Danger signals:

Vaginal bleeding
Persistent vomiting
Abdominal or chest pain
Chills and fever
Pregnancy induced
hypertension
Sudden escape of fluid
from the vagina
Increase or decrease in
fetal movement
1st trimester: acceptance of the
baby
No evident signs and
symptoms
Ambivalence, feeling
surprise, emotional
liability, money worries,
body image concerns
Denial
Task: I am pregnant
Health teachings: bodily
changes, personal hygiene
and nutrition
nd
2 trimester: acceptance of
the baby
More evident signs and
symptoms
Role identification &
heightened sense of time
Mother identifies fetus as
separate being
Change in sexual interest,
father examines own
ability to parent
Task: I am going to have a
baby
H.A: growth and
development of the fetus
3rd trimester: acceptance for
change of role
Mother has identification of
the appearance of the
baby

Fears due to enlarging

abdomen
Anxiety about labor
Artificial family planning
method
Hormonal methods
1. Oral contraceptives
2. Injected or implanted
steroids
contraceptives
Contraceptive pills
- Hormonal agents
consisting of estrogen
and progesterone
Action: inhibit ovulation by
suppressing FSH & LH
thickens cervical mucus;
alters motility of sperm
towards fallopian tube.
Two types of contraceptives
packets:
1. 21 day pill
2. 28 day pill
Different combination:
1. Combination
2. Triphasic
3. Minipills or progestin only
pills
Beneficial effects:
Reduced blood loss
dysmenorrhea and PMS
Helps regulate menstrual
cycle
Does not interrupt sexual
activity
Most effective reversible
methods; 99%
Reduced incidence of
breast and endometrial CA
Side effects:
Increased cervical
discharge
Weight pain

 Headache, dizziness,
vomiting
Breast tenderness
Ache
Spotting and breakthrough
bleeding
Hyperpigmentation of skin
Increased incidence of
monilia infection

Intramuscular injections:
Medroxyprogesterone
150mg
Depo- provera
Every 12weeks
Inhibits ovulation: alter
cervical mucus
Prevent endometrial
growth
Does not menstruate
Same advantage and
disadvantage with implants
Disadvantages:
Fertility return delayed by
6 months
Higher risk for osteoporosis
Impair glucose tolerance in
woman at risk for diabetes
Clients instruction:
Breast, pelvic, pap smear
Report signs
Subcutaneous implants
Norplant
Made up of synthetic
progesterone
biodegradable silicon that

slowly releases
progesterone.
Effective up to 5 years
Suppress out net: thickens
mucus
Advantage:
Long term
Do not interfere with coitus
Has no estrogen related
effects
Can be used during
breastfeed
Return to fertilization
Expensive
Transdermal pat
Side effects:
Weight gain
Hair loss
Depress
Infect
Reaction to itching
Irregular menstruation

Chemical
Spermicides
Making vaginal PH acidic
Contraceptive foam
Cream and jellies
Spermicidal vaginal
tablet
Spermicidal condom
Feline inserted into
vaginal
Mechanical barrier
Diaphragm
Work to prevent entrance
of spermtoutenous
Contradictions:
Allergy to latex
Pelvic pain
DIP
Tight introitus

Side effects:
Cystitis
Allergic reaction
Vaginal trauma or
ulceration
Condom
Intrauterine device
Permanent methods:
Tubal ligation
Vasectomy
Natural method
Calendar
1-10days safe
11-20days fertile
21-30days unfertile
Irregular
BBT (check temperature)
36.8 37.4 36.7 (mother is
ovulating
LAM (lactation amenorrhea
method)
100% protect against next
pregnancy
1st 4 months
Cervical mucus method/ billing
method
Unsafe- wet
Safe- dry

Oxytocin- stimulation
theory
Near- term pregnancy
Posterior pituitary gland
produces oxytocin
Uterus becomes sensitive
Uterine contraction
Progesterone- deprivation
theory
Pregnancy draws near term
Decreases production of
progesterone by the
placenta and corpus
luteum
Increase oxytocin
Uterus becomes sensitive
to oxytocin
Regular rhythmic
contraction of the uterus

Understanding labor
and delivery (intrapartum period)
LABOR
- Series of events in
which uterine
contraction will expel
the fetus and the
placenta out from the
womans body.
Theories of labor onset

Prostaglandin theory
Fetal membranes produce
arachidomic acid
Converted by the maternal
decidua into prostaglandin

As pregnancy draws near

term, increase production
of arachidomic
Increase prostaglandin in
the amniotic fluid
Uterine-stretch theory
Any hallow muscular organ
when stretched to its
capacity will contract and
empty its content and
considered the most
acceptable theory of labor
Theory of the aging
placenta
As placenta ages, there is
decrease production of
progesterone that
maintains the relaxation of
the smooth muscle of the
uterus
Fetal adrenal response
theory
Increase in fetal cortisol
Decrease formation of
progesterone
Increase of prostaglandin

Preliminary signs of
labor
Descent/ dipping
Primi - 2weeks before labor

Multi a day before or on

the day of labor
Signs of lightening
Relief dyspnea
Relief of abdominal
tightness
Increased frequency in
urination
Shooting pains
Increased amount of
discharges
Constipation
Uterus becomes as soft as butter
- ripening of the cervix (goodells
sign)
Braxton- hicks contraction
Known as prodromal or
practice
Labor
Tightening of the uterine
muscles that may begin in
6weeks of pregnancy but is
usually felt until the 2nd or
3rd trimester
Increase level of activity by
the mother
Bloody show
-Release of blood from cervix
when the body is ready for labor
Rapture of membranes
Breaking of bag of water
(ameotic sac)
8 hrs. (Can be infected
or injured)
An indication for
hospitalization

TRUE VS FALSE LABOR

Contraction
false
Interval
irregular
Location
abdominal

true

9.5cm; from below the

occiput to the anterior
fontanel; narrowest AP
diameter.

regular
back to front /

Lumbar to
Hypo gastric
Bloody show present
absent
Cervical
effaces &
usually
Dilation
dilates
longer
Effacement
&
close cervix
5 PS of labor
Passenger
Fetus
- the body part with the
widest diameter is the
head.
Fetal head
7bones ( 2 frontal, 2
parietal,
2 temporal, 1 occipital)
- suture: thin spaces in
between bones
fetal head diameters:
Antero Posterior (ap)
diameter: wider that the
transverse diameter
Occipito-mental:
- 12.5- 13.3 cms;from
occiput to chin; the
widest diameter
occipito-frontal:
- 12cms from occiput to
mid frontal bone
sub- occipitobregmatic:

Transverse diameters:
Biparietal diameter:
- 9.5cm; widest
transverse diameter
bitemporal diameter:
- 8cm
bimastoid:
- 7cm
Fontanels
significant membrane
covered spaces
found at the junction of the
main suture lines
compress during birth to
aid in molding
helps established position
of the fetal head during IE
suture lines
- where bones of skull
meet
sagittal ( 2 parietal)
coronal ( frontal and
parietal)
lambdoid ( occipital and
parietal)
molding
change in the shape of the
fetal skull
produced by the force of
uterine contraction
pressing vertex against
non-dilated cervix

A.
B.
C.
D.

fetal attitude
degree of flexion
relation of fetal parts to
each other
good flexion/ complete
flexion
moderate flexion/ military
position
partial extension/ poor
flexion
very poor flexion/ complete
extention
station
- relationship of the fetal
presenting parts to the
level of the ischial spine.
- +4 crowning.

Fetal lie
relationship between
the long axis of the fetal
body and the long axis
of the womans body
transverse lie
- perpendicular to each
other
longitudinal lie
- paralle to each other
oblique lie
- slant
fetal resentation
cephalic presentation
landmarks:
A. vertex
B. brow
C. face
D. mentum/chin
caput succedaneum
- diffuse swelling of the
scalp In a newborn
cause by the pressure

from the terus or

vaginal wall.
Breech presentation
- either buttocks or the
feet that first contact
the cervix
A. complete
feet; flex,
buttocks
B. frank
buttocks ,feet
extended
C. footling
what ever the
position is, feet is
the 1st

transverse/ shoulder
presentation
- the presenting part
usually one of the
shoulder( acromion
process)
- deliver via cesarean
section
-

fetal position
relationship of the fetal
reference point to one
of the quadrants of the
maternal pelvis
landmarks:
presentation position
vertex
occiput
(o)
face
mentum
(m)
breech
sacrum
(s)
shoulder
acromion/
scapula (A)

ROA/LOA
right/ left occiput
anterior
fetus delivers fastest
ROP/LOP
right/ left occiput
posterior
painful labor

engagement
settling of the
presenting part of the
fetus far enough into
the pelvis to be at the
level of the ischial spine
floating
- present part not
engaged
dipping
- descended but not
reached the ischial
spine
-5, -4, -3, -2, -1
0 = engaged
-

Passageway
- should be adequate in
size and contour
- soft passages ( cervix,
vagina, perineum)
- bony passage (pelvis)
types of pelvis
gynecoid
- normal female pelvis;
rounded oval
- most favorable for
successful labor & birth
android

normal pelvis of a male;

funnel shape
anthropoid
- oval
platypelloid
- flattened; transverse
oval
Important pelvic
measurement at 3 planes
of the pelvis:
Diagonal conjugate
- widest antero-posterior
diameter of the inlet;
adequate size is 12.5cm
- the narrowest diameter
of the inlet
true conjugate
- also called conjugate
vera
- adequate size: 1111.5cm
obstetric conjugate
- can not be measured
directly by examining
fingers
- to estimate: subtract
2cm from diagonal
conjugate (DG)

Cervical changes
Effacement (100%)
- Shortening and
thinning of the cervix
Dilation (10cm)
- Enlargement of the
cervical canal to permit
the passage of the fetus

mechanism of labor (even donna

failed in essay English exam)
E- engagement
D- descent
F- flexion
I- internal rotation
E- extension
E- external rotation
E- expulsion
Power
Supplied by the fundus of
the uterus
Implemented by uterine
contractions
Causes cervical dilation
and expulsion of the fetus
Characteristics of uterine
contraction
Intensity (mild,
moderate, strong)
Frequency (how often?)
Beginning of one
contraction to the
beginning of the next
contraction
Duration (how long)
Beginning to the end
Interval (time in
between)
Phases of uterine contraction
Increment low to high
Acme high point/ pick
Decrement - resolution
Psyche
- Psychological state or
feeling that a woman
brings into labor
Stages of Labor

Stage 1
- baby sulod hulat mag
dilate efface.
- Effacement and dilation
stage/cervical stage
- Starts from true labor
and ends with full
dilation of the cervix
Primi 8 12 hrs.
Multigravida 6 8 hrs.
Phases of labor
(friedman)
Phase/ latent active transition
2nd stage
stage
Cervical 1-4cm 4-7cm 8-10cm
complete
Dilation
Interval 15-30 3-5
11-2
Min
min
2 mn.
Mins.
Duration 15- 30 30-60 60-90
same
Sec
sec
sec
Intensity mild moderate strong
strong
Nursing interventions:
Latent phase:
- Proper positioning-side,
back rub, support
system to stay with the
client.
Active phase:
- Client is less talkative;
more anxious, may not
want to be alone, fears
losing control.
- Drug for comfort; best
given this time

Maternal problem:
hyperventilation
(tingling sensation, or
numbness of nose and
lips, fingertips or toes,
pallor, dizziness,
lightheadedness, spots
before the eyes, or
carpopedal spasms)
Encourage woman to
slow her breathing and
take shallow breaths
Offer client a paperbag
or breath into cupped
hands
Stay with the client

Transition phase:
-may have a strong desire
to push
This should not be
- Lamaze suggest pant
blow pattern
- Maternal problem:
nackache, pressure on
the bladder and rectum
and legs trembling
- Care involves comfort,
coach-breathing
techniques, provide
psychological comfort,
dont leave the client
alone.
- Maternal behavior:
progress from irritability
to participation
- Continue to offer
psychological support;
inform progress of labor
Praise
Reassurance
Encouragement
Inform mother of progress
Support system
Touch
When to transfer to DR?

Primi- 10cm
Multi- 8-9cm
Proper position- lithotomy
Nursing Interventions: good
progress of labor (rapture bag of
water)
- walking
- nipple stimulation
(promote oxytocin)
- induction- begin
- augment add oxytocin
- squat
Stage II
- fetal expulsion stage
- from full cervical
dilation to the birth of
the infant
- there is uncontrollable
urge to push and the
vaginal tissues bulges
and the rectum dilates
- crowning occurs
- Ritgens maneuverprevent perennial
laceration
Towel- prevent pressure to
perineal area
Episiotomy
- facilitates delivery of
the fetus and relieves
pressure to the fetal
head.
- Done not to tear the
perineum as the head
extends
Kinds:
Medio- lateral 7 degrees
cut- right handed; 5
degrees cut left handed;
slower to heal; fats, less
blood vessels
Midline- 6 degrees cut;
east to heal; made up of
muscle, nutrients,
plenty of blood vessels

 Stage III
- placental stage
- from birth of the fetus to
delivery of the placenta
- occurs 15-20mins after
the delivery of the fetus
- the fundus lies just
below the umbilicus
signs of placental separation
- uterus becomes
globular and rises up in
the abdomen
- lengthening of the cord
- sudden gush of blood
from the vagina
mechanism of placental
separation
- schultze(shiny)presenting part, fetal
part
- Duncan(dirty)- maternal
part; no crater
Brandt andrews maneuver
- a maneuver to prevent
uterine inversion.
Stage IV
- ( nipple stimulation;
fundal massagemaintain well
contracted uterus)
- 1-4hrs immediate
postpartum
- recovery stage
nursing interventions:
- Vsq 15 mins
- Monitor bleeding/ lochia

Palpate fundus
Check for bladder
distention
Check perineum
Administer medications
Check laceration,
hematoma
*pain medication
* antibiotic
*vitamins

Puerperium
BUBBLE HE APPROACH
Breast
- lactation status
- inspect and palpate
breast
- condition: soft, filling,
firm, engorged, red,
pain
- nipples: normal, red,
pain, cracked, inverted
Uterus
- assess fundus
- location
- position
- consistency: firm,
boggy- bleeding (ice
pack. Vaso constriction)
Bladder
- assess bladder prior to
and after voiding
- indwelling catheter;
color, quantity, quality,
odor, etc.
- intake output, # of voids
Bowel
- auscultate bowel sounds
- absent, hypoactive,
active, hyperactive
- palpate abdomen: soft,
non- distended
lochia

discharge from uterus

following delivery
- color (red)
- amount (minimal,
moderate, heavy)
- odor
4 Ts
Tone poor uterine
contraction
Trauma laceration
Tissue retain cotyledon
Thrombin causes of
bleeding

3 Stages of Lochia
Lochia rubra
1-4 days of postpartum
appears very bright red
Lochia serosa
- 4-7 days of postpartum
- thinner, brownish or
pink
Lochia alba
- 7-10 days or six weeks
after childbirth
- appears white or
yellowish- white
Episiotomy
- assess perineum
- use REEDA
- hemorrhoids: present,
edematous,
thrombosed, soft,
painful
- caesarian incision:
clean, dry and intact;
closed dressing and
intact, open to air
- dressing: clean, dry and
intact, changed
REEDA scale for incisions
Redness
Edema

Ecchymosis- change
Discharge (blood)
Approximation (length of
incision)
Homans
(thrombophlebitis)
- 0 negative
- plus (+) positive
(indicate R or L)
- calf pain might be
normal due to stress of
delivery
- clonus: 2=2 beats of
clonus, 3=3 beats of
clonus
- edema

reflexes
0 no response (normal)
1+ diminished
response; low normal
2+ average response;
normal
3+ brisker than
average; may not be
abnormal
4+ hyperactive; very
brisky; jerky or clonic
response; abnormal
Emotional
- maternal- infant
- mother holds, cuddles,
ask question and cares
for infants
- bonding or not bonding
with infants
- post partum bluesnormal/ psychosisabnormal

involution process
maternal organs
returning
sub-involution does
not return