labor and delivery

2. -the series of
processes by which the
mature or almost mature
products of conception are
expelled from the woman’s
body (Synonyms: childbirth,
travail, accouchement,
confinement, parturition)

3. DELIVERY- actual
birth of the baby

4. = Regardless of species
 *whether the fetus weighs 2 gm
at the end of a 21-day
pregnancy- mouse 0r it weighs
200 lbs at the end of a 640- day
pregnancy – elephant

5. *labor regularly begins at just
the right time- when the fetus is
mature enough to cope with
extra-uterine conditions but not
yet large enough to cause
mechanical difficulties in labor

6. =The old adage:
“WHEN THE FRUIT IS
RIPE IT WILL FALL”
=these words symbolize the
extent of our knowledge as to
the causation of labor

7. ESSENTIAL FACTORS IN
LABOR: THE “FIVE P’s
PASSENGER : THE FETUS

8. 1.ATTITUDE (habitus or
posture): relationship of
each body part to each
other; normal intrauterine
posture is completely
flexed

9. 2. LIE : relationship of spine
of fetus to spine of mother
Longitudinal or vertical
(1). Fetus parallel with
mother’s spine

10. (2). Either cephalic or sacral presentation
b. Transverse or horizontal
(1). Fetus is at right angle to the mother’s
spine
(2). Presenting part shoulder

11. 3. PRESENTATION: portion of fetus that
enters the pelvis first: presenting part
a. Cephalic: most common, 96%
b. Breech
(1). Frank : sacrum
(2). Footling : foot

12. 4. POSITION: relationship of fetal
reference point or landmark to one of four
quadrants or sides of mother’s pelvis such
as ROA, LOA,etc.
a. Maternal pelvis side
(1). L- left
(2). R- right

13. b. Fetal reference point
(1). O- occiput
(2). M- mentum
(3). B- brow
(4). S- sacrum
(5). Sc- scapula

14. 5. STATION: degree of engagement;
measured in cms; above or below
midplane from presenting part to ischial
spines
Station 0- at ischial spine
Minus station- above spines
Plus station- below spines

15. PASSAGEWAY
PELVIS
Types
(1). Gynecoid , about 50%
Slightly ovoid or transversely rounded
Vaginal delivery in OA position usual

16. (2). Android, about 20%
(a). Heart-shaped or
angulated; resembles male
shape
(b). Vaginal delivery difficult
with forceps, usually CS

17. (3). Anthropoid
(a). Oval, wider anteroposterior
diameter
(b).Vaginal delivery with forceps
or spontaneous, OP or OA
position

18. (4). Platypelloid
(a). Flattened anteroposterior,
transversely wide
(b). Spontaneous delivery
usually

19. b. Planes of true pelvis
(1). Plane of inlet
(2). Midplane- greatest
dimension
(3). Plane of outlet- least
dimension

20. 2. SOFT TISSUES:
lower uterine
segment, cervix,
vagina, and introitus

21. POWERS: Forces acting to
expel fetus
Primary: Involuntary uterine
contractions
Secondary: Voluntary
bearing down

22. Functions of uterine contraction:
Effacement-shortening and
thinning of cervix during first
stage of labor

23. Dilation- enlargement of cervical os and
cervical canal
PERSON/PSYCHOLOGICAL RESPONSE
Response to contractions
Perception and beliefs about labor and
delivery
Prenatal care and education
Support systems
Ability to communicate with others

25. I.Prodromes to labor
A. Lightening or dropping:
subjective sensation as fetus
descends into pelvic inlet
1. Primis- occurs about 10 days to
two weeks prior to labor
2. Multis- this may not occur until
labor has begun

26. 3. easier to breathe
4. more pressure on bladder
5. persistent low back pain from
relaxation of pelvic joints

28. C. Show
1. Vaginal mucosa congested
and vaginal mucus increases
2. Brownish or blood-tinged
cervical mucus passed
(expulsion of mucus plug)

29. D. Cervix ripens, becomes soft,
partly effaced and may begin to
dilate
E. Sudden burst of energy-
“nesting instinct”

30. F. Loss of one to three pounds
from water loss resulting from fluid
shifts produced by changes in
progesterone and estrogen levels
G. Spontaneous rupture of
membrane( SROM)

32. 1. No single cause
2. Hormonal changes
=Oxytocin stimulation
=Progesterone withdrawal
=Estrogen stimulation
=Prostaglandin secretion
=Fetal secretion of cortical steroids

33. 3. Distention of uterus:
increasing intrauterine
pressure
4. Aging of placenta:
associated with increasing
myometrial irritability

35. =Dilation of cervix to 10 cm
=Effacement of cervix
=Physiological retraction ring:
separation of upper and lower
uterine segments

37. A. Engagement: when
presenting part of fetus
becomes fixed in true
pelvis

38. B. Descent: progression of
presenting part through pelvis:
station, degree of descent
C. Flexion: when descending
head meets pelvic floor; chin
brought down to chest

39. D. Internal rotation: fetal
head rotates from
transverse diameter to
anteroposterior diameter
to facilitate movement
through pelvis

40. E. Extension: when fetal head
reaches perineum, it extends to
be born

41. F. Restitution: after delivery of head, it
rotates back to position prior to being
engaged
G. External rotation: shoulders engage
and move similarly to head
H. Expulsion: entire infant emerges
from mother

42. I.FIRST STAGE

43. vs.

44. TRUE
1.=Contractions-regular with
increasing
frequency(shortened
intervals), duration and
intensity

45. 1. =irregular with
usually no change in
frequency, duration, or
intensity

46. TRUE
2.=discomfort radiates
from back around the
abdomen

47. FALSE LABOR
2. =discomfort is
usually abdominal

48. TRUE
3.=contractions
do not decrease
with rest

49. FALSE LABOR
3. =contractions
may lessen with
activity or rest

50. TRUE
4. =cervix progressively
effaced and dilated

51. FALSE LABOR
4. cervical
changes do not
occur

52. A. Definition: onset of regular uterine
contractions to full dilation of cervix
B. Phases
1. LATENT
a. Onset of regular contractions, every
15 to 30 minutes lasting 30 to 40
seconds
b. Effacement complete
c. Dilation from 0 to 3 cm

53. d. Lasts for about 8.5 hours for
primis; 5.5 hours in multis
e. Mother experiences:
(1). Abdominal cramps
(2). Backache
(3). Excitement, alertness, need to talk,
feeling in control

54. 2. ACTIVE
a. contractions, moderate to
strong, every 2 to 4 mins, lasting 30
to 60 seconds
b. Dilation to about 8 cm
c. Lasts about 4 hrs in primis; 2 hrs
in multis

55. d. Manifestations
(1). Bloody show
(2). Moderately increased pain
(3). Client may not want to be
left alone,restless, fears losing
control

56. (4). Unsure if she can cope
with labor
(5). Skin warm and flushed

57. e. Nursing interventions
(1). Change underpads and
assure client that bloody show
normal
(2). Allow client to focus on self

58. (3). Encourage her to use
breathing techniques and stay in
control
(4). Keep client informed on
progress of labor
(5). Apply cool cloth as needed

59. 3. TRANSITIONAL PHASE
a. Contractions moderate to
strong every 2 to 4 minutes
lasting 45 to 90 secs
b. Cervix completely dilated
c. Lasts about 1 hour in primis;
10-15 mins in multis

60. d. Manifestations
(1). Client may be cranky and irritable, may
loss control and express bewilderment
at intensity of contraction
(2). May feel nauseated, hot, and sweaty
(3). Feels rectal and bladder pressure
(4). Backache and circumoral pallor

61. e. Nursing interventions
(1). Help client focus on task
(2). Do not leave client alone
(3). Encourage deep
breathing

62. (4). Quickly clean up vomitus and
change linen as needed
(5). Provide cool cloth and dry linen
(6). Keep client informed on progress
of labor
(7). Praise client’s progress

63. A.Contractions strong, every 2 to 3 mins
lasting 45 to 90 secs
B.Proceeds to full dilation and effacement
of cervix; ends with delivery of the
fetus
C.Lasts 30 to 50 mins in primis; 20 mins in
multis

64. 1.Decreased pain from transitional
stage
2.Increased bloody show
3.Severe rectal pressure

65. 4. Client feels need to
bear down
5.Perineum bulging
6.Client becomes excited
and eager

66. 1.Continue to encourage breathing
2.Reassure client that bleeding is
normal
3.Caution client to bear down only
as needed

67. 4. Assist with episiotomy
5.Continue to offer client
support and report
progress

68. III. THIRD STAGE- PLACENTAL
STAGE
A.Delivery of placenta
B.Lasts 5 t0 30 minutes
C.Strong uterine contractions

69. A.Two phases
1.Placental Separation-takes place
in the spongy layer of the decidua
basalis ( weakest layer of the
decidua)
2.Placental expulsion

70. 3.Signs of placental separation:
a.The uterus becomes globular in
shape and as a rule, firmer
b. The umbilical cord descends 3
or more inches farther out of the
vagina

71. C. Sudden gush of blood
often occurs
d. Usually occurs 3-5
minutes after the delivery of
the fetus

72. 4. Placental expulsion-
detachment usually occurs at the
center of the placenta

73. 5.Two mechanisms of placental
expulsion:
a.Schultze mechanism-placenta is turned
inside out within the vagina and be
born like an inverted umbrella;
glistening fetal surface presenting; no
blood escapes externally until after
extrusion of the placenta

74. b. Duncan Mechanism-
separation is believed to occur
first at the periphery;
maternal surface appears
first-dark, roughened, dirty

75. 6. Probably the mot dangerous to
the mother- hemorrhages most
often occur

76. A.Lasts from delivery of the
placenta to the first 24 hours
after
B.Fundus firm, midline, at or
below umbilicus

77. 1.Lochia flow ant
2.Mother exited, exploring
newborn
3.Infant bonding begins

78. 1.Palpate fundus
2.Provide time for parents
to explore newborn

79. END …..