The Process of Birth
Introduction
Intrapartum\Perinatal Period
Prof. Carole A. Devine
R.N.,MSN.
1
Physiologic Effects of Birth/Adaptation to
Labor
Maternal Response-Alterations in:
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Cardiovascular
Hemopoietic System
Respiratory System
Renal system
Integumentary System
Neurologic System
G.I. System
Endocrine System
Reproductive System
Prof. Carole A. Devine
R.N.,MSN.
2
Cervical Dilation
Prof. Carole A. Devine
R.N.,MSN.
3
B. Fetal Response to Mother’s
Labor:
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Fetal Heart Rate:
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Respiratory Rate
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Fetal Circulation
Prof. Carole A. Devine
R.N.,MSN.
4
Prof. Carole A. Devine
R.N.,MSN.
Placental Circulation
5
II. Components of The Birth Process
Critical Factors in Labor
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The Five P’s:
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1.The Powers
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2. The Passage
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3. The Passenger
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4. Mother’s position
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5. The Psyche
Prof. Carole A. Devine
R.N.,MSN.
6
Powers
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1. Primary: Uterine Contractions
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2. Secondary:
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Abdominal and Intercostal Muscles
The Perineal Muscles
Prof. Carole A. Devine
R.N.,MSN.
7
Prof. Carole A. Devine
R.N.,MSN.
Uterine Muscle Layers
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Uterine Response
Contractions Measured in:
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Frequency
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Duration
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Intensity
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Phases of Contractions:
Increment
Acme
Decrement
Prof. Carole A. Devine
R.N.,MSN.
9
Phases of Contractions
Prof. Carole A. Devine
R.N.,MSN.
10
B. Passage (The Pelvis)
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1. Landmarks:
The True Pelvis
( divided into 3
sections)
Inlet
Cavity
Outlet
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2. Types of Pelvises
Gynecoid
Anthropoid
Android
Platypelloid
3. Significant
Measurement:
Bi-ischial diameter
Prof. Carole A. Devine
R.N.,MSN.
11
Prof. Carole A. Devine
R.N.,MSN.
Female Pelvis
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Pelvic Measurements
Prof. Carole A. Devine
R.N.,MSN.
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Comparisons of Pelvises
Gynecoid
Prof. Carole A. Devine
R.N.,MSN.
Android
Anthropoid
Platypelloid
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50%
20%
25%
05%
C. Passenger ( Baby!)
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1. Fetal head/Fontanels
a. Posterior
b. Anterior
c. Bi-Parietal Measurement
2. Fetal Presentation
a. Cephalic
b. Breech
c. Transverse
Prof. Carole A. Devine
R.N.,MSN.
15
Prof. Carole A. Devine
R.N.,MSN.
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Prof. Carole A. Devine
R.N.,MSN.
17
Passenger (Continued)
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Fetal Lie
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Fetal Attitude
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Fetal station
Prof. Carole A. Devine
R.N.,MSN.
Fetal Position:
a. side of Pelvis:
Referred to as: (R or
L)
b. Fetal Presenting Part
Referred to as:( O,S,M
or A)
c. Anterior, Posterior or
Transverse Lie :
Referred to as:( A, P
or T)
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Prof. Carole A. Devine
R.N.,MSN.
19
Prof. Carole A. Devine
R.N.,MSN.
20
Prof. Carole A. Devine
R.N.,MSN.
Fetal Station
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Mother’s Position in Labor
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Affects anatomical and physiologic
adaptation to labor( standing ,
walking, sitting or squatting)
Gravity can assist in the decent of
baby/increases effacement and
dilation of cervix
Ferguson’s reflex
Prof. Carole A. Devine
R.N.,MSN.
22
Mother’s Psyche !
Prof. Carole A. Devine
R.N.,MSN.
23
Labor and Delivery
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Prof. Carole A. Devine
R.N.,MSN.
III. Normal Labor
A. Premonitory Signs
of Labor
1. Braxton Hicks
Contractions
2. Cervical Changes
3.Bloody Show
4.Rupture of
Membrane
5. Sudden Burst of
Energy
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B. True vs. False Labor
Characteristics
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False Labor
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- no change in cervix
-discomfort in low
abdomen and groin
-irregular contractions
-no increase in
frequency or intensity
of contractions
Prof. Carole A. Devine
R.N.,MSN.

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True Labor
Progressive cervical
dilatation and
effacement
Discomfort in back
and abdomen
Contractions occur at
regular intervals
Progressive increase
in frequency and
intensity of
contractions
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C. Initial Maternal Assessments
During Labor
1.PrenatalHistory ie:
Gestational Age?
wt.gain,EDD/EDC, Lab
Values, Bld.Type
2.Risk Factors: Rubella
status; STD’s, Group B
Step. Status
3.Prior Obstetrical
History( GTPAL)
4. Asses Labor Progress
6. Educational needs of
this Mother/Family
7. ? Support System
8.Maternal Allergies?
9. Base line Vital Signs
10. Status of the Baby
5.?Education Preparation
Prof. Carole A. Devine
R.N.,MSN.
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E. Mechanism of Labor
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Cardinal Movements of the baby
1. Engagement, Descent, Flexion
2.Internal Rotation
3.Extention-Beginning
4.Extention Complete
5.External Rotation(Restitution)
6.External Rotation(Shoulder Rotation)
7.Expulsion
Prof. Carole A. Devine
R.N.,MSN.
27
Four Stages of Labor
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1.First Stage (Dilation
Stage)
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2.Second Stage
(Stage of Expulsion)
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Divided into three
phases:
a. latent
b. active
c. transition
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3. Third Stage
(Placental Stage)
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4. Fourth Stage
(Recovery Stage)
Prof. Carole A. Devine
R.N.,MSN.
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Prof. Carole A. Devine
R.N.,MSN.
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