NURSES’ RESPONSIBILITIES IN RELATION TO THE

MECHANISMS IN LABOR A. Initial Fetal Assessment

MONITOR VITAL SIGNS
✓ Body temperature
➢ Temperature of the body; normally 98.6
F or 37°C in humans; usually measures
to obtain a quick evaluation of a
person’s health
✓ Blood pressure
➢ Pressure of the circulating blood against
the walls of the blood vessels; results
from the systole of the left ventricle of
the heart; sometimes measured for a
quick evaluation of a person’s health
➢ Normal: 120/80 mmHg
✓ Pulse rate
➢ The rate at which the heart beats;
usually measured to obtain a quick
evaluation of a person’s health
➢ Normal: 60-80 bpm
✓ Although fairly passive in labor, a fetus is
subjected to extreme pressure by uterine
contractions and passage through the birth
canal, so it is important to ascertain that the
FHR remains within the normal despite these
pressures
B. Auscultation of Fetal Heart Sounds
✓ Fetal heart sounds are transmitted best
through the convex portion of a fetus
because that part is the part that lies in
closest contact with the uterine wall
C. Initial Electronic Monitoring
✓ It is noninvasive, easily applied, and does not
require cervical dilation or fetal descent
before it can be used, so it can be introduced
at any time during labor

✓ Respiration rate
➢ The rate at which a person inhales and
exhales; obtain a quick evaluation of a
person’s health
➢ Normal: 16-20

COMPONENTS OF LABOR (4 P’S)

A. Passage
➢ Woman’s pelvis
➢ Gynecoid (ideal)
➢ Adequate size and contour

B. Passenger
➢ Fetus
➢ Appropriate in size and in an
advantageous position and
presentation
➢ Cephalic (ideal position)

C. Powers
➢ Uterine factors
➢ Should be adequate

D. Psyche
➢ Psychological outlook
➢ Which mother can view labor as a
positive experience

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 ANXIETY RELATED TO STRESS OF LABOR
PAIN
✓ Sensation of discomfort
✓ Subjective and personal symptom
✓ Only the experiencing person can validate the
presence of pain
✓ It is a protective mechanism that alerts a person
that something is happening somewhere in the
body
ETIOLOGY OF LABOR PAIN
1. Uterine contractions
➢ Uniquely, contractions cause pain
(unlike the all involuntary muscle
contractions: heart, stomach, and
intestine) due to anoxia to muscle
fibers. Anoxia occurs when there is
constriction of blood vessels, reducing
the supply of oxygen.
Anoxia – absence or deficiency of oxygen
2. Stretching of the cervix and the perineum
➢ This phenomenon is similar to intestinal
pain when accumulated gas is
stretching the intestines
Perineum – area between the external genitalia
and the anus
3. Pressure of the surround tissues and organs
➢ Fetal presenting part can cause
pressure on the tissues, surrounding
organs such as the bladder, urethra,
and the lower colon
Fetal Presenting Part – part of the baby that
leads the way through the birth canal. It is the
baby’s head but it can be a shoulder, buttocks
or the feet depending on the fetal position
PERCEPTION OF PAIN
1. Expectations and preparedness of labor
➢ Woman who expected pain to be
horrible are usually surprised because
the expected agony never materialized
while woman who expected pain to be
minimal would be overwhelmed by the
intensity of the pain.
➢ Unrealistic expectations cause tense,
making labor pain worse than when she
is relaxed
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2. The length of the labor
➢ Prolonged labor (medical term:
dystocia), labor that occurs very slowly,
is associated with worse labor pain than
expected, leading to greater use of
epidural analgesia and risk of operative
interventions
➢ Contractions tend to become longer,
stronger and more frequent as time
progressed
3. Position of the fetus
➢ Fetus in an occiput posterior position
cause intense or nagging back pain,
even between contractions much more
than if the fetus in occipitoanterior
position
➢ Baby’s head can painfully press against
the spine and tailbone of the mother –
reason why it is causes more back pain
when the baby is faced up.
4. Presence of fear, anxiety, worry, body image
and self-efficacy
➢ Woman who believe that they can
control situation (self-efficacy) are
reported to have a satisfactory birth
experience than those who are not in
control.
➢ fear, anxiety and ability to cope at labor
affect the severity and perception of
women’s labor pain
5. Availability of support persons
➢ Support persons can be a husband,
mother, friend or doula
➢ A doula is person who is experienced in
childbirth and postpartum support.
➢ These type of support persons provide
physical emotion and informational
support prenatally, during labor and
birth, and even postnatal period
➢ An effective doula can increase self-
esteem, speed of the labor process, and
improve breast feeding success
 6. Production of Endorphins
➢ Endorphins are chemicals produced
naturally by the nervous system
(primarily made in the hypothalamus
and pituitary glands) to cope with pain
or stress. (Berry, 2018). This may
influence the amount of pain a person
receives at a given time
➢ Production of endorphins vary among
individuals. Therefore, a person’s
overall pain threshold is different

7. Cultural Expressions
➢ Refusal of pain medications during
labor, which affect the perception of
pain due to limited pain relief measures
or treatments
➢ General cultural beliefs about labor pain
are associated with racial biases
➢ Cultural influences in pain management
can contribute to cultural conflict,
miscommunication, misdiagnosis,
inappropriate care and ineffective
patient care

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