1. Fast Track into OB
Labor and Delivery

2. Lightening

3. Five Ps of Labor
Passage
Passenger
Psyche
Powers
Pain

4. Passage: the bony pelvis and soft tissue
False pelvis (upper flaring part)
True pelvis (lower part)
Inlet
Middle
Outlet
Shaped like a wide curved funnel
Soft Tissue
Impacted by previous births
Impacted by scaring

5. More on the true and false pelvis
See text page 25
Divided by false line: linea terminalis
Extends from sacroiliac joint to anterior iliopubic prominence
The upper false pelvis support the enlarging uterus and guides fetus into true pelvis
The TRUE pelvis however dictated the bony limits of the birth canal

6. Anatomical picture of pelvic inlet

7. Passage dimensions

8. Anatomical features of the pelvic outlet Page 25-26
Transverse diameter between the inner surfaces of the ischial tuberosities (spines) (bi ischial diameter)
Anterior posterior measurement of outlet is between lower border of symphysis pubis and tip of sacrum.

9. Passenger Page 122 Fetal skull page 123
Lie: orientation to Mom’s spine
Attitude: normally flexed
Presentation: part entering pelvis
Position: how a reference point on the fetal presenting part oriented within the mother’s pelvis

10. The Passenger

11. Passenger

12. Molding

13. Transverse Lie

14. Fetal Lie

15. Fetal Lie Longitudinal Fetal Presentation: Vertex

16. Attitude: Flexion/Extension

17. Fetal Attitude: a well flexed head

18. Attitude; Brow

19. Presentation: Breech

20. Presentation

21. Fetal Positions

22. Position: Posterior

23. Fetal Positions

24. Using Fetal Heart Tones to Determine Position

25. Psyche Woman’s mental state
Emotional; not described as surgical procedure
Mental State greatly impacts mothers ability to cope and tolerate discomfort
Perception of pain
Anxiety

26. Powers of Labor Involuntary forces of labor Contractions
Mother’s pushing efforts

27. Contraction Cycle

28. Effects of contractions on the cervix
Effacement
Thins the cervix
Before labor approximately 2 cm long
Thinning of cervix is expressed in %
100% thin slick membrane at edge of fetal head
Dilation
Opening of the cervix
Described in cm of opening
Full dilation at 10 cms

29. Effacement and Dilation

30. Effects of Contractions on Cervix

31. Effacement

32. Dilation

33. Mechanisms of Labor Descent Flexion Rotation Extension Restitution
External Rotation

34. Engagement: Stations

35. Mechanisms of labor with effacement and dilation

36. Read to learn activity Signs of impending labor (page 131)
Signs of True Labor (136)
Signs of False Labor ( )
Read those sections and then we will do a quiz together. RELAX!

37. Contractions; Page 120-21 Frequency Duration Interval
Increment/Peak/decrement
Intensity: Mild, moderate, strong

38. Contraction Monitoring The basics
Frequency
From the beginning of one contraction to the beginning of the next contraction
Duration
From the beginning of one contraction to the end of that contraction
Interval
The space between two contractions; from the end of one contraction to the beginning of the next one

39. Rule of contractions Based on infant getting adequate oxygenation
The frequency must not be less than two minutes
The duration must not be more than 90 seconds
The interval must not be less than 60 seconds

40. Fetal Heart monitoring
Intermittent
Allows freedom of movement
Does not offer a continuous record
Obtain a baseline rate
Rule: any FHR outside the normal limits or slowing that persists after the contraction ends is promptly reported to the health care provider
See box 6-2 page 133

41. Continuous Fetal Heart Monitoring
Offers a written record
Allows collection of more data
May however run a strip on admission and then re run a strip at regular intervals during the labor
Referred to in terms of reassuring and non reassuring patterns.
Box 6-3 page 135

42. Fetal and Contraction Monitoring The Basics
Top of strip is the fetal heart monitoring
Bottom of strip is the contraction pattern
Each small square is 10 seconds
Between each bold line is 60 seconds

43. Reassuring fetal heart/contraction pattern
bpm
Variability
Accelerations
Early decelerations
Contraction frequency greater than every 2 minutes, duration less than 90 seconds; relaxation interval of at least 60 seconds.

44. Non reassuring patterns
Fetal tachycardia
Fetal bradycardia
Variable decelerations
Late decelerations
Absences or decreased variability

45. Decelerations Early Late Variable
Due to fetal head compression during contractions and are expected
Late
Due to utero-placental insufficiency and are non reassuring
Variable
Due to cord compression and are non reassuring.

46. Early decelerations
Reassuring pattern of deceleration during the early contraction due to fetal head compression
Always return to baseline before the end of the contraction
They often mirror a contraction

47. Picture of an early deceleration

48. Late deceleration NON reassuring Due to lack of oxygen to the baby
Uteroplacental insufficiency
Do NOT return to baseline FHR after the contraction ends

49. Picture of late deceleration

50. Variable Deceleration
Due to cord compression
V, W, or U shaped
Do not exhibit a consistent pattern in relation to the contractions

51. Picture of variable deceleration

52. Nursing responses to non reassuring patterns
Reposition mom, especially helpful in the variable decelerations
Oxygen 100% per tight face mask
IV fluids to expand blood volume and to dilute Pitocin (if given)
Stopping Pitocin
Giving tocolytic drugs to decrease uterine contractions

53. More FH patterns to look at

54. Stages of Labor First Second Third Fourth
Onset of labor until cervical effacement and dilation is complete (10 cm)
Second
From the completion of effacement and dilation until the baby is born
Third
Expulsion of placenta
Fourth
Recovery phase

55. First stage divisions Latent Active Transition 4-6 hours 1-4 cm
Mild to moderate intensity
Active
2-6 hours
4-7 cm
Moderate to firm intensity
Transition
.5-2 hours
7-10 cm
Firm intensity

56. Descent

57. Mechanism of Labor, Continued

58. Mechanism of labor; continued

59. Delivery of shoulders

60. Second Stage
Second stage is also divided into three stages in other texts
Uncontrollable urge to push if no epidural
Exhaustion after each contraction
Unable to follow directions
“BABY IS COMING!!!”

61. Baby is HERE!

62. Third stage Expulsion of placenta Elation and relief
Shivers and tremors
Signs of placental seperation
Lengthening of cord
Uterus rises and becomes firm
Fresh blood expelled from vagina

63. Recovery Period
Number one priority for the mother’s care is prevention of hemorrhage
Infant care focuses on
airway,
breathing and circulation
maintaining body temperature maintaining blood glucose
Critical period of bonding and breast feeding.

64. Immediate care of Mother
Assessment and care bullets; Page 148
Observing for hemorrhage
Maintaining a firm fundus
Preventing bladder distention
Promoting comfort
Ice pack
Warm blanket
Assisting with breast feeding
Assessment of lower extremities

65. Immediate Care of the Infant
First hour infant is in “quiet alert” phase and this is critical time form bonding and breast feeding.
Unless the infant is in a medical emergency most of care can be done right at mother’s breast
Now let’s see what will happen when you observe a birth!!!!

66. Immediate Care of Infant
APGAR score
Keep warm: dry and place on mothers chest: skin to skin with blanket over and cap on
Assure that the nose is clean, bulb suction nose as well as mouth. Usually done at perineum
Clamp the cord.
Vigilant observation of infants cardiorespiratory status

67. Later Needs of the Infant
Detailed examination
Bath
Erythromycin eye ointment
Aquamephyton (vitamin K injection)]
Hepatitis B vaccination

68. APGAR Score; Page 143

69. APGAR Score
Let’s take some time to score to do the critical thinking exercise on APGAR scoring found in your workbook

70. NCLEX Prep question
A client at 38 weeks gestation tells the nurse that it feels like her baby is sitting on her bladder causing her to urinate more frequently. However, the client states it has made it easier for her to breathe. The nurse recognizes that this is a sign of:
Lightening
Quickening
Contractions
Flexion

71. NCLEX Prep Question
A client reports that her contractions started about 2 hr ago, did not go away when she had two glass of water and rested, and became stronger since she started walking. She thinks the contractions occur every 10 minutes and last about half a minute. She hasn’t had any fluid leak from her vagina, however, she did think she saw some blood when she wiped after voiding. The nurse should recognize that the client is experiencing:
Braxton Hick contractions
Rupture of membranes
Fetal descent
True Contractions

72. NCLEX Prep Question
A nurse is monitoring the FHR and contractions of a client in labor. The FHR is in the 140s. Contractions are every 5 min and sec in duration. The nurse performs a vaginal exam and finds the cervix is 2 cm dilated, 50% effaced and the fetus is at the -2 station. One hour later the dilation is still 2 cm, but now the effacement is 80% Which of the following stages and phases of labor is this client experiencing?
The first stage, latent phase
The first stage, active phase
The first stage, transition phase
The second stage of labor

73. NCLEX Prep Question
A nurse is admitting a client to the birthing unit. The client suddenly states, A”I think I urinated on myself. It’s all wet down there, I’m so embarrassed.” Which of the following actions should the nurse take at this time?
Test the fluid with Nitrazine paper, it will confirm urine by turning blue
Test the fluid with Nitrazine paper, which will confirm urine by turning pink.
Test the fluid with Nitrazine paper, which will confirm amniotic fluid by turning it blue
Test the fluid with Nitrazine paper, which will confirm amniotic fluid by turning it yellow.

74. NCLEX Prep Question
A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. The nurse’s first action should be to:
Test to see if the fluid is amnionic fluid
Monitor fetal heart rate for distress
Dry the client and make her comfortable
Monitor the client’s maternal contractions

75. NCLEX prep question
While conducting an admission history for a client at 39 weeks gestation, the client tells the nurse that she has been leaking water from her vagina for 2 days. The nurse knows that this client is at risk for:
Cord prolapse
Infection
Malpresentation.
hydramnios

76. NCLEX Prep Question
A client in active labor becomes nauseous with emesis, is very irritable, and feels she needs to have a bowel movement. She states, “I’ve had enough. I can’t do this anymore. I want to go home right now.” The nurse knows that these signs indicate the client is in the:
Second stage of labor
Fourth stage of labor
Transition phase of labor.
Active phase of labor