PROCESSES AND STAGES OF BIRTH
N160 Nursing of Women and Newborns
Key Factors of Labor
Passenger (the fetus)
Passageway (the pelvis)
Powers (contractions and bearing down efforts)
Psychosocial (personal history, beliefs, culture, SES,
PASSAGEWAY
Size of pelvis
Type of pelvis
Ability of cervix to dilate
PASSENGER
Fetal head
Lie
Attitude
Position
Station
POWERS
Uterine contractions
Intra-abdominal pressure (pushing)
Position for labor
Musculature changes in the pelvic floor
PSYCHOSOCIAL FACTORS
Education
Cultural beliefs
Fatigue level
Pain tolerance
Previous experience
Anxiety level
Availability of coping techniques
CAUSES OF LABOR
Oxytocin stimulation
Progesterone withdrawl
Estrogen stimulation
Fetal cortisol
Uterine distension
Prostoglandins
PREMONITORY SIGNS OF LABOR
Lightening
Burst of energy
Braxton-Hicks contractions
Cervical softening and effacement
Bloody show
Rupture of membranes
TRUE VS. FALSE LABOR
TRUE
regular UC
UC: stronger, longer, closer over time
UC’s increase with walking
Cervix thins and opens
FALSE/PRACTICE
irregular UC
UC don’t change or lessen over time
UC’s don’t change with activity
Cervix doesn’t change
STAGES OF LABOR
FIRST
Latent
Active
Transition
SECOND
THIRD
FOURTH
FIRST STAGE- latent
Labor onset to 3 cm
longest phase of labor
woman may remain at home
woman feels able to cope with contractions
woman my be excited, anxious, talkative, reflective, smiling
SECOND STAGE-active
Cervix dilates 4- 8 cm
fetal descent is progressive
cervical dilation is usually 1.2 cm/hr in primips and 1.5 cm/hr in multips
woman is having to concentrate on contractions and breathing patterns
FIRST STAGE-transition
Cervical dilation from 8-10 cm
rate of descent increases
usually 3 hrs for primips and 1 hr for multips
Woman may be increasingly anxious & uncomfortable, feel out of control, change positions frequently, be
very inner-directed and withdrawn
“I can’t do this anymore”
SECOND STAGE OF LABOR
Complete dilation/ ready to push to delivery
1 hr for primip, 15 min. for multip
Woman uses the forces of ctxs and intra-abdominal pressure to deliver fetus
Woman feels more in control and able to DO something
THIRD STAGE OF LABOR
Birth of baby to delivery of placenta
placental separation happens in 5-30 minutes
Signs: gush of blood, lengthening of cord, return of maternal contractions
Shultz (shiny)/ Duncan (dirty)- appearance of placenta indicates mechanism of separation
FOURTH STAGE OF LABOR
Recovery
fundus at umbilicus
moderate amt of rubra lochia
mother may be thirsty and hungry
shaking is common
mother is excited, happy, tired, bonding, breastfeeding, proud, euphoric
CARDINAL MOVEMENTS OF DELIVERY
Descent
Flexion
Internal Rotation
Extension
Restitution
External rotation
Expulsion
MATERNAL SYSTEMIC RESPONSE TO LABOR
Cardiovascular system
Cardiac output increases between Ucs as labor progresses
Increase in BP during UC
Increase in BP r/t anxiety, pain, meds
Slow progressive rise in pulse
MATERNAL SYSTEMIS RESPONSE TO LABOR
Gastrointestinal
Gastric motility decreases
Decreased emptying
Absorption of fluid not effective
OK to eat during labor
MATERNAL SYSTEMIC RESPONSE TO LABOR
Respiratory
Oxygen consumption increases
Hyperventilation secondary to anxiety is common (numbness and tingling of face, fingers, arms)
MATERNAL SYSTEMIC RESPONSE TO LABOR
Hemoatopoietic
WBCs increase from 5-10K to 25K/mm3
Increased plasma fibinogen
Decreased clotting time
MATERNAL SYSTEMIC RESPONSE TO LABOR
Renal and Urologic
Decreased sensory perceptions may impair ability to feel full bladder
Pressure of presenting part may cause bladder neck edema
Trace protein is normal r/t muscle breakdown
MATERNAL SYSTEMIC RESPONSE TO LABOR
Fluid and Electrolyte
Fluid loss r/t diaphoresis, increased respiratory rate and emesis