Normal Labor and DeliveryPhysiological Adaptations

Chapter 17

Presented by Amie Bedgood

LABOR

The process by

which the products of

conception are expelled

from the body

UTERINE CONTRACTIONSUTERINE CONTRACTIONS

Contraction - exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement)

Intensity - strength of uterine contraction

Incr

emen

t

acmeDecrem

ent

UTERINE CONTRACTIONSUTERINE CONTRACTIONS

Incr

emen

t acme

Decrement

Duration

Frequency

Duration- from beginning of one contraction to the end of the same contraction

Frequency- from beginning of one contraction to the beginning of another contraction

Interval

Interval - resting time between contractions allows for placental perfusion

Uterine Contraction - review

Assessment of ContractionAssessment of Contraction

1. Subjective symptoms by woman

2. Palpation and timing by the nurse

3. Use of Electronic Fetal Monitor

(EFM)

Fill in the blank ! Fill in the blank !

Length of a uterine contraction__________.

Strength of a uterine contraction is ___________.

The time from the beginning of one contraction to the beginning of the next contraction is _______.

The time that allows for placental perfusion is __. The peak of a contraction is also known as ____.

When the biparietal diameter of the head passes through the pelvic inlet it is said to be ________.

CERVICAL ASSESSMENT

Dilation – is expressed in centimeters of the size of the cervical opening.

Full dilation = 10cm

Effacement – is estimated as a percentage of the amount the cervix has thinned.

Complete effacement = 100%

Myometrial ActivityMyometrial Activity

Effacement- thinning of the cervix (%)Dilation – enlargement and widening of the os (cm)

Essential Factors in Labor

Passenger

PowersPassageway

Psychological

THE

POWERS

THE

POWERS

Major Powers InvolvedMajor Powers Involved

Primary Force: Involuntary Uterine Contractions or

Muscular contractions which lead to dilation and effacement in the First Stage of Labor

Secondary Force:Voluntary Uterine Contractions or

Abdominal muscles assist in the Second Stage of Labor with pushing. Increase intra-abdominal pressure to aid in expulsive forces

THEPASSAGEWAY

THE PELVIS

Determine if the pelvic cavity is of adequate size to allow for the passage of the full term infant

Optimum shaped pelvis is Gynecoid

THE PELVIS

False Pelvis Supports the

weight of the uterus

Shallow basin above the inlet or brim

True Pelvis Represents the bony limits of the birth canal

True Pelvis vs False Pelvis

True Pelvis

Inlet - upper margin of symphysis pubis to the upper margin of sacrum

Midpelvis - level of the ischial spines

Outlet - Lower pubic bone to tip of coccyx. This area is the smallest

portion that the baby must travel through.

THE

PASSENGER

And

PPRESENTATION

Fetal HeadFetal Head

Because of its size and rigidity, the fetal head has a major impact on delivery.

The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal.

Head also can rotate, flex, and extend

Fetal LieFetal Lie

Relationship of the long axis of the fetus to the long axis of the mother.

Longitudinal Lie Transverse Lie

True or False?

The optimum lie of the fetus is the longitudinal lie.

A. True

B. False

AttitudeAttitude

Relationshipof fetal body parts toeach other

Optimumattitude isflexion or ovoid

Fetal PresentationFetal Presentation

The portion of the fetus that enters the pelvis first

Three Types:CephalicBreechShoulder

Cephalic = HeadVertex, Military, Brow, Face

Breech = Buttock or FootFrank, Full, Footling

Shoulder = Transverse lie

Reference Points Reference Points of Presentationof Presentation

Cephalic Presentations

Breech Presentations

PositionPosition

PositionPosition

Relationship of the Fetal Presenting Part to the Maternal Pelvis

Steps: 1. Determine the Presenting Part

2. Divide the mothers pelvis into 4 imaginary quadrants

A

P

12

L3

6

9R

Test Yourself !

What is the reference point of a cephalic presentation when the head is fully flexed?A. occiput

B. mentum

C. frontal

d. sagittal

Overlapping of the fetal skull to facilitate its passage through the bony pelvis is ___________.

Relationship of fetal body parts to each other is_____________.

Head first presentation is_________________. Relationship of the fetal spine to the maternal

spine is ________________. Term that refers to the part of the fetus that

enters the pelvic inlet first is _____________.

Test Yourself

THE

PSYCHOLOGICAL

THE

PSYCHOLOGICAL

FEARFEAR

TENSIONTENSION

PAINPAIN

BREAK THE CYCLE !BREAK THE CYCLE !

CAUSES OF LABORCAUSES OF LABOR

Increase in EstrogenDecrease in Progesterone

Degeneration of Placenta

Over-distention of Uterus

High levels ofProstaglandins

Premonitory Signs of LaborPremonitory Signs of Labor

The impending signs that take place the last several weeks of pregnancy or even the last several days

Premonitory Signs of LaborPremonitory Signs of Labor

LIGHTENING

FALSE LABOR PAIN (Braxton Hicks)

SHOW

Rupture of Membranes (ROM)

BACKACHE

DIARRHEA

SUDDEN INCREASE IN ENERGY

True vs False Labor

TRUE LABOR Contractions are: * Regular * Increase in intensity and

duration with walking

* Felt in lower back, radiating to lower portion of abdomen Bloody show Dilation and effacement Fetus usually engaged

FALSE LABOR Contractions are: * Irregular

* No change or decrease

with walking

* Contractions felt in

abdomen above

umbilicus:

Braxton Hicks No change in cervix Fetus is ballotable

Mechanisms of Labor/ Mechanisms of Labor/ Cardinal Movements Cardinal Movements

StationStation

Station- degree that the presenting part has descended into the pelvis

in relationship to ischial spines.

Goal: Move from

– to + stations

EngagementEngagement

Descent of the fetal presenting part in relation to the ischial spines of the maternal pelvis = 0 station.

EngagementEngagement

Engagement -largest diameter of

presenting part has passed through the pelvic inlet

- Assessed during

vaginal exam

Ballotable

Engaged

Phases and Stages of LaborPhases and Stages of Labor

Stage 1: 0 - 10 cm. Phase 1 - Latent - dilate 0 - 3 cm. Phase 2 - Active - dilate 4 - 7 cm. Phase 3 - Transition - dilate 8 - 10 cm

Stage 2: From complete dilation and effacement to delivery of the baby Stage 3: From delivery of baby to the delivery of the placenta Stage 4: the first hour after delivery

Signs of Second Stage of LaborSigns of Second Stage of Labor

Complete dilatation of cervix

Urge to bear down

Perineum begins to bulge, flatten and move anteriorly

Increase in bloody show

Rectal pressure

Labia begins to part with each contraction

Signs of Stage Three of LaborSigns of Stage Three of Labor

Fourth Stage of Labor

Recovery period after delivery and bonding with the newborn.Last from 1- 4 hours.

Nursing CareNursing Care

Nursing Nursing Assessment and Assessment and

Interventions Interventions during Labor and during Labor and

Birth.Birth.

Nursing Nursing Assessment and Assessment and

Interventions Interventions during Labor and during Labor and

Birth.Birth.

Technique for Assessing Fetal Technique for Assessing Fetal Presentation and Position Presentation and Position

Abdominal Palpation/Leopold’s Maneuver Standing on the right side, face the woman and

palpate with the palms of the hands. Step 1 - Start at upper fundus and palpate for

the head or buttocks Step 2 - Go down each side and locate back Step 3 - Gently grasp lower portion of uterus

and feel for the head or buttock Step 4 - Turn and face the woman feet, using

both hands palpate lower abd. for cephalic prominence or brow.

AusculationAusculation

Assess for the area of greatest intensity of the FHR.Usually best heard at the fetal back

True or False ?

If the fetal heart tones (FHT’s) are heard loudest (PMI) in the patient’s upper right quadrant of her abdomen, the fetus would be assessed for a breech presentation.

A. True

B. False

Amniotic Membranes

Intact Ruptured

SROM AROM

Color Clear Yellow Meconium

Amount

Vaginal ExaminationVaginal Examination

Presentation – presenting part (head/buttock)

Position – fetal head (OA, OP etc.)Condition of Membranes – ruptured or

intactDilation - enlargement & widening of os (cm)Effacement – thinning of the cervix (%)

Vaginal Examination Vaginal Examination – cont’d– cont’d

Station- degree that the presenting part has descended into the pelvis. Relationship to ischial spines (-, 0, +)

Engagement -largest diameter of presenting part has passed through the pelvic inlet

Try this !

When the cervical os widens or opens it is said to________.

The level of the ________ _________ (bony structure) is station zero.

The most common type of pelvis for a woman ____________.

When the cervix shortens and thins is _______________.

For delivery to occur, the fetus must accommodate to this rigid passageway______________.

Duration of LaborDuration of Labor

Resistance of the Cervix Presentation and position of the

fetus, The woman’s pelvis Preparation and relaxation of the

mother Primigravida - up to 22 hrs; average 12 1/2 hrs Multigravida - 8 - 17 hrs; average 10 hrs.

The End

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