Normal

1
Normal Labor and
Delivery Physiological Adaptations
Presented by Ann Hearn
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LABOR
The Process by which the Products of
Conception are expelled from the body
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Passenger
Essential Factors in Labor
Powers
Passageway
Psychological
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THE PASSAGEWAY
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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

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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

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True Pelvis vs. False Pelvis

• True Pelvis
• Inlet - upper margin of pubic
  bone to
• upper margin of
  sacrum
• Outlet - Lower pubic bone to
  tip of
• coccyx. This
  area is the
• smallest
  portion that the baby
• must travel
  through.

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THE PASSENGER And PPRESENTATION
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Fetal 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

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Fetal Lie

• Relationship of the long axis of the fetus to the
  long axis of the mother.
• Longitudinal Lie
  Transverse Lie

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True or False?

• The optimum lie of the fetus is the longitudinal
  lie.
• A. True
• B. False

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Fetal Presentation

• That portion of the fetus that enters the Pelvis
  first and covers the internal os.
• Three Types
• Cephalic
• Vertex, Face, Brow
• Breech
• Shoulder

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Reference Points

• Cephalic Occiput, posterior fontanel
• Breech Sacrum
• Face Mentum

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Attitude
Relationship of fetal body parts to each other
Optimum attitude is flexion or ovoid
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POSITION
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POSITION

• 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
12
R
L
3
9
6
P
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ENGAGEMENT

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

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Engagement

• Engagement
• -largest diameter of presenting part has
  passed through the pelvic inlet
• Assessed during
• vaginal exam

Ballotable
Engaged
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Station

• Station- degree that the presenting part has
  descended into the pelvis
• in
• Relationship to ischial spines
• Goal
• Move from to stations

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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

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Test Yourself

• 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 _____________.

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THE POWERS
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Major Powers Involved

• Involuntary Uterine Contractions or Primary
  Powers
• Muscular contractions which lead to dilation and
  effacement in the First Stage of Labor
• Voluntary Uterine Contractions or Secondary
  Powers
• Abdominal muscles assist in the Second Stage of
  Labor with pushing. Increase intra-abdominal
  pressure to aid in expulsive forces

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THE PSYCHOLOGICAL
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BREAK THE CYCLE !
FEAR
TENSION
PAIN
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Techniques for Assessment

• Abdominal Palpation / Leopolds 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.

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Ausculation

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

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True or False ?

• If the fetal heart tones (FHTs) are heard
  loudest (PMI) in the patients upper right
  quadrant of her abdomen, the fetus would be
  assessed for a breech presentation.
• A. True
• B. False

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Vaginal Examination

• Presentation presenting part (head/buttock)
• Position fetal head (OA, OP etc.)
• Condition of Membranes ruptured or intact
• Dilation - enlargement widening of os (cm)
• Effacement thinning of the cervix ()

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Vaginal Examination

• 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

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Station

• Station- degree that the presenting part has
  descended into the pelvis
• in
• Relationship to ischial spines
• Goal
• Move from to stations

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Critical Thinking

• If the fetal head did not descend through the
  pelvis and stayed at the same station for a
  prolonged period of time, what do you think would
  be the treatment of choice?

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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______________.

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CAUSES OF LABOR
Increase in Estrogen
Decrease in Progesterone
High levels of Prostaglandins
Degeneration of Placenta
Over-distention of Uterus
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Myometrial Activity

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

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FORCES OF LABOR

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

acme
Decrement
Increment
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FORCES OF LABOR
acme
Decrement
Increment
Duration
Interval
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 - Resting time between contractions for
placental perfusion
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Uterine Contraction - review
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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
  ________.

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Assessment of Contraction

• 1. Subjective symptoms by woman
• 2. Palpation and timing by the nurse
• 3. Use of Electronic Fetal Monitor
• (EFM)

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Duration of Labor

• Resistance of the Cervix
• Presentation and position of the fetus,
• The womans pelvis
• Preparation and relaxation of the mother
• Primigravida - up to 22 hrs average 12 1/2 hrs
• Multigravida - 8 - 17 hrs average 10 hrs.

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

• LIGHTENING
• FALSE LABOR PAIN (Braxton Hicks)
• SHOW
• Rupture of Membranes (ROM)
• BACKACHE
• DIARRHEA
• SUDDEN INCREASE IN ENERGY

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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

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Phases 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

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Signs 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

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Mechanisms of Labor/
Cardinal Movements
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Signs of Stage Three of Labor
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• The End
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