Chapter 16 Labor and Birth Processes Maternity & Women’s Health Care, 11th Edition by Lowdermilk, Perry, Cashion, and Alden Instructor: LaTricia Perry, MSN, RN, COI

Factors Affecting Labor Passenger Passageway Powers Position Psychological Response

Factors Affecting Labor 5 factors affecting process of labor and birth Passenger: fetus Size of fetal head Fontanels Molding Fetal presentation Cephalic Breech Shoulder Fetal lie

Factors Affecting Labor (cont.) 5 factors affecting process of labor and birth Passenger: fetus Fetal attitude General flexion Biparietal diameter Suboccipitobregmatic diameter Fetal position Station Engagement

Factors Affecting Labor (cont.) 5 factors affecting process of labor and birth Passageway: birth canal Bony pelvis Gynecoid Android Anthropoid Platypelloid Soft tissues Retraction ring

Factors Affecting Labor (cont.) 5 factors affecting process of labor and birth Powers Primary powers: contractions Frequency, duration, intensity Effacement Dilation Ferguson reflex Secondary powers: bearing-down efforts Valsalva maneuver

Contractions:

Cervical effacement

Cervical dilation

Factors Affecting Labor (cont.) 5 factors affecting process of labor and birth Position of laboring woman Upright position “All fours” position Lithotomy position Semirecumbent position Lateral position

Factors Affecting Labor (cont.) Psychologic Response Unique to each woman Cultural beliefs Previous experience Anxiety level Environment

Onset of Labor Cannot be ascribed to a single cause Onset preceded by a number of signs Braxton Hicks contractions Lightening Bloody Show Nesting Cannot be ascribed to a single cause Change in uterus and hormones (progesterone) Hormones produced by fetus’ hypothalamus Uterine distention and prostaglandins Increased uterine pressure

Process of Labor First stage Second stage Third stage Fourth stage Dilation First stage Delivery of fetus Second stage Expulsion of placenta Third stage Recovery x 2 hours Fourth stage

First Stage of Labor – Effacement and Dilation Begins with onset of regular uterine contractions Ends with full cervical effacement and dilation Three phases - Latent phase (up to 3 cm of dilation) Active phase (4 to 7 cm of dilation) Transition phase (8 to 10 cm of dilation)

First Stage of Labor: Latent (Early) Early: - lasts 5 to 12 hours Physical changes: Bloody show, loss of mucus plug, diarrhea Dilation – 0 to 3 cm Effacement – 50% to 80% Contractions - duration – 30 sec to 45 sec frequency – 5 to 30 min apart intensity – usually mild building to moderate

First State of Labor: Latent (Early) Emotional changes: excited, nervous, not sure this labor, restless, wants to talk, best to be at home Psychological: Interested in everything go on, need for reassurance, positive verbal and emotional support

First State of Labor: Active Active: last 3 to 7 hours Physical changes: Decreased appetite, using more energy, smell of food may make her nauseous, difficult to walk or talk through contractions, need to change positions Dilation – 4 to 7 cm Effacement – 80% to 100% Contractions - duration – 40 sec to 70 sec frequency – 3 to 5 min apart intensity – moderate to strong

First Stage of Labor: Active Emotional changes: Focused on labor, decreased talking, wants focused emotional and physical support, irritated by noises Psychological: Only involved in what is going on in room is in, decreased modesty, more dependent on partner,

First Stage of Labor: Transition Transition: last ½ hr to 1 ½ hr Physical changes: Nausea, vomiting, difficulty focusing, double peaked contractions, hot and cold flashes, shaking, hiccups, burping, common time for rupture of amniotic sac, need to bear down Dilation – 10 cm Effacement – 100% Contractions - duration – 45 sec to 90 sec frequency – 2 to 3 min apart intensity – extremely strong

First State of Labor: Transition Emotional changes: Losing control, desire to quit, bargaining, may ask for medication, inward centered, irritable, natural amnesia, needs undivided attention Psychological: Only focus about 10 inches from her face, easily overwhelmed , needs unwavering encouragement and praise

Second Stage of Labor Infant is born Begins with complete effacement (100%) and full cervical dilation (10 cm) Ends with baby’s birth

Seven Cardinal Movements of the Mechanism of Labor Engagement Descent Flexion Internal Rotation Extension Restitution and External Rotation Expulsion

Posterior position

Second Stage of Labor -Birthing the baby Two phases – ½ to 2 hours Latent (“Laboring Down”): relatively calm with passive descent of baby through birth canal Active Pushing (Descent): active pushing and urges to bear down Ferguson reflex

Third Stage of Labor – 15 to 60 min Placental separation and expulsion Firmly contracting fundus Change in uterus Sudden gush of dark blood from the introitus Apparent lengthening of the umbilical cord Vaginal fullness

Fourth Stage of Labor – 1 to 2 hours post-delivery Begins after delivery of placenta Body is attempting to regain homeostasis Watch for abnormal bleeding

Fetal Adaptation to Labor Fetal Heart Rate (FHR) Fetal Circulation Fetal Respiration

Maternal Physiologic Adaptation to Labor (cont.) Cardiovascular changes Respiratory changes Renal changes Integumentary changes Musculoskeletal changes Neurologic changes Gastrointestinal changes Endocrine changes Women exhibit both objective and subjective symptoms:

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