5 Characteristics of Contractions Contraction-exhibits a wavelike pattern that begins slowly climbing (increment) to a peak, and decreases (decrement)peakIncrementDecrementDurationIntervalFrequencyDuration- from beginning of one contraction to the end of the samecontractionFrequency- from beginning of one contraction to the beginning ofanother contractionInterval - Resting time between contractions for placental perfusion
6 Opposing Features of Uterine Activity Upper 2/3 of uterus contracts activelyLower third and cervix are passiveThese lead to downward progression of fetuswith each contraction
7 Cervical Changes Effacement- thinning of the cervix (%) Dilation – enlargement and widening of the os (cm)
8 Cardiovascular System Changes During each contraction, blood flow to the placenta gradually decreases, causing an increase in the woman’s blood volume causing her B/P to increase and slowing of her pulse.Because these changes occur during a contraction, it is best to assess vital signs between contractions.
9 What are acceptable positions for the woman to assume while in labor?
10 Respiratory System Changes During labor a woman is likely to hyperventilate causing:Tingling in hands and feetNumbnessDizzinessHave the woman slow her breathing or breath into a paper bag.
11 Gastrointestinal System Changes Most woman are limited to clear liquids or NPO during the labor process.Gastric motility and digestion of food is reduced.Decrease risk of aspirationWhy?
12 Urinary System Changes Reduce sensations of needing to voidIntense contractionsAnesthesiaUnaware of having a Full bladderInhibit fetal descent
13 Hematopoietic SystemMost woman lose ~ 500ml blood during a vaginal delivery and ~1000ml during a cesarean birth.Clotting factors are elevated and Fibrinolyis is decreased to promote coagulation at the placental site
16 Uterine Contractions Maternal Pushing Efforts Involuntary Uterine Contractions or Primary PowersMuscular contractions which lead to dilation and effacement in the First Stage of LaborVoluntary Uterine Contractions or Secondary Pushing PowersAbdominal muscles assist in the Second Stage with pushing. Increase intra-abdominal pressure to aid in expulsive forces
17 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 ____.
19 THE PELVIS False Pelvis True Pelvis Represents Supports the weight of the uterusShallow basin above the inlet or brimTrue PelvisRepresentsthe bonylimits of thebirth canal
20 True Pelvis vs. False Pelvis Inlet Inlet - upper margin of pubic bone to upper margin of sacrum Outlet Outlet - Lower pubic bone to tip of coccyx. This area is the smallest portion that the baby must travel through.
23 Fetal HeadBecause 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 extendCompare the bones, suture lines and fontanels of the fetal head. What do the bones of the fetal head do to accommodate the birth canal?
24 Fetal LieRelationship of the long axis of the fetus to the long axis of the mother.Longitudinal Lie Transverse LieDefine the term "fetal lie". Explain the difference between transverse lie and longitudinal lie. Which is the most favorable for a vaginal delivery?
25 Attitude Relationship of fetal body parts to Optimum each other attitude isovoidThe head is flexed forward, with the chin almost resting on the chest. The arms and legs are flexed.
26 True or False? The optimum lie of the fetus is the longitudinal lie. A. TrueB. False
27 Fetal PresentationThat portion of the fetus that enters the Pelvis first and covers the internal os.Three Types:CephalicVertex, Face, BrowBreechShoulderDefine the term “fetal presentation” and explain difference between presentations.Cephalic PresentationThe head is entering the pelvis first.
28 Reference Points Cephalic = Occiput, posterior fontanel Breech = SacrumFace = MentumWhat reference point would the nurse use when assessing cephalic presentation? A breech presentation? A face presentation?What reference point would the nurse use when assessing breech presentation?
29 POSITIONRelationship of the Fetal Presenting Part to the Maternal PelvisSteps:1. Determine the Presenting Part2. Divide the mothers pelvis into 4 imaginary quadrantsWhat is fetal position? What are the steps in assessing position?A12RL936P
33 Theories of OnsetDecrease in ProgesteroneHigh levels ofProstagladinsStretching, pressure or irritation of the uterus and cervix20. What are the possible causes of labor onset?
34 Premonitory Signs of Labor The impending signsthat take place the lastseveral weeks ofpregnancy or even thelast several daysWhat are the premonitory signs of labor?
35 Premonitory Signs of Labor LIGHTENINGBraxton-Hicks ContractionsCervical changesSHOWROMBACKACHESUDDEN INCREASE IN ENERGYWeight loss
36 True vs. False Labor FALSE LABOR TRUE LABOR Contractions are irregular Often stop with walkingContractions felt in abdomen above umbilicus (abdominal pains)No change in cervixFetus is ballotableTRUE LABORContractions are:* Regular*Increase in intensityand duration withwalking*Felt in lower back, radiating to lower portion of abdomenBloody showDilation and effacementFetus usually engaged23. What assessment findings differentiate true labor from false labor?
37 Mechanisms of Labor/ Cardinal Movements Engagement / DescentFlexionInternal RotationExtensionExternal Rotation25. Explain the positional changes /cardinal movements of stage 2 and why they occur in this order?Expulsion
38 EngagementEngagement-largest diameter of presenting part has passed through the pelvic inletAssessed duringvaginal examBallotable8. What is engagement? How is it determined?Engaged
39 StationStation- degree that the presenting part has descended into the pelvisinRelationship to ischial spinesGoalMove from – to + stations9. What is station? How is station determined and measured? Does the station need to be a + or – for delivery?
40 Phases and Stages of Labor Stage 1 – From 0 cm. dilated to 10 cm.Stage 2 - From complete dilation andeffacement to delivery of thebabyStage 3 - From delivery of baby to thedelivery of the placentaStage 4 - the first hour after delivery
41 Phases of First Stage of Labor Latent Phase – is from 0 to 3 cm. dilatedActive Phase – is from 4cm. to 7 cm.Transition 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 )
42 Signs of Second Stage of Labor Complete dilatation of cervixUrge to bear downPerineum begins to bulge, flatten and move anteriorlyIncrease in bloody showRectal pressureLabia begins to part with each contraction
43 Signs of Stage Three of Labor GlobularShape of UterusFundus Rise in AbdomenSudden Gush of BloodProtrusion of Umbilical cordWhat are the signs in the third stage that indicate that the placenta is ready for delivery?
44 Test Yourself !What is the reference point of a cephalic presentation when the head is fully flexed?A. occiputB. mentumC. frontald. sagittal
45 Test YourselfOverlapping 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 _____________.
46 Critical ThinkingIf 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?
47 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______________.