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Process and Stages of Labor and Birth Chapter 17.

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Presentation on theme: "Process and Stages of Labor and Birth Chapter 17."— Presentation transcript:

1 Process and Stages of Labor and Birth Chapter 17

2 LABOR The Process by which the Products of Conception are expelled
from the body

3 Critical Factors In Labor


5 THE PELVIS False Pelvis True Pelvis Represents
Supports the weight of the uterus Shallow basin above the inlet or brim True Pelvis Represents the bony limits of the birth canal 1. Differentiate between the terms true pelvis and false pelvis.

6 True Pelvis vs. False Pelvis
Inlet - upper margin of pubic bone to upper margin of sacrum Outlet - Lower pubic bone to tip of coccyx. This area is the smallest portion that the baby must travel through. 2. Explain the difference between the two main sections of the true pelvis and how they impact delivery of the fetus. Which of the following is most important in providing a successful delivery? Why?

7 The Fetus

8 Fetal Head Because of its size and rigidity, the Fetal Head has a major impact on delivery. The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal. Head also can rotate, flex, and extend 3. Compare the bones, suture lines and fontanels of the fetal head. What do the bones of the fetal head do to accommodate the birth canal?

9 Attitude Relationship of fetal body parts to each other Optimum
attitude is ovoid 4. What is attitude? What is the optimum attitude for delivery? The head is flexed forward, with the chin almost resting on the chest. The arms and legs are flexed.

10 Fetal Lie Relationship of the long axis of the fetus to the long axis of the mother. Longitudinal Lie Transverse Lie 5. Define the term "fetal lie". Explain the difference between transverse lie and longitudinal lie. Which is the most favorable for a vaginal delivery?

11 True or False? The optimum lie of the fetus is the longitudinal lie.
A. True B. False True

12 Fetal Presentation That portion of the fetus that enters the Pelvis first and covers the internal os. Three Types: Cephalic Vertex, Face, Brow Breech Shoulder 6. Define the term “fetal presentation” and explain difference between presentations. Cephalic Presentation The head is entering the pelvis first.

13 Reference Points Cephalic = Occiput, posterior fontanel
Breech = Sacrum Face = Mentum 7. What reference point would the nurse use when assessing cephalic presentation? A breech presentation? A face presentation? 9. What reference point would the nurse use when assessing breech presentation?

14 Relationship of Maternal Pelvis and Presenting Part

15 Engagement Engagement -largest diameter of presenting part has passed through the pelvic inlet Assessed during vaginal exam Ballotable 8. What is engagement? How is it determined? Engaged

16 Station- degree that the presenting part has descended into the pelvis
Relationship to ischial spines Goal Move from – to + stations 9. What is station? How is station determined and measured? Does the station need to be a + or – for delivery?

17 POSITION Relationship of the Fetal Presenting Part to the Maternal Pelvis Steps: 1. Determine the Presenting Part 2. Divide the mothers pelvis into 4 imaginary quadrants 10. What is fetal position? What are the steps in assessing position? A 12 R L 9 3 6 P

18 Test Yourself ! What is the reference point of a cephalic presentation when the head is fully flexed? A. occiput B. mentum C. frontal d. sagittal

19 Test Yourself Overlapping of the fetal skull to facilitate its passage through the bony pelvis is ___________. Relationship of fetal body parts to each other is_____________. Head first presentation is_________________. Relationship of the fetal spine to the maternal spine is ________________. Term that refers to the part of the fetus that enters the pelvic inlet first is _____________.

20 The Physiologic Forces of Labor

21 Major Powers Involved Involuntary Uterine Contractions or Primary Powers Muscular contractions which lead to dilation and effacement in the First Stage of Labor Voluntary Uterine Contractions or Secondary Powers Abdominal muscles assist in the Second Stage with pushing. Increase intra-abdominal pressure to aid in expulsive forces 12. What are the primary and secondary powers/forces of labor? 13. When are the secondary powers used during the labor process? 15. When are the secondary powers used during the labor process?

22 FORCES OF LABOR Contraction -exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement) acme Decrement Increment Duration 14. Explain the parts of a contraction and the relationship including: Interval Frequency Duration- from beginning of one contraction to the end of the same contraction Frequency- from beginning of one contraction to the beginning of another contraction Interval - Resting time between contractions for placental perfusion

23 Fill in the Blank Length of a uterine contraction__________.
Strength of a uterine contraction is ___________. The time from the beginning of one contraction to the beginning of the next contraction is _______. The time that allows for placental perfusion is __. The peak of a contraction is also known as ____. When the biparietal diameter of the head passes through the pelvic inlet it is said to be ________.

24 PSYCHOLOGICAL Considerations

18. How can stress and anxiety interfere with the process of labor? 19. What are nursing interventions to assist clients in decreasing anxiety? PAIN

26 Physiology Of Labor

27 Progesterone Withdrawal Corticotropin-Releasing Hormone
CAUSES OF LABOR Progesterone Withdrawal High levels of Prostagladins Corticotropin-Releasing Hormone 20. What are the possible causes of labor onset?

28 Myometrial Activity Effacement- thinning of the cervix (%)
Dilation – enlargement and widening of the os (cm) 21. Define effacement and dilatation and how measured

29 Critical Thinking If the fetal head did not descend through the pelvis and stayed at the same station for a prolonged period of time, what do you think would be the treatment of choice?

30 Try this ! When the cervical os widens or opens it is said to________.
The level of the ________ _________ is station zero. The most common type of pelvis for a woman ___________. When the cervix shortens and thins is _______________. For delivery to occur, the fetus must accomodate to this rigid passageway______________.

31 Premonitory Signs of Labor
The impending signs that take place the last several weeks of pregnancy or even the last several days 22. What are the premonitory signs of labor?

32 Premonitory Signs of Labor

33 True vs. False Labor TRUE LABOR FALSE LABOR Contractions are:
* Regular *Increase in intensity and duration with walking *Felt in lower back, radiating to lower portion of abdomen Bloody show Dilation and effacement Fetus usually engaged FALSE LABOR Contractions are irregular Often stop with walking Contractions felt in abdomen above umbilicus (abdominal pains) No change in cervix Fetus is ballotable 23. What assessment findings differentiate true labor from false labor?

34 Phases and Stages of Labor
Stage 1 – From 0 cm. dilated to 10 cm. Stage 2 - From complete dilation and effacement to delivery of the baby Stage 3 - From delivery of baby to the delivery of the placenta Stage 4 - the first hour after delivery

35 Phases of First Stage of Labor
Latent Phase – is from 0 to 3 cm. dilated Active Phase – is from 4cm. to 7 cm. Transistion Phase – is from 8 cm. to 10 cm. 24. What are the three phases of the first stage of labor and characteristics of each? (p )

36 Signs of Second Stage of Labor
Complete dilatation of cervix Urge to bear down Perineum begins to bulge, flatten and move anteriorly Increase in bloody show Rectal pressure Labia begins to part with each contraction

37 Mechanisms of Labor/ Cardinal Movements
Descent Flexion Internal Rotation Extension External Rotation 25. Explain the positional changes /cardinal movements of stage 2 and why they occur in this order? Expulsion

38 Signs of Stage Three of Labor
Globular Shape of Uterus Fundus Rise in Abdomen Sudden Gush of Blood Protrusion of Umbilical cord 26. What are the signs in the third stage that indicate that the placenta is ready for delivery? (p. 412)

39 The End

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