Labor and Birth Process

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Labor and Birth Process

• Chapter 13

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What cause Labor?

• Dont know!
• Progesterone decrease- estrogen increases
• Prostaglandins ripen cervix and stimulates
  contractions
• Oxytocin stimulates contractions

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Premonitory Signs

• Cervical changes- dilation
• Lightening- can breath, primi vs. multiparas
• Burst of energy- clean house- make cookies
• Bloody show- dislodged 24 48 before labor
• Braxton Hicks prepare cervix for labor
• SROM- danger of prolapse

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True vs. False Labor

• True
• UCs regular and closer
• Strength- stronger
• Pain- increases
• Position change does not relieve pain
• 5 min. apart, no talking

• False
• UCs- irregular
• Strength- not stronger
• Felt in front not back
• Stop with walking
• Fluid or position change makes ucs change

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Factors Effecting Labor

• Passageway- size of the pelvis- Gynecoid
• Pelvic inlet- entrance to pelvis
• Mid pelvis- helps to expel fluid durng birth
• Pelvic outlet- wider from front to back
• Fetus aligns itself to fit through widest parts.

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Passenger

• Fetal skull-Most important part and is the widest
• Bones are no fused- sutures allow molding
• Fontanelles- front diamond back triangle
• Fetal attitude- flexion or extension of the
  joints- makes self small
• Fetal lie- longitudinal or tranverse

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Passenger

• Fetal presentation
• Cephalic- most common
• Breech- pelvis first or feet
• Shoulder first
• Fetal position- ROA and LOA most common
• Fetal station- Fetal engagement

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Cardinal Movements of Labor

• Smallest part of fetus to largest part of pelvis
• Engagement- head enters pelvis in transverse
  position
• Descent- pushed through pelvis by forces of labor
• Flexion- resistance- fetal chin to chest

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Cardinal Movements of Labor

• Internal rotation- rotate from transverse to face
  down
• Extension- head meets resistance from symphysis
  pubis must extend
• Restitution- shoulders remain oblique as head
  extends, shoulder rotate to largest portion of
  pelvis
• Expulsion- shoulder clear--- delivery

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Powers

• Uterine contractions cause thinning of cervix
• From 2cm long to paper thin
• Dilation- opening of cervix
• Increment- Acme- Decrement
• From beginning of one to beginning of next
• Relaxation fetal perfusion
• Stronger the abdomen better able to push

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Psychological Response

• Information
• Support
• Self confidence
• Trust
• Positive reaction to pregnancy
• Control- breathing- decision making
• Preparation

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Positioning

• Back lying- convenient for caregivers
• Bed- able to monitor more closely
• Need to be connected to technology
• What is better?
• Kneeling- Squatting- Side Lying
• Benefits- reduce perineal trauma- less assisted
  deliveries- reduce length of labor

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Psychological response

• Partners- caring person at bedside
• Patience- do not limit length of labor
• Patient preparation- Client reports better
  experience if prepared
• Pain control- Control pain without compromising
  fetus

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Physiological Response to Labor

• Maternal
• Increase-HR, BP, P, R
• Increase white count
• Decrease gastric motility and emptying
• Increase BMR
• Decrease glucose
• Increase muscle stress

• Fetal
• Accelerations and decelerations
• Decrease in fetal perfusion with ucs
• Fetal acidosis
• Decrease in breathing movements

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First stage

• Dilated to 10 cms.
• Latent-0-3 cms Pain is tolerable
• Active 3-7 cms. Increase discomfort noted
• Encourage to use breathing techniques
• Transition 8-10 cms.- shortest but most intense

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Second stage

• Starts with complete dilation and ends with birth
• Contractions 2-3 minutes
• Follow mothers urge to push
• Pelvic phase fetal head still negotiating
• Perineal phase urge to push
• Crowning- can see head between contractions

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Third stage

• Placental separation
• Uterus rises
• Cord lengthens
• Gush of blood
• Uterus shape changes to globular
• Expulsion- up to 30 minutes
• Massage uterus- EBL

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Fourth Stage

• Delivery of placenta to recovery of mother
• Attachment begins
• Evaluate recovery
• V/S- Lochia-Episiotomy- Bladder distention
• Food- Water- Warmth