LABOR AND BIRTH
COMPONENTS OF THE BIRTH
PROCESS
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Passage
Passenger
Relationship between
the passage and the
fetus
Powers
Psyche
Final weeks of pregnancy: mother/baby prepare
for birth. Five important factors :
the passage, the fetus, the relationship
between the passage and the fetus, the
forces of labor,and psychosocial
considerations.
Often called the 5 “P”s of Labor: Passageway,
Passenger, Powers, Position, and Psychological
responses
THE BIRTH PASSAGE
Ability of pelvis and cervix to accommodate
passage of fetus
PASSAGE : Birth passage – 3
sections of “true pelvis”
– inlet, pelvic cavity (midpelvis),
& outlet.
Four classifications : gynecoid ,
android, anthropoid, &
platypelloid.
THE FETUS
Ability of the fetus to complete the birth
process:
fetal skull
molding: cranial bones overlap under
pressure of the powers of labor and
demands of unyielding pelvis
PASSENGER: Fetal head:
Considerations: face, base of skull, &
vault of cranium (roof). Bones in face
fused but vault has movable bones;
overlap under pressure – molding.
Sutures –membranous spaces between
bones; intersections – fontanel's (‘soft
spot”)
Landmarks: mentum – chin; sinciput –
brow; vertex – space between
fontanel's; occiput – occipital bone
Fetal attitude – relationship of fetal parts to one
another: norm: mod flexion of head, flexion of arms
unto chest, & flexion of legs to abdomen
Fetal lie – relationship of cephalocaudal axis (spinal
column) of fetus to c. a. of mother
longitudinal: parallel
transverse: fetal c.a. is 90° to woman’s spine
Fetal Presentation – determined by fetal lie and by
the body part that enters the pelvic passage first.
The portion of the fetus is referred to as the
presenting part. Fetal presentation may be
cephalic, breech, or shoulder.
Engagement – when largest diameter of presenting
part reaches or passes through pelvic inlet.
Figure 15-7, p 314
The biparietal diameter (BPD) of fetal head settles into
inlet of pelvis. In most instances, the occiput is at the
level of the ishial spines () station.
Station –refers to the relationship of presenting part to
an imaginary line drawn between the ischial spines of
the maternal pelvis. If the presenting part is higher than
the ischial spines, the station has a negative #,
referring to centimeters above 0 station. Minus 5 is at
the pelvic inlet. Positive #s = presenting part has
passed the ischial spines. Positive (+) 4 is at the outlet.
See Figure 15-8, p 315
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Fetal position – relationship of the designated
landmark of fetal presenting part to the left or right side
of the maternal pelvis. The designated landmarks are
vertex: the occiput; in face presentation: the mentum.
In breech: the sacrum; for shoulder: the acromion
process of the scapula. If directed to side, it is
designated as transverse.
The landmark on the fetal presenting part r/t four
imaginary quadrants: left anterior, right anterior, left
posterior, and right posterior, meaning: Is the presenting
part directed toward the front, back, left or right of the
passage?
Three notations:
Right ® or left (L) side of maternal pelvis
The landmark of fetal presenting part: occiput (O);
mentum (M), sacrum (S), or acromion process (A).
Anterior (A), posterior (P), or transverse (T )
PHYSIOLOGIC FORCES OF LABOR
characteristics of contractions and
effectiveness of expulsion methods
Primary and secondary forces
PSYCHOLOGICAL
CONSIDERATIONS
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Preparation for childbirth
Support systems
Present emotional status
Beliefs and values
PHYSIOLOGY OF LABOR
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Progesterone and estrogen
Thinning of the cervix
Contractions
PREMONITORY SIGNS OF LABOR
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Lightening: fetus
descends into pelvic
inlet
Braxton hicks
contractions: irregular
intermittent
contractions
PREMONITORY SIGNS
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Cervical changes: cervix begins to soften
and weaken
Bloody show: loss of cervical mucous plug
PREMONITORY SIGNS
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RUPTURE OF MEMBRANES
SUDDEN BURST OF ENERGY
WEIGHT LOSS
DIARRHEA
DIFFERENTIATE BETWEEN TRUE LABOR
AND PRE LABOR
PHYSIOLOGICAL AND PSYCHOLOGICAL CHANGES
OF EACH STAGE OF LABOR
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Latent phase
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Active phase
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Transition
LATENT PHASE
Psychological changes
Regular mild contractions
Cervical effacement and dilation begin
Psychological changes
relief that labor has begun
excitement and anxiety
ACTIVE PHASE
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Physiological changes
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Contractions increase in intensity, frequency &
duration
Cervical dilation changes from 4 to 7 cm
Fetus descends into pelvis
Psychological changes
fear of loss of control
increased anxiety
TRANSITION PHASE
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Physiological changes
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Contractions continue to increase in intensity
Cervix dilates from 8-10 cm
Fetus descends rapidly into the birth passage
Women may experience rectal pressure, n/v
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Psychological changes
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Increased feelings of anxiety
Irritability
Eager to complete birth process
Need to have support person or nurse at side
SECOND STAGE
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Physiologic changes
Begins with complete cervical dilation and ends with
birth of the infant
 Women pushes
 Perineum begins to bulge, flatten and move anteriorly
Psychological changes
may feel out of control
may feel sense of purpose
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THIRD STAGE OF LABOR
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Physiological changes
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Placental separation
Psychological changes
women may feel relief
usually focused on infant
THIRD STAGE OF LABOR
S/S placental separation
 globular shaped uterus
 rise of the fundus in the
abdomen
 a sudden gush or trickle of
blood
 further protrusion of the
umbilical cord out of the
vagina
FOURTH STAGE OF LABOR
INTRAPARTAL NURSING
ASSESSMENT
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DISCUSS HIGH RISK SCREENING AND
INTRAPARTAL ASSESSMENT OF
MATERNAL AND PSYCHOSOCIOCULTURAL
FACTORS
HIGH RISK SCREENING
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Obtain maternal history and note high
risk factors
Name and age of mother
 LMP & EDB
attending physician or CNM
Personal data
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PHYSICAL ASSESSMENT
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Integral part of admission procedure and
essential for ongoing care.
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Assessment of body systems
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Actual labor progress
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Laboratory findings
CULTURAL ASSESSMENT
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Address and honor values and beliefs of laboring
women
Nurses are more effective when aware of
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Cultural beliefs of a specific group
The impact individual differences may have on
laboring women
Be aware of stereotyping
PSYCHOLOGICAL ASSESSMENT
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Laboring client may have preconceived
ideas, knowledge and fears about
childbirth
Support system what are their planned
caretaking activities
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Need to consider possibility that women
has experienced domestic violence
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Use ACOG (1998) guidelines when
interviewing and interview alone
Do an anxiety assessment
ASSESSMENT TOOLS
Vital signs
CONTRACTIONS
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Uterine assessments are assessed by palpation
or continuous monitoring
Assess at least three contractions
Good time to assess laboring mother’s
perception of pain
ASSESSMENT OF CONTRACTIONS BY
PALPATION
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Assess contractions for frequency, duration, and intensity
by placing one hand on the uterine fundus
Determine frequency-note the time from the beginning
of the contraction to beginning of next contraction
Determine contraction duration
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Note time when tensing of fundus is felt and again when it
relaxes
Intensity can be determined by estimating indent ability
of fundus
TOOLS CONTINUED
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Electronic fetal monitoring
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Provides continuous data and is
routine for high risk clients
TOOLS CONTINUED
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Cervical assessment
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Dilation and effacement evaluated by
doing a vaginal exam-also provides
information about
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Membrane status
Characteristic of amniotic fluid
Fetal position
Station
TOOLS CONTINUED
assessment of fetal membranes
12% of women at term rupture
prior to onset of labor
If membranes ruptured longer
than 12-24 hours labor induced
Ruptured membranes increase risk of
infection
Spontaneous rupture of membranes occurs
at the height of the contraction with a
gush of fluid out of vagina
Artificial rupture of membranes called
amniotomy
ASSESSMENT OF MEMBRANES
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Assess for rupture
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Nitrazine paper
Ferning
CHECK FETAL HEART TONES FIRST
FERNING
Fluid assessment
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Assess character of fluid for
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Consistency
Amount of fluid
Odor
Color of fluid
Assess fht frequently
TOOLS CONTINUED
Freidman’s Graph
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Dilation
Station
FOURTH STAGE OF LABOR
Care of the mother
Assessments