1. C. Lutkenhaus, MSN, RNC-OB, C-EFM Updated 8/2015
Chapter 16—Giving Birth
C. Lutkenhaus, MSN, RNC-OB, C-EFM
Updated 8/2015

2. What causes Labor? Multiple Theories
Changes in maternal estrogen to progesterone?
Prostaglandins produced by the decidua in placenta and the amniotic membranes?
Increased secretion of natural oxytocin?
Oxytocin receptors in uterus increase markedly?
Fetus secretes oxytocin?
Stretching, pressure, irritation of uterus as approaches term?
What about premature labor and delivery?
Bladder infections, GBS infections, septicemia

3. Components of the Birth Process 4 P’s
Powers (Uterine Muscle)
Contractions
Maternal pushing
Passage
Pelvis must be adequate for fetal passage

4. Pelvis Types

5. Components of the Birth Process
Passenger
Fetal head: Head is divided into designated areas (1) brow portion; (2) the vertex, or top of the head between the 2 fontanels; (3) the occiput or back of the head over the occipital bone.
Fetal presentation: The part of the fetal body that enters (or presents to) the maternal pelvis. Most common = cephalic presentation (head first). Breech, Footling, Brow, etc.
Fetal Lie – longitudinal, transverse
Fetal Attitude- flexion , extension of head
Fetal Position- LOA, LOP, ROA, ROP

6. Components of the Birth Process
Psyche
Marked anxiety
Fear
Fatigue
Cultural Values
Religious Values
Knowledge of labor

7. Nursing Responsibilities
During Admission
Establish a therapeutic relationship
Assessments
Maternal VS between ctx
Fetal status
Leopold maneuvers
EFM
Vag Exam
Impending birth indicators
Labor status
During Labor
Assess FHR for fetal oxygenation
Assist in managing pain
Provide comfort measures
Teaching during various stages of labor

8. Physiologic Effects of Birth Process – Fetal Response
Placental circulation
Blood flow to placenta stops during contractions
Placental reserves allow fetus to tolerate contraction
FHR reacts to labor with normal HR of

10. Normal Labor Premonitory signs Braxton-Hicks cntx Lightening
Increased secretions
Bloody show
Energy spurt
Weight loss
True and false labor
True labor changes the cervix (dilation/effacement)
False labor stops when pt stops
Psyche
Marked anxiety reduces blood flow to the placenta
Decreases oxygen saturation of the fetus

11. Mechanisms of Labor Descent Engagement Flexion Internal rotation
Extension
External rotation
Expulsion

12. Stages of Labor (0-10 cm) First “Dilation” stage
Begins with labor and ends at 10 cm dilation
Phases
Latent (0 to 3-5 cm)
Eager to learn about labor
Active (4-6 cm)
More anxious
May seek pain relief
Transition (7-8 to 10 cm)
May lose control, are irritable
May have urge to push before dilation complete

13. Labor Progress Normal labor is characterized by:
Consistent progression of uterine contractions
Cervical dilation and effacement
Fetal descent
Fetus is the more vulnerable of the maternal-fetal pair.
Normal fetal heart rate at 40 weeks average is beats per minute.

14. Stages of labor (10 cm- baby born)
Second “Expulsion” stage
Will have involuntary pushing response
May say, “The baby’s coming”
Mom feels more control because she is actively pushing the baby out
Begins at 10 cm dilation and ends when baby is expelled

16. Conditions Associated with Fetal Compromise
Fetal heart rate outside normal range
Meconium-stained amniotic fluid
Cloudy, yellowish, or foul odor to amniotic fluid
Excessive frequency or duration of contractions
Incomplete uterine relaxation
Maternal hypotension
Maternal hypertension
Maternal fever

18. Stages of Labor (delivery of baby-delivery of placenta)
Third “Placental” stage
Uterus has globular shape
Cord appears to lengthen
Gush of blood
Expelled in one of two ways
Schultz – shiny fetal side is most common
Duncan – beefy, dull maternal side

19. Placenta

20. Nursing Responsibilities
During Intra-partum Delivery
The nurse must be alert for signs of impending births. Stay with mom if emergency arises
Use call button for help, if physician is not close
The patient states "The baby's coming"
Grunting sounds
Bearing down
Check the perineum
If delivery occurs
Use bulb syringe to clear infant’s nose and mouth
Dry infant, place on mom’s chest
Clamp cord

21. Stages of Labor (after delivery of placenta)
Fourth “Recovery” stage
Lasts from expulsion of placenta for 4 hours
Hemorrhage is greatest risk
No more than 1 pad saturated per hour
Assess fundal height and firmness
Red bleeding called lochia
Chilling and shivering is common
Pain treated with ice and analgesics
Mother is excited and exhausted

23. Nursing Responsibilities
During immediate postpartum phase
Care of the infant
Support respirations
Perform APGAR
Place ID bands
Care of mother
Observe for hemorrhage VS
Fundal status
Lochia does not saturate 1 pad per hour
Ice pack to perineum
Warm blankets for chilling
Analgesics prn
Urination or catheterize
Provide for privacy
Assist with feeding
Allow family to visit
Observe for signs of attachment/bonding
Assist with cultural rituals
Chart!