1. Labor and Birth Processes
Chapter 13
Labor and Birth Processes
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

2. Factors Affecting Labor
At least five factors affect process of labor and birth. Five P’s:
Passenger (fetus and placenta)
Passageway (birth canal)
Powers (contractions)
Position of mother
Psychologic response
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

3. Factors Affecting Labor (Cont.)
Passenger
Size of fetal head
Fetal presentation
Fetal lie
Fetal attitude
Fetal position
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

4. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

5. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

6. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

7. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

8. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

9. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

10. Factors Affecting Labor (Cont.)
Passageway
Passageway, or birth canal, is composed of:
Bony pelvis
Cervix
Pelvic floor muscles
Vagina
Introitus (external opening to the vagina)
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

11. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

12. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

13. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

14. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

15. Factors Affecting Labor (Cont.)
Powers
Primary powers
Effacement
Dilation
Ferguson reflex
Secondary powers
Bearing-down efforts
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

16. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

17. Factors Affecting Labor (Cont.)
Position of laboring woman
Position affects woman’s anatomic and physiologic adaptations to labor
Frequent changes in position
Relieve fatigue
Increase comfort
Improve circulation
Laboring woman should be encouraged to find positions most comfortable to her
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

18. Process of Labor
Labor: process of moving fetus, placenta, and membranes out of uterus and through birth canal
Various changes take place in woman’s reproductive system in days and weeks before labor begins
Labor can be discussed in terms of mechanisms involved in process and stages woman moves through
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

19. Process of Labor (Cont.)
Signs preceding labor
Lightening or dropping
Bloody show
Onset of labor
Onset of true labor cannot be ascribed to single cause. Many factors involved, including changes in maternal uterus, cervix, and pituitary gland
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

20. Process of Labor (Cont.)
Stages of labor
First stage
Onset of contractions to full dilation of the cervix
Second stage
Full dilation to birth
Third stage
Birth of the fetus until delivery of the placenta
Fourth stage
2 hours postdelivery of the placenta
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

21. Process of Labor (Cont.)
Mechanism of labor
Seven cardinal movements of mechanism of labor that occur in vertex presentation
Engagement
Descent
Flexion
Internal rotation
Extension
Restitution and external rotation
Expulsion (birth)
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

22. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

23. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

24. Physiologic Adaptation to Labor
Fetal adaptation
These changes occur in:
Fetal heart rate
Fetal circulation
Fetal respiration
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

25. Physiologic Adaptation to Labor (Cont.)
Maternal adaptation
As a woman progresses through stages of labor, various body system adaptations cause her to exhibit both objective and subjective symptoms
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

26. Physiologic Adaptation to Labor (Cont.)
Maternal adaptation
Cardiovascular changes
Respiratory changes
Renal changes
Integumentary changes
Musculoskeletal changes
Neurologic changes
Gastrointestinal changes
Endocrine changes
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

27. Question
A pregnant woman is at 38 weeks of gestation. She wants to know if any signs indicate that “labor is getting closer to starting.” The nurse informs the woman that this is a sign that labor may begin soon:
Weight gain of 1.5 to 2 kg (3 to 4 lbs)
Increase in fundal height
Urinary retention
Surge of energy
ANS: D
Feedback
A Incorrect: The woman may lose 0.5 to 1.5 kg, the result of water loss caused by electrolyte shifts, which in turn are caused by changes in the estrogen and progesterone levels.
B Incorrect: When the fetus descends into the true pelvis (called lightening), the fundal height may decrease.
C Incorrect: Urinary frequency may return before labor.
D Correct: Women speak of having a burst of energy before labor.
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.