Prof. Carole A. Devine R.N.,MSN. 1 The Process of Birth Introduction Intrapartum\Perinatal Period

Prof. Carole A. Devine R.N.,MSN. 2 Physiologic Effects of Birth/Adaptation to Labor Maternal Response-Alterations in: Cardiovascular Cardiovascular Hemopoietic System Hemopoietic System Respiratory System Respiratory System Renal system Renal system Integumentary System Integumentary System Neurologic System Neurologic System G.I. System G.I. System Endocrine System Endocrine System Reproductive System Reproductive System

Prof. Carole A. Devine R.N.,MSN. 3 Cervical Dilation

Prof. Carole A. Devine R.N.,MSN. 4 B. Fetal Response to Mother’s Labor: Fetal Heart Rate: Fetal Heart Rate: Respiratory Rate Respiratory Rate Fetal Circulation Fetal Circulation

Prof. Carole A. Devine R.N.,MSN. 5 Placental Circulation

Prof. Carole A. Devine R.N.,MSN. 6 II. Components of The Birth Process Critical Factors in Labor The Five P’s: The Five P’s: 1.The Powers 1.The Powers 2. The Passage 2. The Passage 3. The Passenger 3. The Passenger 4. Mother’s position 4. Mother’s position 5. The Psyche 5. The Psyche

Prof. Carole A. Devine R.N.,MSN. 7 Powers 1. Primary: Uterine Contractions 1. Primary: Uterine Contractions 2. Secondary: 2. Secondary: Abdominal and Intercostal Muscles Abdominal and Intercostal Muscles The Perineal Muscles The Perineal Muscles

Prof. Carole A. Devine R.N.,MSN. 8 Uterine Muscle Layers

Prof. Carole A. Devine R.N.,MSN. 9 Uterine Response Contractions Measured in: Frequency Duration Intensity Phases of Contractions: Increment Acme Decrement

10 Phases of Contractions

Prof. Carole A. Devine R.N.,MSN. 11 B. Passage (The Pelvis) 1. Landmarks: 1. Landmarks: The True Pelvis The True Pelvis ( divided into 3 sections) ( divided into 3 sections) Inlet Inlet Cavity Cavity Outlet Outlet 2. Types of Pelvises 2. Types of Pelvises Gynecoid Gynecoid Anthropoid Anthropoid Android Android Platypelloid Platypelloid 3. Significant Measurement: Bi-ischial diameter Bi-ischial diameter

Prof. Carole A. Devine R.N.,MSN. 12 Female Pelvis

Prof. Carole A. Devine R.N.,MSN. 13 Pelvic Measurements

Prof. Carole A. Devine R.N.,MSN % 20% 25% 05% Comparisons of Pelvises Gynecoid Android Anthropoid Platypelloid

Prof. Carole A. Devine R.N.,MSN. 15 C. Passenger ( Baby!) 1. Fetal head/Fontanels a. Posterior b. Anterior c. Bi-Parietal Measurement 2. Fetal Presentation a. Cephalic b. Breech c. Transverse

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Prof. Carole A. Devine R.N.,MSN. 18 Passenger (Continued) Fetal Lie Fetal Lie Fetal Attitude Fetal Attitude Fetal station Fetal station Fetal Position: Fetal Position: a. side of Pelvis: Referred to as: (R or L) a. side of Pelvis: Referred to as: (R or L) b. Fetal Presenting Part Referred to as:( O,S,M or A) b. Fetal Presenting Part Referred to as:( O,S,M or A) c. Anterior, Posterior or Transverse Lie : Referred to as:( A, P or T) c. Anterior, Posterior or Transverse Lie : Referred to as:( A, P or T)

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Prof. Carole A. Devine R.N.,MSN. 21 Fetal Station

Prof. Carole A. Devine R.N.,MSN. 22 Mother’s Position in Labor Affects anatomical and physiologic adaptation to labor( standing, walking, sitting or squatting) Affects anatomical and physiologic adaptation to labor( standing, walking, sitting or squatting) Gravity can assist in the decent of baby/increases effacement and dilation of cervix Gravity can assist in the decent of baby/increases effacement and dilation of cervix Ferguson’s reflex Ferguson’s reflex

Prof. Carole A. Devine R.N.,MSN. 23 Mother’s Psyche !

Prof. Carole A. Devine R.N.,MSN. 24 Labor and Delivery III. Normal Labor III. Normal Labor A. Premonitory Signs of Labor A. Premonitory Signs of Labor 1. Braxton Hicks Contractions 1. Braxton Hicks Contractions 2. Cervical Changes 2. Cervical Changes 3.Bloody Show 3.Bloody Show 4.Rupture of Membrane 4.Rupture of Membrane 5. Sudden Burst of Energy 5. Sudden Burst of Energy

Prof. Carole A. Devine R.N.,MSN. 25 B.True vs. False Labor Characteristics False Labor False Labor - no change in cervix - no change in cervix -discomfort in low abdomen and groin -discomfort in low abdomen and groin -irregular contractions -irregular contractions -no increase in frequency or intensity of contractions -no increase in frequency or intensity of contractions True Labor True Labor Progressive cervical dilatation and effacement Progressive cervical dilatation and effacement Discomfort in back and abdomen Discomfort in back and abdomen Contractions occur at regular intervals Contractions occur at regular intervals Progressive increase in frequency and intensity of contractions Progressive increase in frequency and intensity of contractions

Prof. Carole A. Devine R.N.,MSN. 26 C. Initial Maternal Assessments During Labor 1.PrenatalHistory ie: Gestational Age? wt.gain,EDD/EDC, Lab Values, Bld.Type 2.Risk Factors: Rubella status; STD’s, Group B Step. Status 3.Prior Obstetrical History( GTPAL) 4. Asses Labor Progress 5.?Education Preparation 6. Educational needs of this Mother/Family 7. ? Support System 8.Maternal Allergies? 9. Base line Vital Signs 10. Status of the Baby

Prof. Carole A. Devine R.N.,MSN. 27 E. Mechanism of Labor Cardinal Movements of the baby Cardinal Movements of the baby 1. Engagement, Descent, Flexion 1. Engagement, Descent, Flexion 2.Internal Rotation 2.Internal Rotation 3.Extention-Beginning 3.Extention-Beginning 4.Extention Complete 4.Extention Complete 5.External Rotation(Restitution) 5.External Rotation(Restitution) 6.External Rotation(Shoulder Rotation) 6.External Rotation(Shoulder Rotation) 7.Expulsion 7.Expulsion

Prof. Carole A. Devine R.N.,MSN. 28 Four Stages of Labor 1.First Stage (Dilation Stage) 1.First Stage (Dilation Stage) Divided into three phases: Divided into three phases: a. latent a. latent b. active b. active c. transition c. transition 2.Second Stage (Stage of Expulsion) 2.Second Stage (Stage of Expulsion) 3. Third Stage (Placental Stage) 3. Third Stage (Placental Stage) 4. Fourth Stage (Recovery Stage ) 4. Fourth Stage (Recovery Stage )

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