Intrapartum

• To determine presentation and position of the
• fetus and aid in location of fetal heart sounds

• Palpate fundus:
• distinguishes between a cephalic (buttock on fundus) and breech (head on fundus) presentation.

• Palpate the Left and Right
• sides of uterus. Determines which side of the uterus has the fetal back and which side has the fetal arms and legs

Palpate the suprapubic area (pubic hair area). Confirms the presentation and determines whether the presenting part is engaged (0 to -5).

• Place hands on uterus with fingers pointing down towards the pelvic inlet. Determines whether the
• head is flexed (vertex) or extended (face). The forehead felt on opposite side of the back if baby in vertex and same side if extended (face).

• Descent of presenting part of fetus to true
• pelvis

• Engagement
• Presenting part of fetus reaches the ischial spine
• Station of presenting part is 0 or lower (-5 to 0 cm)

• Flexion
• Head is flexed to so that smallest diameter of the head is aligned with the smaller
• diameter of the mid pelvis

• Internal Rotation
• Internal rotation allows the largest head diameter to align with largest pelvis
• diameter.

• Extension
• The resistance of the pelvic floor and the pivoting action of the pubic symphysis
• causes the fetal head to extend with each push.

• External Rotation
• Head rotates and aligns the head with the fetus’ shoulder. When the head externally rotations, the
• shoulders internally rotate to align.

Expulsion of the body

Dilation, Effacement, Station

• 0-10cm
• latent 0-3 cm
• active 4-7cm
• transition 7-10cm

• the softening, thinning, and shortening of the cervical canal as it is drawn up into the body of the uterus by labor contractions
• Thinning of the cervix (head descends). 0-100%
• It is 100% during active phase of first stage (begins the cardinal movement during this phase).

• Describes the descent of the fetal presenting part in relation to the level of the ischial spine. Determines whether or not the fetus' head is engaged.
• Scale is +5 to -5.
• Engaged when it's 0 to -5 (coming out).
• Ballotable if +5 to +1 (still inside)

• Braxton Hicks Contractions
• Lightening
• Increased Vaginal Mucous secretion
• Cervical ripening and bloody show
• energy spurt
• weight lost

Irregular, mild uterine contractions that occur throughout pregnancy that make it seem like labor is coming when it isn't. It becomes stronger in the last trimester.

• Fetus moves down, so mother can breathe more
• easily but pees more frequently due to increased pressure, causing leg cramps and edema.
• Most noticeable in nulliparas and occurs 2-3 weeks prior to labor

• Cervix softens due to relaxin and increased water content.
• Effacement and dilation causes expulsion of mucous
• plug that sealed cervix during pregnancy, rupturing small cervical capillaries (bloody).

• Sudden increase in energy also called "nesting".
• Women should save energy for labor

Altered estrogen and progesterone ratio causes excretion of extra fluid. Lose about 2.2-6.6 lb (1-3 kg).

Passenger, Passageway, Powers, Positioning, and Psyche/Psychologic response

• Uterine contraction (occurs during first stage of labor). Primary force
• Maternal pushing effort (occurs during second stage of labor when cerrvix is fully dilated). Secondary force

The passage is determined by maternal pelvic anatomy—the bony pelvis and the muscles of the pelvic floor and perineum

• Consists of maternal pelvis and soft tissues. Softening of cartilage linking the pelvic bone occurs near term due to the increase of the hormone relaxin
• Linea terminalis (pelvic brim) divides false and true pelvis
• True pelvis is most important during childbirth
• 3 subdivisions of true pelvis: Inlet (upper opening), Midpelvis (pelvic cavity), Outlet (lower pelvic opening)

Consist of the fetus, membranes and placenta.

• The anteroposterior diameter of the head (varies with the degree of flexion) is most favorable in suboccipitobregmatic (9.5cm)
• The fetal lie (orientation of fetus to mother): longitudinal, transverse and oblique)
• Attitude: Flexion (good)
• Presentation: Fetal part that first enters the pelvis

Cephalic (common and most favorable because it can mold, and effective part to dilate cervix), Breech and shoulder.

• Vertex: most common and favorable because smallest diameter of head (suboccipitobregmatic) is presenting. Head is fully flexed, also called occiput presentation.
• Military: neutral head position (not flexed/extended). occipitofrontal diameter.
• Brow: partially extended, can turn into vertex/face. supraoccipitomental diameter
• Face: Head is extended. Submentobregmatic diameter.

Buttock presenting first, more commonly in preterm fetus or fetus with abnormalities and abnormalities of maternal uterus and pelvis and with placental previa (placenta in lower uterus).

• Umbilical cord can be compressed after fetal chest is born.
• Head must be delivered quickly to allow the infant to breathe.
• It does not permit gradual molding of fetal head

• Frank: most common where fetal legs are extended across the abdomen towards the shoulder
• Full (complete): reversal of cephalic presentation.
• Footling: one or both feet presenting.

The location of a fixed refrence point on the presenting part in relation to the four quadrants of the maternal pelvis. Right anterior, left anterior, right posterior and left posterior.

• Right/Left
• Occiput/Mentum/Sacrum (can be Sc-scapula for shoulder presenting or F-fonto for brow presenting)
• Anterior/Posterior/Transverse
• 16 different combination: LOA, ROA, LOT, ROT, LOP, ROP, LMA, RMA, RMP, LMP, LSA, LSP, RSA, RSP, brow and shoulder.

• Cultural values, how birth is seen as (healthy/sick or joyful/sadness-unwanted or accident), Support group, anxious or relaxed.
• Maternal catecholamines, excreted during anxiety and fear, inhibit uterine contractility and placental blood flow. (birthing process is easier when relaxed).