1. Normal Labor and Delivery Physiological Adaptations Presented by Jeanie Ward

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

3. Essential Factors in Labor Passenger Powers Passageway Psychological

4. THE PASSENGER

5. Fetal Head Fetal Head ä Because of its size and rigidity, the Fetal Head has a major impact on delivery. ä The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal. ä Head also can rotate, flex, and extend

6. Fetal Lie ä Relationship of the long axis of the fetus to the long axis of the mother. Longitudinal Lie Transverse Lie

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

8. Fetal Presentation ä That portion of the fetus that enters the Pelvis first and covers the internal os. ä Three Types: ä Cephalic ä Vertex, Face, Brow ä Breech ä Shoulder

9. ä Cephalic = Occiput, posterior fontanel ä Breech = Sacrum ä Face = Mentum Reference Points

10. Attitude Relationship of fetal body parts to each other Optimum attitude is ovoid

11. POSITION ä Relationship of the Fetal Presenting Part to the Maternal Pelvis ä Steps: 1. Determine the Presenting Part 2. Divide the mothers pelvis into 4 imaginary quadrants A P 12 L 3 6 9 R

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

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

14. THE PASSAGEWAY

15. THE PELVIS ä Determine if the pelvic cavity is of adequate size to allow for the passage of the full term infant Optimum shaped pelvis is Gynecoid

16. True Pelvis vs. False Pelvis False Pelvis Supports the weight of the uterus Shallow basin above the inlet or brim True Pelvis Inlet - upper margin of pubic bone to upper margin of sacrum Outlet - Lower pubic bone to tip of coccyx

17. THE POWERS THE POWERS

18. Major Powers Involved ä Involuntary Uterine Contractions or Primary Powers ä Muscular contractions which lead to dilation and effacement in the First Stage of Labor ä Voluntary Uterine Contractions or Secondary Powers ä Abdominal muscles assist in the Second Stage with pushing. Increase intra-abdominal pressure to aid in expulsive forces

19. THE PSYCHOLOGICAL THE PSYCHOLOGICAL

20. FEAR TENSION PAIN BREAK THE CYCLE !

21. Techniques for Assessment ä Abdominal Palpation / Leopold’s Maneuver ä Standing on the Right side, face the woman and palpate with the palms of the hands. ä Step 1 - Start at upper fundus and palpate for the head or buttocks ä Step 2 - Go down each side and locate back ä Step 3 - Gently grasp lower portion of uterus and feel for the head ä Step 4 - Turn and face the woman and repeat the steps.

22. Ausculation ä Assess for the area of Greatest Intensity of the FHR.

23. True or False ? ä If the fetal heart tones (FHT’s) are heard loudest (PMI) in the patient’s upper right quadrant of her abdomen, the fetus would be assessed for a breech presentation. A. True B. False

24. Vaginal Examination ä Presentation ä Position ä Condition of Membranes -- ruptured or intact ä Dilation - enlargement and widening of os ( cm.) ä Effacement- thinning of the cervix (%)

25. Vaginal Examination ä Station - degree that the presenting part has descended into the pelvis. Relationship to ischial spines ä Engagement - largest diameter of presenting part has passed through the pelvic inlet

26. Critical Thinking ä 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?

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

28. CAUSES OF LABOR Increase in Estrogen Decrease in Progesterone Degeneration of Placenta Overdistention of Uterus High levels of Prostagladins

29. FORCES OF LABOR ä Contraction - exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement) Increment acme Decrement Duration 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 Interval - Resting time between contractions for placental perfusion

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

31. Assessment of Contraction ä 1. Subjective symptoms by woman ä 2. Palpation and timing by the Nurse ä 3. Use of Electronic Fetal Monitor

32. Duration of Labor ä Resistance of the Cervix ä Presentation and position of the fetus, the mother’s pelvis ä Preparation and relaxation of the Mother ä Primigravida - up to 22 hours; ave. 12 1/2 hrs ä Multigravida - 8 - 17 hours; ave. 10 hrs.

33. Premonitory Signs of Labor The impending signs that take place the last several weeks of pregnancy or even the last several days

34. Premonitory Signs of Labor LIGHTENING FALSE LABOR PAIN SHOW ROM BACKACHE DIARRHEA SUDDEN INCREASE IN ENERGY

35. True vs. False Labor ä TRUE LABOR ä Contractions are: * Regular *Increase in intensity and duration with walking *Felt in lower back, radiating to lower portion of abdomen ä Bloody show ä Dilation and effacement ä Fetus usually engaged ä FALSE LABOR ä Contractions are irregular ä Often stop with walking ä Contractions felt in abdomen above umbilicus (abdominal pains) ä No change in cervix ä Fetus is ballotable

36. Phases and Stages of Labor  Stage 1 0 - 10 cm.  Phase 1 - Latent - dilate 0 - 3 cm.  Phase 2 - Active - dilate 4 - 7 cm.  Phase 3 - Transition - dilate 8 - 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

37.  The End Return to Module