Process of Labor and birth

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  1. Intrapartal period
    Begins with the onset of regular contractions and ends with the expulsion of the placenta

    labor: known as the process by which childbirth will occur

    Normal process (healthy) not ill
  2. Labor Triggers- Maternal factor
    • Uterine stretch
    • estrogen increases/Progesterone withdrawl
    • increase oxytocin sensitivity
    • increase release of prostagladins- hormone sends message for contraction- even the fetus will excrete this. this comes from different place
    • increase of relaxin- relax all organs and helps to separate symphis

    Each stage of labor has a different nurse intervention
  3. Labor triggers- fetal factors
    Placental aging triggering initiation of contraction

    Prostagladins synthesis by the fetal membrane and the decidua stimulates contractions

    fetal cortisol levels produced by the adrenal gland rises and acts on the placenta to reduce progesterone levels and incre prostagladins levels
  4. Premonitory signs and labor
    • backache 
    • cervical changes
    • lightening- primite 2 wks before multi right before
    • incre energy level (nesting)
    • bloody show- mucous plug- the cervix is very vascular which causes this show
    • contractions- may be irregular (braxton hicks) that eventually progress in strength and regularity 
    • spontaneous rupture of membranes- maybe or not
    • GI changes- everything slows down this is what moms can't eat cause they will vomit this
  5. Critical factors affecting labor and birth (5 p's)
    • Passageway (birth canal pelvis and soft tissue)
    • Passenger (fetus and placenta)
    • Powers (contractions)
    • Position (maternal)- get moms up and moving
    • Psychological response- fear and anxiety can cause them to tighten up
  6. Passageway- bony pelvis
    • Maternal bony pelvis
    • - imaginary line called the linea terminalis divides the pelvis into true and false portions

    • false pelvis (above linea terminalis)
    • True pelvis
    • - inlet
    • - mid pelvis
    • - outlet (pelvic measurements)
  7. Passageway: pelvic measurements bony
    transverse diameter- from hip to hip

    anterior-posterior diameter- this goes from ur pubic bone to your coccoxy (this is the easiest to measure)
  8. PASSAGEWAY pelvis shape bony
    a nice gynecoid pelvis is the best for babies to navigate in.
  9. Passageway: soft tissue
    • Cervix- muscle
    • - dilation and effacement- 1-10cm 100% effaced
    • Pelvic floor muscles
    • - the pelvic floor muscles help the fetus to rotate anteriorly as it passes thru the birth canal
    • Vagina
    • - expands to accommodate the fetus during birth
  10. effacement and dilation of the cervix
    • effacement- shortening and thinning of the cervix
    • - expressed as percentage related to the length of the cervical canal in comparison to a noneffaced cervix

    • Dilation: opening or enlargement of the cervix
    • - expressed in cm
    • - 0cm (closed) to 10cm (fully dilated)
    • Cervical softening loss of rigidity- tightness
  11. cerival dilation, effacement, station, presenting part
    • u do this bi manual
    • it is pretty much subjective
    • use of sterile gloves
  12. Fetal engagement
    • Floating
    • - above 0 station (above ischial spine) not engaged. at a negative station
    • - presenting part hits the ischial spine this is called engagement
    • - presenting part is directed towards the pelvis but can be moved out of the inlet
    • - considered to be floating
    • - ballotable- when u go to check mom vaginally- can get push the baby out..above the ischial spine fetus in negative
  13. Fetal station: fetal descent
    station: refers to the relationship of the presenting part to the level of the maternal pelvis ischial spine 

    engagement: signifies the entrance of the largest diameter of the fetal presenting part (usually the fetal head) into the smallest diameter of the maternal pelvis. the fetus is engaged when the presenting part reaches 0 station. 
  14. Passanger 
    • Fetus with the placenta
    • - fetal skull (size and pressence of molding)
    • - fetal attitude (degree of body flexion)
    • - fetal lie (relationship of body part)
    • - fetal presentation (first body part)
    • - fetal position ( relationship to maternal pelvis)
    • - fetal station
    • - fetal engagement
  15. Passanger: fetal skull
    • Molding:
    • - elongated shape of the fetal skull at birth as a result of overlapping of cranial bones

    • Sutures:
    • - composed of strong but flexible connective tissue that fills the spaces that lie between the cranial bones

    • fontanels: 
    • - membrane filled spaces
    • - anterior
    • - posterior
    • - tells you fetus position- we can tell if the baby is looking up or is the baby looking down?
  16. Fetal skull
    u want the baby to present with their sub occipital bone
  17. Fetal attitude
    refers to the posturing of the joints (flexion or extension) and the relationship of the fetal parts to one another (is the fetus flexed or extended)

    an attitude of extension present the larger fetal skull diameters, which may birth difficult
  18. Passanger: fetal attitude flexion and extension
    • Vertex (best)- nice tucked flexed position
    • Miltary lay- when the fetus head is not flexed but just straight (moderate) standing at attention trying to come thru the pelvis straight on
    • Brow: head up alittle bit. u are touching the forhead. if u are going to reach for the anterior fontanel u may have to reach more for it
    • face presentation: face is head (this is a huge diameter). when baby is like this u have to c-section (extended)
  19. Fetal lie
    fetal lie refers to the relationship to the maternal long axis (spine) to the fetus long axis (spine)

    Longitudinal- (parellel lie fetal spine to maternal spine)

    transverse lie- fetal spine lies across the maternal abdomen and cross her spine (makes a t). moms pelvis is not fitting in nice
  20. Fetal presentation: cephalic
    • Fetal presentation 
    • cephalic presentation (four types)

    Vertex presentation: head fully flexed. occipital bone presenting (sub occipitobregmatic diameter)

    Miltary presentation: head presents in a neutral postion. top of head ( occipitalfrontal diameter)

    Brow presention: fetal head is partially extending

    Face presentation: fetal head is fully extending
  21. Fetal Presentation: Breech
    fetal buttocks enter the maternal pelvis first 

    3 types

    Frank presentation- legs go straight up 

    complete (full) presentation- indian sitting legs cross, hands cross head tuck

    footling presentation- single footling, double footling
  22. shoulder presentation
    • transverse lie 
    • u cant see the attitude
    • c-section
  23. cephalic v breech
    cephalic advantages- vaginal

    breech- c-section- if the next contraction didnt come quick enough the cervix will begin to close and this usually happens around the neck so thats why they prefer to section
  24. Fetal position
    fetal position the relationship of the presenting part, preferable the occiput in reference to its directional position as it relates to one of the four quadrants

    split into four parts: right anterior, left anterior, right posterior, left posterior

    • Fetal presenting part:
    • occipital bone- O vertex presentign
    • chin (mentum M) face presenting
    • buttucks (sacrum S). breech presentation
    • scapula (acromion process A) shoulder presentation
    • dorsal (D) fetal back in shoulder presentation 
  25. fetal position- ie how to label
    position is indicated by three letter abreviation documentation

    • First letter
    • is the presenting part towards the left or right of maternal pelvis

    • Second letter
    • what is the presenting part of the fetus?
    • occiput, scarum, acromion process, dorsal
  26. 3rd letter fetal position
    is the presenting part anterior (A) front portion of maternal pelvis or Posterior back portion of maternal pelvis or is the presenting part transverse (side to side)
  27. Cardinal movements of labor fetal navigation GPS
    • Engagement
    • Descent
    • flexion (once the navigate thru this pelvis then they do)
    • Internal rotation (until they get into a nice position)
    • extension (now they need to find the vagina)
    • external rotation (to get the shoulders out)
    • expulsion

    every darn fool in rotherdam eats rotten egg roll everyday
  28. Powers: contraction
    2 types: primary and secondary
    • Primary
    • - involuntary contractions (once the prostagladins are working that why pre term mom cant have sex cause sperm has prostagladins in it)
    • - with each contraction, upper segment of the uterus shorter and thicker (fundus bc of power)
    • - lower segment becomes longer and thinner (so the baby can move down in it)
    • - responsible for dilation and effacement of cervix
    • - facilitate movement of presenting part toward the lower uterine segment
  29. Secondary power contraction
    • Intra abdominal pressure (voluntary muscle contractions) exerted by the women has she pushes and bears down
    • promotes birth of the fetus and expulsion of the fetal membranes and placenta from the uterus 
    • during second stage of labor
  30. Position (maternal)
    • moving around during labor and birth (even with epidural) or
    • changing position every two hours- from left to right
    • - influences pelvic size and contour
    • - facilitate fetal descent and rotation (gravity)
    • - reduces the length of labor
    • - enhance sense of control
    • - increase comfort/reduce requests for pain medication
    • - if no epidural they can be up sitting on balls
  31. continue position maternal
    • psyche women;s state of mind can impact the process
    • Positive
    • have a strong sense of self confidence and control
    • support not being alone
    • feel safe and secure trust staff caring for her
    • positive reaction to pregnancy
    • preparation for childbirth experience
    • negative
    • fear and anxiety decreases a women's ability to cope due to increase catecholamine excretion (fear hormone) makes their cervix tight
    • during this time things that happened in her childhood like sexual abuse may occur..which she may be anxious bc she is being violated
  32. Additional P's philosophies partners
    Philosophies two: disease process v normal process (low tech and high touch)

    • Partners (supportive)
    • supports, massage, conveys laboring women's wishes
    • doula
    • nursing pressence: positive experience less intervention
  33. Add'l p's patience pt preparation
    Patience (natural timing) or reduced c-section 

    • patient preparation (childbirth knowledge based)
    • prepares her with knowledge
    • increases feeling of control confidence
    • active participant
    • opportunity to strenthen family by anticipatory guidance
  34. add'l P Pain
    • universal experience
    • subjective - interaction
    • focus pain relief controlling pain w/out harming baby
    • check every hour

    usually mom has a birth.
Card Set
Process of Labor and birth
joys of seeing ur bundle
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