Normal
Labor and Delivery
Physiological Adaptations
Presented by
Jeanie Ward
LABOR
The Process by
which the Products of
Conception are expelled
from the body
Passenger
Passageway
Essential
Factors
in
Labor
Psychological
Powers
THE
PASSENGER
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
Fetal Presentation
That portion of the fetus that enters
the Pelvis first and covers the
internal os.
 Three Types:

 Cephalic

Vertex, Face, Brow
 Breech
 Shoulder
Reference Points

Cephalic = Occiput, posterior
fontanel

Breech = Sacrum

Face = Mentum
Attitude
Relationship
of fetal body
parts to
each other
Optimum
attitude is
ovoid
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
9
3
6
P
L
Test Yourself !

What is the reference point of a
cephalic presentation when the head
is fully flexed?
A.
B.
C.
d.
occiput
mentum
frontal
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 _____________.
THE
PASSAGEWAY
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
True Pelvis vs. False Pelvis
False Pelvis
Supports the weight of the uterus
Shallow basin above the inlet or brim
True Pelvis
Inlet - upper margin of pubic bone to upper
margin of sacrum
Outlet - Lower pubic bone to tip of coccyx
THE
POWERS
Major Powers Involved

Involuntary Uterine Contractions or
Primary Powers


Muscular contractions which lead to dilation
and effacement in the First Stage of Labor
Voluntary Uterine Contractions or
Secondary Powers

Abdominal muscles assist in the Second Stage
with pushing. Increase intra-abdominal
pressure to aid in expulsive forces
THE
PSYCHOLOGICAL
BREAK THE CYCLE !
FEAR
TENSION
PAIN
Techniques for Assessment

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
 Step 4 - Turn and face the woman and
repeat the steps.
Ausculation

Assess for the area of Greatest
Intensity of the FHR.
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
Vaginal Examination
 Presentation
 Position
 Condition
intact
of Membranes --ruptured or
 Dilation - enlargement and widening of os
( cm.)
 Effacement- thinning of the cervix (%)
Vaginal Examination
 Station- degree that the presenting part
has descended into the pelvis.
Relationship to ischial spines
 Engagement -largest diameter of
presenting part has passed through the
pelvic inlet
Critical Thinking

If the fetal head did not descend
through the pelvis and stayed at the
same station for a prolonged period
of time, what do you think would be
the treatment of choice?
Try this !

When the cervical os widens or opens it is said
to________.

The level of the ________ _________ is station zero.

The most common type of pelvis for a woman
___________.

When the cervix shortens and thins is _______________.

For delivery to occur, the fetus must accomodate to this
rigid passageway______________.
CAUSES OF LABOR
Decrease in Progesterone
Increase in Estrogen
High levels
of
Prostagladins
Overdistention
of
Uterus
Degeneration
of
Placenta
FORCES OF LABOR

Contraction -exhibits a wavelike pattern that
begins slowly climbing (increment) to a peak
(acme), and decreases (decrement)
acme
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 for placental perfusion
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 ________.
Assessment of Contraction

1. Subjective symptoms by woman

2. Palpation and timing by the Nurse

3. Use of Electronic Fetal Monitor
Duration of Labor
Resistance of the Cervix
 Presentation and position of the
fetus, the mother’s pelvis
 Preparation and relaxation of the
Mother
 Primigravida - up to 22 hours; ave. 12 1/2 hrs
 Multigravida - 8 - 17 hours; ave. 10 hrs.

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
SHOW
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
Often stop with walking
Contractions felt in
abdomen above
umbilicus (abdominal
pains)
No change in cervix
Fetus is ballotable




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

The End
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