exact mechanism unknown Theories: Uterine stretching Prostaglandin Oxytocin stimulation Cervical pressure Aging.

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Presentation on theme: "Labor and birth process. Labor Process Exact mechanism unknown Theories: Uterine stretching Prostaglandin Oxytocin stimulation Cervical pressure Aging."— Presentation transcript:

1 Labor and birth process

2 Labor Process Exact mechanism unknown Theories: Uterine stretching Prostaglandin Oxytocin stimulation Cervical pressure Aging placenta Increased fetal cortisol levels

3 Signs of labor Lightening Increased level activity Weight loss Braxton hicks contractions Cervical changes Uterine contractions Bloody show Rupture of membranes

4 True labor verses False labor Differentiated ONLY by cervical changes: Dilation Effacement

5 Components of labor 1. Passage 2. Passenger 3. Power 4. Psyche 5. Placenta

6 Passage Route fetus must travel from uterus to perineum Shape of pelvis Gynecoid Anthropoid Android Platypelloid

7 Passage Bony structures Joints, bones False pelvis True pelvis Pelvic diameters Diagonal conjugate Soft tissues

8 Passenger Fetal skull Bones Suture lines Fontanelles Diameter Molding


10 Passenger Presentation – fetal body part that will be first to pass through cervix Affects duration and difficulty of labor Affects method of labor Describe as variations of: Cephalic- vertex, brow, sinciput, mentum Breech – complete, frank, incomplete, footling Shoulder – shoulder, iliac crest, hand, elbow





15 Passenger Lie – refers to relationship of long axis (spine) of fetus to long axis of mother Longitudinal Cephalic, breech Transverse Horizontally, side to side Oblique 45 degree angles

16 Passenger Attitude Complete flexion – chin to chest Moderate flexion – military Partial extension – brow Complete extension - face


18 Passenger Position – relationship of presenting part of fetus to specific section of mothers pelvis 1. Patients pelvis – 4 sections 1. Right anterior 2. Left anterior 3. Right posterior 4. Left posterior 2. Fetus parts – 1. Occiput (O)– vertex 2. Mentum (M)- face 3. Sacrum (S) – breech 4. Acromion (A) - shoulder

19 Passenger position Fetal position described by using three letters: 1. First letter defines whether fetal landmark pointing to mothers right or left 2. Second letter designates fetal landmark 1. Occiput(O), mentum(M), sacrum(Sa), Acromion(A) 3. Last letter defines whether landmark points anteriorly(A), posteriorly(P), or transverse(T) 4. LOA – left occiput anterior most common


21 Passenger Station – relationship of presenting part to ischial spine of mother -5 (pelvis)to +4(perineum) Station 0 is at level of ischial spines – engagement occurs Floating, ballotable crowning


23 Cardinal movements of labor Number of fetal position changes as travels through birth canal 1. Engagement 2. Decent 3. Flexion 4. Internal rotation 5. Extension 6. External rotation 7. Expulsion


25 Power Force of uterine contractions Contractions of abdominal muscles Contraction pattern Begin pacemaker point upper uterine segment Wavelike pattern relaxation Phases: Increment Acme Decrement Duration Contour changes


27 Power Cervical changes – increased diameter of cervical canal and lumen occurs by pulling cervix up over present part with uterine contractions Effacement – shortening and thinning of cervical canal % - 0 to 100% Dilation – enlargement of cervical canal from 1 to 10cm


29 Psyche / Psychological Response Feeling woman brings to labor Psychological readiness for labor Factors affecting Preparation Support person Past experiences Task of pregnancy Situational control

30 Maternal Position Philosophy of Childbirth Partners Patience Patient Preparation

31 Maternal physiologic response to labor Cardiovascular Fluid and electrolyte Respiratory Hematopoietic GI Renal Musculoskeletal neurologic

32 Fetal Response to Labor Healthy fetus adapts to stress of labor Periodic fetal heart rate changes Circulation Increase PCO2 Decrease Partial PO2 Decrease fetal breathing movements

33 Stages of labor 1. Dilation – 0 to 10 cm 2. Expulsion 3. Placental 4. Immediate postpartum

34 Dilation Begins with true labor contractions ends with complete cervical dilation Divided into 3 phases 1.Latent:0-3cm 2. Active:4-6cm 3. Transitional:7-10cm

35 Latent Phase Preparatory phase Contractions mild and short 30-40sec Dilation 0-3cm 4-6 hours Analgesia too early prolongs phase Walking, packing, preparing

36 Active Phase Working phase 4-6cm Contractions stronger, sec, every 3 to 5 min True discomfort 2-4 hours Rupture of membranes Analgesia little effect on progress of labor

37 Transition phase Feeling of loss of control occurs here 7-10cm Contractions peak intensity 2-3 min 90 second duration Feelings of urge to push Intense discomfort, nausea, vomiting, anxiety, panic, irritability Focus inward on task of birth

38 Expulsion Full dilation and effacement to birth of infant 20 min to 2 hours Fetus moved by cardinal movements of labor Uncontrollable urge to push with contractions 2-3 min n/v, perspires, distended blood vessels, petechae Perineum bulge Inverted anus crowning

39 Placental Birth of infant to delivery of placenta Placental separation Bleeding on maternal side Lengthening of umbilical cord Gush vaginal blood Change shape of uterus Presentation: Shiny schultz Dirty duncan


41 Immediate post-partum 3 hours after delivery Stabilizing Mom Bleeding, bp, perineum, uterus, pain Stabilizing baby Acclimated extrautering life Promoting bonding Bleeding, bp, perineum, uterus, pain

42 Nursing Management Nursing Management during labor and birth

43 Assessments Maternal Vaginal Exam - Dilation, effacement, station, membranes Contraction pattern

44 Contraction patterns Phases Duration Frequency intensity



47 Assessments Fetal Position – Leopolds maneuvers Amniotic fluid Electronic fetal monitoring Intermittent Continuous External Internal


49 Fetal heart rate patterns Baseline Fetal Heart Rate Baseline variability Increased variability Decreased variability

50 Periodic Baseline Changes Accelerations Decelerations Early Late Variable




54 Other Fetal Assessment Methods Fetal Pulse Oximetry Fetal Stimulation Scalp Ph

55 Providing comfort Etiology of pain Perception Fetal position

56 Nonpharmacologic Measures Labor Support Ambulation / Position Changes Acupuncture / pressure Focused Imagery Breathing Techniques Therapeutic touch / Massage Effleurage


58 Pharmacologic Systemic IV, IM, PO Regional Epidural Spinal Regional block Local General




62 Nursing Care Admission assessment Continual Assessment First Stage Second, Third, Fourth Stage

63 Nursing care VS I&O Pain Emotional support Sterile technique Teaching cleanliness

64 Nursing care calm environment Clear liquids Output Ambulate Involve support person IV-blood samples Position changes Breathing techniques Perineal care Monitor contractions Monitor FHR VE

65 Nursing Care During First Stage of Labor General measures Obtain admission history Check results of routine laboratory tests and any special tests Ask about childbirth plan Complete a physical assessment Initial contact either by phone or in person

66 First Stage of Labor: Phone Assessment Estimated date of birth Fetal movement; frequency in past few days Other premonitory signs of labor experienced Parity, gravida, and previous childbirth experiences Time frame in previous labors Characteristics of contractions Bloody show and membrane status (whether ruptured or intact) Presence of supportive adult in household or if she is alone

67 First Stage of Labor: Admission Assessment Maternal health history Physical assessment (body systems, vital signs, heart and lung sounds, height and weight) Fundal height measurement Uterine activity, including contraction frequency, duration, and intensity Status of membranes (intact or ruptured) Cervical dilatation and degree of effacement Fetal heart rate, position, station Pain level

68 First Stage of Labor: Admission Assessment (contd) Fetal assessment Lab studies Routine: urinalysis, CBC HbsAg screening, GBS, HIV (with womans consent), and possible drug screening if not included in prenatal history Assessment of psychological status

69 First Stage of Labor: Continuing Assessment Womans knowledge, experience, and expectations Vital signs Vaginal examinations Uterine contractions Pain level Coping ability FHR Amniotic fluid

70 Nursing Management: Second Stage Assessment Typical signs of 2 nd stage Contraction frequency, duration, intensity Maternal vital signs Progress of labor, crowning Fetal response to labor via FHR Amniotic fluid with rupture of membranes Coping status of woman and partner

71 Nursing Management: Second Stage Interventions Supporting woman & partner in active decision-making Supporting involuntary bearing-down efforts; encouraging no pushing until strong desire or until descent and rotation of fetal head well advanced Providing instructions, assistance, pain relief Using maternal positions to enhance descent and reduce pain Preparing for assisting with delivery

72 Nursing Management: Second Stage Interventions with birth Cleansing of perineal area and vulva Assisting with birth, suctioning of newborn, and umbilical cord clamping Providing immediate care of newborn Drying Apgar score Identification

73 Nursing Management: Third Stage Assessment Placental separation; placenta and fetal membranes examination; perineal trauma; episiotomy; lacerations Interventions Instructing to push when separation apparent; giving oxytoxic if ordered; assisting woman to comfortable position; providing warmth; applying ice to perineum if episiotomy; explaining assessments to come; monitoring mothers physical status; recording birthing statistics; documenting birth in birth book

74 Nursing Management: Fourth Stage Assessment Vital signs, fundus, perineal area, comfort level, lochia, bladder status Interventions Support and information Fundal checks; perineal care and hygiene Bladder status and voiding Comfort measures Parent-newborn attachment Teaching

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