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Labor and Delivery

Labor and Delivery

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Labor and Delivery

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  1. Labor and Delivery Marianne F. Moore

  2. Critical Factors in Labor • Passage

  3. Critical Factors in Labor • Passage • Passenger

  4. Critical Factors in Labor • Passage • Passenger • Powers

  5. Critical Factors in Labor • Passage • Passenger • Powers • Psyche

  6. Critical Factors in Labor • Passage • Passenger • Powers • Psyche • Position(Maternal)

  7. Critical Factors in Labor • Passage • Passenger • Powers • Psyche • Position (Maternal) • Placental

  8. Skeletal Structures Pelvis Types Gynecoid Anthropoid Android Platypelloid Passage

  9. Skeletal Structures Pelvis Types Gynecoid Anthropoid Android Platypelloid Passage

  10. Soft Tissue Structures Cervix Cervical Scarring Vagina Obstructions “Tissue Dysplasia” Passage

  11. Passenger • Lie

  12. Passenger • Lie • Attitude

  13. Passenger • Lie • Attitude • Presentation

  14. Passenger • Lie • Attitude • Presentation • Position

  15. Passenger • Lie • Attitude • Presentation • Position • Station

  16. Contractions Duration Frequency Intensity Powers

  17. Contractions Increment Acme Decrement Powers

  18. Fatigue Anxiety Trust in Medical Care and Self Ability to Receive and Use Support Psyche • Immediate Issues

  19. Pre-Existing Issues Motivation for the Pregnancy Self-Confidence Personal Expectations Relationship with Support Person(s) Culture and Its’ View of Childbirth Obstetric/ Family History Childbirth Education Classes Psyche

  20. Maternal Position • Bedrest: Low semi-Fowler’s • Necessary position with epidural placement • Patient is tipped to one side to avoid vena cava syndrome • Changing position from one side to other changes relationship of presenting part to maternal pelvis

  21. Maternal Position • Bedrest: Side-lying or “runner’s position” • Useful for rest in early labor • Also a good position for sleep in advancing pregnancy • Needs lots of pillows for comfort and correct positioning

  22. Maternal Position • Upright Positions: • Chair/Rocker • Walking • Stair Climbing (especially 2 at a time) • Birthing Ball • Squatting/Squat Bar • Toilet sitting

  23. Maternal Position • Positions to help back labor: • Leaning over the bed • All fours • Pelvic rocking • Leaning on the hallway bars • Slow dancing • Counterpressure

  24. Placenta • Low-lying placenta may cause the baby to assume a transverse lie • May also impede descent of the baby

  25. Cardinal Movements • Engagement

  26. Cardinal Movements • Engagement • Descent

  27. Cardinal Movements • Engagement • Descent • Flexion

  28. Cardinal Movements • Engagement • Descent • Flexion • Internal Rotation

  29. Cardinal Movements • Engagement • Descent • Flexion • Internal Rotation • Extension

  30. Cardinal Movements • Engagement • Descent • Flexion • Internal Rotation • Extension • Restitution

  31. Cardinal Movements • Engagement • Descent • Flexion • Internal Rotation • Extension • Restitution • External Rotation

  32. Cardinal Movements • Engagement • Descent • Flexion • Internal Rotation • Extension • Restitution • External Rotation • Expulsion (BIRTH!)

  33. Signs of Labor • Lightening • Frequent Urination • Sciatic Nerve Discomfort • Back Discomfort

  34. Signs of Labor • Lightening • Frequent Urination • Sciatic Nerve Discomfort • Back Discomfort • Braxton-Hicks (Warm-Up) Contractions • Vaginal Discharge • Bloody show • Nesting

  35. Signs of Labor • Rupture of membranes • Called PROM if before contractions start • Amount of fluid can vary • Assess • Time of Rupture • Color of fluid • Clarity of fluid • Fetal movement since rupture? • Have contractions started?

  36. Signs of Labor • What is “False Labor”? • Looks/feels like labor to mother but no change in cervix • Abdominal/groin pain • Changing level or type of activity makes contractions go away • Contractions don’t get stronger, longer or closer together (intensity, duration, frequency) • Contractions do not change the dilatation or effacement of cervix

  37. Signs of Labor • What is “True Labor”? • Contractions that efface or dilate the cervix • Contractions usually cause low back pain or suprapubic pressure (or both) • Contractions are regular and rhythmic • Changing type or level of activity does NOT make them go away • Contractions get longer, stronger, closer together (duration, intensity, frequency)

  38. Theories About the Onset of Labor • Progesterone Deprivation Theory • Oxytocin Theory • Fetal Endocrine Control Theory • Prostaglandin Theory

  39. Physiologic changes with L & D • Labor is hard physical work

  40. Physiologic changes with L & D • Labor is hard physical work • Increases in systolic and diastolic BP

  41. Physiologic changeswith L & D • Labor is hard physical work • Increases in systolic and diastolic BP • Increased cardiac output

  42. Physiologic changeswith L & D • Labor is hard physical work • Increases in systolic and diastolic BP • Increased cardiac output • Fluid and electrolyte loss: • diaphoresis • hyperventilation • elevated temperature

  43. Physiologic changeswith L & D • Peristalsis slows in most of GI tract, except lower colon

  44. Physiologic changeswith L & D • Peristalsis slows in most of GI tract, except lower colon • Decreased absorption of solids

  45. Physiologic changeswith L & D • Peristalsis slows in most of GI tract, except lower colon • Decreased absorption of solids • Anorexia is common

  46. Physiologic changes with L & D • Peristalsis slows in most of GI tract, except lower colon • Decreased absorption of solids • Anorexia is common • Nausea and vomiting can occur during transition

  47. Fetal Response to Labor • Persistent fetal heart rate changes may indicate changes in fetal well-being

  48. Fetal Response to Labor • Persistent fetal heart rate changes may indicate changes in fetal well-being • Most fetuses are well equipped for the stress of labor

  49. Fetal Response to Labor • Persistent fetal heart rate changes may indicate changes in fetal well-being • Most fetuses are well equipped for the stress of labor • Initial assistance to the fetus is provided through the mother (position change, fluids, O2)

  50. Fetal Response to Labor • Persistent fetal heart rate changes may indicate changes in fetal well-being • Most fetuses are well equipped for the stress of labor • Initial assistance to the fetus is provided through the mother (position change, fluids, O2) • A more thorough discussion is in the section on fetal monitoring