1. Definition of Labor INTRAPARTUM
Labor is the series of events by which contractions expel the fetus and placenta from the uterus
It is characterized by contractions and cervical change.

2. INTRAPARTUM THE 5 P’S: POWERS PASSAGEWAY PASSENGER POSITION
PSYCHOLOGICAL RESPONSE

3. INTRAPARTUM POWERS UTERINE CONTRACTIONS EVALUATION OF CONTRACTIONS
WORK OF THE UTERUS
CONTRACTILE POWERS OF THE UTERUS AND MATERNAL PUSHING EFFORTS IN SECOND STAGE
THEORIES ONLY. (PROGESTERONE, OXYTOCIN, FETAL INITIATION, UTERTONIN)
WOMAN’S BONY PELVIS AND SOFT TISSUES OF BIRTH CANAL AND OUTLET
INITIATED AT A UTERINE PACEMAKER
MOVES FROM FUNDUS TO CERVIX
ACTIVE & PASSIVE UTERINE SEGMENTS
BANDL’S RING
INTENSITY, FREQUENCY, DURATION, INTERVAL
METHODS
PALPATION
EXTERNAL/INTERNAL MONITOR
Cervical Effacement
Cervical Dilation
Fergerson’s reflex
Descent of the Fetus
Birth of the Baby

4. INTRAPARTUM PASSAGEWAY
CONSISTS OF 4 BONES - 2 innominate, sacrum, and coccyx; and 4 JOINTS - 2 sacroiliac, symphysis pubis, and sacrococcygeal
FALSE PELVIS
TRUE PELVIS - Inlet, Midplane, Outlet
PELVIC STRUCTURES
GYNECOID
ANTHROPOID
ANDROID
PLATYPOID

5. INTRAPARTUM PASSENGER FETUS AFFECTS PROGRESS OF LABOUR BECAUSE OF ITS:
SIZE
PRESENTING PART:
CEPHALIC - 96%,
BREECH - 3.5%,
SHOULDER - 0.4%
DENOMIATOR
LIE
POSITION
ATTITUDE and HEAD DIAMETERS
Parts of fetal head SUTURES
FONTANELS
SYNCLITISM/ASYNCLITISM
MOULDING
STATION (LIGHTENING)/ENGAGEMENT

12. INTRAPARTUM
POSITION
UPRIGHT POSISITONS - walking, sitting, squatting, kneeling - enhance effects of gravity and are beneficial to maternal cardiac output
SUPINE POSITIONS force uterus to work against gravity and can compress aorta and vena cava compromising cardiac output
ALL FOURS relieves backache with OP position and may assist in anterior rotation
SEMI RECUMBENT requires more effort and due to pressure moving coccyx forward decreases outlet size

14. INTRAPARTUM PYSCHOLOGIC RESPONSE
MATERNAL PSYCHOLOGIC RESPONSE TO PREGNANCY AND LABOR can impede of facilitate progress.
KNOWLEDGE AND RELAXATION facilitates progress and enhances oxygenation of fetus and maternal tissues
FEAR, TENSION, and GRIEF have reverse effect

15. INTRAPARTUM – Signs of Labor
TRUE LABOR
FALSE LABOR
IMPENDING LABOR
True: REGULAR CTX DECR INTERVAL
INCR DURATION INCR INTENSITY
BACK TO FRONT WALKING INCR INTENSITY
ASSOC PAIN/INT
False IRREG CTX INTERVAL SAME
DEC DURATION DEC INTENSITY
FRONT ONLY WALKING NO CHANGE
Impending MUCUS PLUG - BLOODY SHOW
WEIGHT LOSS
DIARRHEA
INCREASED: BRAXTON HICKS CONTRACTIONS
VAGINAL SECRETIONS
BACKACHE/SLEEP DISTURBANCE

16. INTRAPARTUM MECHANISMS OF LABOR Also called the CARDINAL MOVEMENTS
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
RESTITUTION
EXTERNAL ROTATION
BIRTH OF SHOULDERS
BIRTH OF BODY
EXPULSION OF PLACENTA

17. INTRAPARTUM – Stages & Phases
First Stage
Latent Phase
EXCITEMENT
ANTICIPATION
SCARED
CAN TALK BETWEEN AND THROUGH CONTRACTIONS
Lose MUCUS PLUG - BLOODY SHOW
ONSET LABOR TO 3CM
PROFOUNDLY AFFECTED BY SEDATION AND ANALGESIA
DURATION
6-20 HOURS PRIMIP (AVERAGE 8.6)
2-10 HOURS MULTIP (AVERAGE 5.3)

19. INTRAPARTUM FIRST STAGE ACTIVE PHASE ACCELERATION PHASE
3-4 CM NOTICED RETROSPECTIVELY
PHASE OF MAXIMUM SLOPE
4-8 CM MOST RAPID
PRIMIP 1.2CM/HR
MULTIP 1.5 CM/HR

21. INTRAPARTUM MATERNAL BEHAVIOR ACTIVE PHASE MAY VOMIT
CONCENTRATES W/ CONTX
DISCOURAGED
FEARFUL
RESTLESS
WEEPY

23. INTRAPARTUM FIRST STAGE ACTIVE PHASE TRANSITION DECELERATION PHASE
8-10 CM
ALSO CALLED TRANSITION
MOST INTENSE PHASE
PRIMIP 1CM/HR
MULTIP 2.1CM/HR

24. INTRAPARTUM MATERNAL BEHAVIOR TRANSITION NAUSEA VOMITING
INCREASED BLOODY SHOW
DIARRHEA
IRRITABLE/SHAKEY
RECTAL PRESSURE
SLEEPS BTWN CTX
TURNS INWARD

26. INTRAPARTUM SECOND STAGE COMPLETE DILATION TO BIRTH
MATERNAL PUSHING - spontaneous, directed, valsalva, and open glottis, Valsalva increases fetal hypoxia directed increases perennial tears
PHASE OF MAXIMUM DESCENT
PRIMIP 30 MINUTE - 1 HOUR
MULTIP 5-30 MINUTES

28. INTRAPARTUM POSITIONS FOR SECOND STAGE
SITTING AND SQUATTING makes use of gravity
KNEELING OR SQUATTING facilitates descent and expulsion by moving uterus forward, straightening long axis of birth canal, and increasing pelvic outlet 28% (bispinous diameter 0, cm and AP diameter 2 cm).
LATERAL - aids in rotating fetus from posterior position and good when less force is required
CHOICE OF POSITION dependent on maternal preference, comfort, progress of second stage, and fetal status

31. INTRAPARTUM THIRD STAGE BIRTH TO DELIVERY OF PLACENTA 5-30 MINUTES
UTERINE CONTRACTIONS CAUSE PLACENTAL SEPARATION

32. INTRAPARTUM INSPECTION OF PLACENTA SHAPE SIZE
WEIGHT -1:5 PLACENTAL:FETAL
CALCIFICATION
INFARCT
RETROPLACENTAL CLOT
IS IT COMPLETE? EXTRA LOBE?
CORD INSERTION
LENGTH, 3 VESSELS, WHARTONS JELLY
MEMBRANES - INTACT, COLOR
ODOR

33. INTRAPARTUM Vacuum extraction
Used to expedite delivery of the baby, especially if maternal exhaustion if present. Many conditions must be met before this can be accomplished. Not without risk.

34. INTRAPARTUM Forcep Assisted Delivery
That’s about how many you will see these days as the training has dramatically decreased, so less forcep deliveries are attempted. It is a learned skill which requires careful evaluation of the fetal position and maternal pelvis. There are various types of forceps, each with a specific purpose.

35. INTRAPARTUM Dystocia Cephalo-Pelvic Disproportion
Some difficulty in the labor; blockage. Can be caused by fat; by bones as is shoulder dystocia
Literally “head-pelvic doesn’t fit”

36. INTRAPARTUM Caesarian Section
Major surgery, with all risks of surgery. Sometime it is the best way to be born. Very high rates at the present time.

37. INTRAPARTUM