Normal Labor and Delivery Physiological Adaptations Chapter 17 Presented by Ann Hearn
LABOR The process by which the products of conception are expelled from the body
UTERINE CONTRACTIONS • Contraction - exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement) • Intensity - strength of uterine contraction acme Decrement Increment
UTERINE CONTRACTIONS 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 allows forplacental perfusion
Assessment 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 ! • 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 Activity Effacement- thinning of the cervix (%) Dilation – enlargement and widening of the os (cm)
Passenger Essential Factors in Labor Powers Passageway Psychological
Major 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
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 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 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
Attitude Relationship of fetal body parts to each other Optimum attitude is flexion or ovoid
Fetal Presentation • The portion of the fetus that enters the pelvis first • Three Types: • Cephalic • Breech • Shoulder
Reference Points of Presentation • Cephalic = Head • Vertex, Military, Brow, Face • Breech = Buttock or Foot • Frank, Full, Footling • Shoulder = Transverse lie
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 9 3 6 P
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
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 _____________.
BREAK THE CYCLE ! FEAR TENSION PAIN
CAUSES OF LABOR Increase in Estrogen Decrease in Progesterone High levels of Prostaglandins Degeneration of Placenta Over-distention of Uterus
Premonitory Signs of Labor The impending signs that take place the last several weeks of pregnancy or even the last several days
Premonitory 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
Station Station- degree that the presenting part has descended into the pelvis in relationship to ischial spines. Goal: Move from – to + stations
Engagement • Descent of the fetal presenting part in relation to the ischial spines of the maternal pelvis = 0 station.
Engagement Engagement -largest diameter of presenting part has passed through the pelvic inlet Assessed during vaginal exam Ballotable • Engaged
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
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
Forth Stage of Labor • Recovery period after delivery and bonding with the newborn. • Last from 1- 4 hours.
Nursing Care Nursing Assessment and Interventions during Labor and Birth.
Technique for Assessing Fetal 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.
Ausculation • 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 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 (%)
Vaginal Examination – 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