Theories of Labor Onset

1. Uterine stretch theory any hallowed organ when

stretched to its maximum capacity will contrast and empty.
2. Oxytocin theory Oxytocin, which causes contractions
of the smooth muscles of the posterior pituitary gland as a
result of stressful event in labor.
3.Progesterone Deprivation Theory Progesterone,
secreted by the corpus Luteum and then by the placenta,
is essential in maintaining pregnancy. However, the
decrease in the level of progesterone circulating in the
body will initiate body pains.
4. Prostaglandin Theory Prostaglandins, formed by the
uterine deciduas under level of concentration in the
amniotic fluid and blood of women increases during labor.
Research has shown prostaglandin to be very effective in
inducing uterine contraction at any stage of gestation.
Initiation of labor is said to be the result of the release of
arachidonic acid is believed to increase prostaglandin
synthesis contractions.
5. Theory of Aging Placenta as the placenta matures,
blood supply decreases resulting in uterine contractions.

Related Terms:
Labor is the process of moving the fetus, placenta
and membranes out of the uterus and through the birth
canal. Synonymous with childbirth and parturition.
Delivery is the actual birth of baby.
Crowning encircling of the largest diameter of the
babys head by the vulvar ring.
Effacement shortening and thinning of the cervical
canal. It is expressed in percentage (%).
Dilatation is the enlargement of the cervica l os from
an orifice a few millimeters in size to an aperture large
enough to permit the passage of the fetus.
Show is a mucoid discharge from the cervix that is
present after the mucous plug has been discharged.
Attitude the relationship of the fetal parts to one
another.
Lie relationship of the fetal spine to the spine of the
mother.
Presentation portion of the fetus that enters the pelvis
first.
Position relationship of the assigned area of the
presenting part of the landmark of the material pelvis.
Station measurement of the progress of descent of
the presenting part in relation to the ischial spine.
Frequency from the beginning of one contraction to
the beginning of the next contraction.
Duration from the beginning of contraction to its
completion.
Intensity the strength of contraction to its completion.

Effacement progressive thinning and shortening of

the cervix.
Dilatation opening of the cervix os during labor.

SIGNS of LABOR
1. Lightening setting of fetal head into pelvic brim.
occurs approximately 10-14 days before labor begins.
gives the woman relief from diaphragmatic pressure and
shortness of breath.
occurs early in primiparas.
mother may experience: shooting leg pains from the
increased pressure on the sciatic nerve, increased
amounts of vaginal discharge and urinary frequency from
pressure on the bladder.
2. Increased in Level of Activity related to an increase
in epinephrine release that is initiated by a decrease in
progesterone produced by the placenta.
3. Braxton Hicks Contractions painless irregular
contractions, sometimes strong that may cause
discomfort.
4. Ripening of the cervix Goodells sign: the cervix
feels softer than normal similar to earlobe throughout
pregnancy; at term cervix is described butter-soft.

Signs of TRUE LABOR:

1. Uterine Contractions surest sign that labor has
begun.
2. Show the blood mixed with mucus, takes on a pink
tinge. It is when mucus plug is expelled and capillaries are
exposed.
3. Rupture of the membranes experienced either as a
sudden gush or as a scanty, slow seeping of clear fluid
from the vagina.

False Labor:
Irregular contractions
Pain is confined to the abdominal
No increase in duration, frequency, and intensity.
Pain disappears with ambulating
No cervical change
Sedation stops contractions

True Labor:
Regular contractions
Pain on the lower back to the abdomen
Increase in duration, frequency and intensity
Pain not relieved upon ambulating
Accompanied with effacement and dilatation
Sedation does not stop contraction

CHARACTERISTICS of CONTRACTIONS
1. Mild uterine muscle are somewhat tense but can be
indented by a gentle pressure.
2. Moderate uterus is moderately firm and a firmer
pressure is needed to indent.
3. Strong the uterus becomes very firm that at the
height of contraction cannot be indented.

COMPONENTS of LABOR
1. Passage refers to the shape and measurement of
maternal pelvis and distensibility of birth canal ; refers to
the route a fetus must travel from the uterus through the
cervix and vagina to the external perineum.; Elastic to
expand and accommodate.

4 Basic Classification of
Pelvis:
a. Gynecoid best pelvis; half of thepopulation
b. Android common in men, 20% in women; heart
shape and difficult for vaginal delivery.
c. Anthropoid common in men; 20-30%,pelvic inlet
oval.

d. Platypelloid flat pelvis; least common; 5% of the

population, long sacrum.
2. Passenger refers to the fetus, its size, presentation,
and position.
3. Power forces acting together to expel fetus from the
uterus

2 TYPES of POWER
a. Primary Powers involuntary contractions of the
uterus,
b. Secondary Powers- voluntary bearing down efforts of
the mother.
4. Psyche reflects the womans frame of mind in dealing
with the labor experience.

Structure of the fetal skull

Cranium uppermost portion of the skull, comprises
eight bones.
- the four bones: the frontal (actually 2 fused bones), 2
parietal and occipital.
- The other four: sphenoid, ethmoid, and 2 temporal bones

The Suture Lines:

Sagittal suture- joins the 2 parietal bones of the skull.
Coronal suture the line of juncture of the frontal
bones and the 2 parietal bones.
Lambdoid suture the line of juncture of the occipital
bone and 2 parietal bones.

Fontanelles:
- significant membrane-covered spaces that are found at
the junction of the main suture lines.
Anterior Fontanelle referred to as bregma; lies at the
junction of the coronal and sagittal sutures;
- diamond-shape
- anteroposterior diameter is 3-4cm
- transverse diameter is 2-3cm
Posterior Fontanelle lies at the junction of the
lambdoidal and sagittal sutures.
- triangular
- smaller than the anterior Fontanelle
- only 2cm across its widest part
Vertex the space between two fontanelles.
Sinciput the area over the frontal bone.
Occiput the area over the occipital bone.

Suboccipitobregmatic narrowest diameter, 9.5cm;

from the inferior aspect of the occiput to the center of the
anterior fontanelle.
Occipitofrontal measured from the bridge of the nose
to the occipital prominence is 12cm.
Occipitomental the widest which is 13.5cm; measured
from the chin to the posterior fontanelle.
Molding the change in shape of the fetal skull produced
by the force of uterine contractions pressing the vertex of
the head against the notyetdilated cervix.

FETAL PRESENTATION and

POSITION
Attitude describes the degree of flexion a fetus
assumes during labor or the relation of fetal parts to each
other.
1) Good Attitude (complete flexion) the spinal column
is bowed forward that the chin touches the sternum, the
arms are flexed and folded on chest, the thighs are flexed
onto the abdomen and the calves are pressed against the
posterior aspect of the thighs.
2) Moderate flexion the chin is not touching the chest
but is in an alert or
military position.

3) Poor flexion the back is arched, the neck in extended

and a fetus is in complete extension, presenting the
occipitomental diameter of the head to the birth canal
(face presentation).
Engagement refers to the settling of the presenting part
of a fetus far enough into the pelvis to be at the level of the
ischial spines.
Floating a presenting part that is not engaged.
Dipping one that is descending but has not yet reached
the ischial spines
Station refers to the relationship of the presenting part
of a fetus to the
level of ischial spines
0 station presenting part of a fetus is at the level of the
ischial spines
+4 station head is at outlet.
-4 station head is floating.

FETAL LIE
the relationship between the longaxis of the body and
the long axis of
a womans body.
2 Primary Lie: 1. Longitudinal
2. Transverse

FETAL PRESENTATIONS
denote the body part that will first contact the cervix of
be born first.
- this is determined by a combination of fetal lie and the
degree of flexion.

3 Main Presentations:
a. Cephalic the fetal head is the body part that will first
contact the cervix
- the four types of cephalic presentation: vertex, brow, face
and mentum.
b. Breech either the buttocks or the feet are the first
body part that will contact the cervix.
- the 3 type of breech presentation: complete,frank, and
footling)
c. Shoulder the presenting part is usually one of the
shoulders (acromion process, an iliac crest, a hand, or an
elbow.
POSITION the relationship of the presenting part to a
specific quadrant of a womans pelvis.

POWERS
UTERINE CONTRACTIONS:
Origins
Labor contractions begin a pacemaker point located in
the myometrium near one of the uterotubal junctions.
In some women, contractions appear to originate in the
lower uterine segment
rather than in the fundus.
Phases
3 Phases: increment, acme, decrement
Increment- when the intensity of the contraction
increases.
Acme- when the contraction is at its strongest.
Decrement- when the intensity decreases.
As labor progresses the relaxation intervals decrease
from 10 minutes to 2 3 minutes.
The duration also changes from 20-30 sec to a range of
60-90 sec.
Contour Changes
Upper segment becomes thicker and active, preparing it
to be able to exert the
strength necessary to expel the fetus when the expulsion
phase of labor is reached.
The lower segment becomes thin-walled, supple, and
passive so that the fetus can be pushed out of the uterus
easily

Physiologic retraction ring a ridge on the inner

uterine surface that marks the boundary between the 2
portions.
Pathologic retraction ring (Bandls ring) it is a
danger sign that signifies impending rupture of the lower
uterine segment if the obstruction to labor is not relieved .
Cervical Changes
Effacement
Shortening and thinning of the cervical canal.
Normally the canal is 1-2cm.
With effacement the canal virtually disappears because
of longitudinal traction
from the contracting uterine fundus.
Dilation
Refers to the enlargement or widening of the cervical
canal from an opening of few millimeters wide to one large
enough (10cm).
First reason why dilation occurs is uterine contractions
gradually increase the
diameter of the cervical canal lumen by pulling the cervix
up over the presenting
part of the fetus.
Second, the fluid-filled membranes press against the
cervix.
As dilation begins there is large amount of vaginal
secretions (show) because the last of the operculum or
mucus plug in the cervix is dislodged and capillaries in the
cervix rupture.

STAGES OF LABOR
1. Stage 1 (stage of dilatation) begins with the true
labor pains and ends when the cervix has reached full
dilatation.
Nursing Care:
Stay with woman; provide constant support .
Reminds, reassures and encourages woman to
reestablish breathing patterns and concentration as
needed.
Prompts partial respirations if woman begins to push
prematurely accepts woman inability to comply with
instructions.
Keeps woman aware of progress.

3 Phases:
1. Latent Phase
Begins at the regularly perceived uterine contractions and
ends when
rapid cervical dilatation begins Contractions are mild and
short lasting
20-40 seconds .Cervix dilates from 0-3cm. 6 hours in
nullipara and
4.5 hours in multipara.
Nursing Care:
- Assists woman to cope with contraction.

- Helps to concentrate in breathing techniques.

- Assists into comfortable position .
- Informs woman of the progress of labor.
- Explains procedure and routines.
- Offer fluids, ice chips, food as ordered.

2. Active Phase
Dilatation increases from 4 7 cm
Contraction lasts 40-60 sec and occur
every 3-5 minutes
3 hours in nullipara
2 hours in multipara
Show and spontaneous rupture of membranes may occur.
Nursing Care:
- Finds assessment techniques between contractions
- Assists with frequent position change
- Applies counter pressure to sacrococcygeal area
- Encourages and praises
- Keeps woman aware of progress
- Check bladder and encourages voiding
- Gives oral care

3. Transition Phase
Contractions reached their peak of
intensity occurring every 2-3 minutes with duration of 6090sec
Maximum dilatation 8-10cm
Complete cervical effacement

Woman experiences intense discomfort accompanied by

nausea and vomiting
Woman may also experience a feeling of loss of control,
anxiety, panic or irritability
2. Stage 2 (Stage of Expulsion) the period from full
dilatation to birth of the infant. Contractions change from
the characteristic crescendo-decrescendo pattern to
overwhelming uncontrollable urge to push or bear down
with each
contraction as if to move her bowels. Woman perspire and
the blood vessels in
her neck may become distended. Crowning takes place.
The need to push become intense and the woman cannot
stop herself.

6 Cardinal Movements of the Mechanism of labor

o Descent downward movement of the biparietal
diameter of the fetal head to
within the pelvic inlet
- full descent occurs and the fetal head extrudes beyond
the dilated cervix and touches the posterior vaginal floor
o Flexion the head bends forward onto the chest,
making the smallest anteroposterior diameter
o Internal rotation the occiput rotates until it is superior,
or just below the symphysis pubis, bringing the head into
the best relationship to the outlet of the pelvis
o Extension as the occiput is born, the back of the neck
stops beneath the pubic arch and acts as a pivot for the

rest of the head. The head extends, and the foremost

parts of the head, the face and chin are born.
o External Rotation almost immediately after the head
of the infant is born, the
head rotates (from the anteroposterior position it assumed
to enter the outlet)
back to the diagonal or transverse position of the early
part of labor
o Expulsion the rest of the baby is born easily and
smoothly because of its smaller part size. The end of the
pelvic division of labor.
Nursing Care:
Put both legs at the same time when positioning to the
lithotomy position. Instruct mother to push as fetal head
crowns. If hyperventilation occurs, let patient breathe into
a brown paper or a cupped hand.
3. Stage 3 (Placental Stage) begins from the delivery of
the baby up to the delivery of the placenta
2 Phases:
a. Placental Separation
Signs:
- Lengthening of the cord
- Sudden gush of blood
- Change of shape of the uterus
b. Placental Expulsion

- Brandt Andrews Maneuver tract the cord slowly,

winding it around the clamp until placenta spontaneously
comes out rotating it slowly so that no membranes are left.
Nursing Care:
Dont hurry the expulsion of the placenta, just watch for
the signs of placental separation.
Take note of the time of placental delivery
Inspect for the completeness of the placenta
Palpate the uterus to determine degree of contraction. If
relaxed, massage gently and apply ice cap.
Inspect for lacerations
Types of Placental Presentation
Schultzes appearing shiny and glittering from the
fetal membranes
Duncan it looks raw, dirty, meaty, red and irregular

4. Stage 4 (Puerperium Stage) first 4 hours after

delivery of placenta
Degrees of Perineal Lacerations:
1. First Degree skin and superficial to muscle
2. Second Degree muscles of the perineum
3. Third Degree continues to anal sphincter
4. Fourth Degree involves the anterior anal wall

Episiotomy incision made to the perineum to enlarge

the vaginal opening for easy delivery
Types:
a. Midline/Median
b. Mediolateral
c. Lateral
Advantages:
1. Enlarging of the vaginal opening
2. Shortening of the second stage of labor
3. Minimizing the stretching of the perineal muscle
4. Preventing perineal tearing.

NCM 102 Lec

HIGH RISK PREGNANCY:

COMPONENTS OF LABOR
Written Report

GROUP 1, BSN II SECTION 1

ACOSTA, JEFFERSON R.
AGBUYA, RODERICK G.
ALARMADO, MARY EDEN JEAN F.
ALLELIGAY, LEONEE
AZARCON, GERALD MIKE G.
BAYANIN, HERON JAYSON E.
BAUTISTA, KIRK RAYMUND E.
BEREDO, HANNA FAYE
BUNDALIAN, ALLOREN GRACE