“Leopold’s

Maneuver”
“Maternal Care_LAB”
Mechanism of Labor
Engagement
- occurs when the largest diameter of the fetal head fits into the largest diameter of the maternal pelvis
- As the fetal head engages, the head moves towards the pelvic brim in either the left or right occipto-
transverse position.
- This allows the widest part of the fetal head to fit through the widest part of the pelvic inlet.
Descent

- The baby descends through the pelvic inlet towards the pelvic floor.
- Descent occurs due to:
-Uterine contractions
-Amniotic fluid pressure
-Abdominal muscle contraction
Flexion

- As the fetal head come into contact with the pelvic floor, cervical flexion occurs.
- This allows the presenting part of the fetus to be sub-occipito bregmatic.
- In this position, the fetal skull has a smaller diameter, which assists passage through the pelvis.
Internal Rotation

- The pelvic floor has a gutter shape, with a forward and downward slope.
- This allows the head to rotate from a left or right occipito-transvers position to an occipito-anterior
position.
Crowning

- It occurs when the widest diameter of the fetal head successfully negotiates through the narrowest part
of the maternal bony pelvis.
- This is clinically evident when the head, visible at the vulva, no longer retreats between contractions.
Extension

- The occiput slips beneath the suprapubic arch as the head extends and the nape of the neck is pivoting
against the arch.
- Extension of the head causes stretching of the perineum.
External Rotation and Restitution

- The head externally rotates to face the right or left medial thigh of the mother.
- At the same time, the shoulders are rotating from a transverse position to an anterior-posterior
position.
- This re-alignment of the shoulders with the head is called Restitution.
 “Essential Intrapartum
Newborn Care”
“Maternal Care_LAB”
Stages of Labor
ABOR AKA PARTURITION
1. Starts with Uterine Contraction
- When fetus is Full term (37-42 weeks gestation)
Third Trimester (Before Labor Starts)- the true labor contractions
-True labor contractions progress in frequency, duration & intensity
-Plug of Mucus&Blood or known as “Bloody Show” or
-Amniotic sac ruptures or known as “Water Breaking”
-Braxton-Hicks Contractions – False Labor contractions
CERVIX
-EFFACES – cervix gets thinner
-DILATES – cervix opens up
FIRST STAGE OF LABOR
Early Stage (Latent)
-Irregular contractions – every 5-30 mins and last for 30secs
-Effaces: 30%
-Dilates: 0-3cm
-20 hours
Regular contractions – every 3-5 mins and last for 1 min
Effaces: 80%
Dilates: 3-6cm
Active Stage
Effaces: 100%
Dilates: 6-10cm
-Intense contractions – last 60-90sec with 0.5-2min of rest in between
-Amniotic sac often ruptures in this stage
SECOND STAGE OF LABOR (Pushing Stage)
 2. Delivery of fetus
3Ps
Power – forceful uterine contractions
Passenger - fetus
Passage – the route of the fetus through bony pelvis
Cardinal Movements of Labor
a. Descent – downward movement of fetus to Pelvic Inlet
Fetal Station
Ischial spine of mom - station 0
Symphysis Pubis – station +4
Engagement
Flexion- Chin against Chest; Resistance from Pelvic Floor
Internal Rotation – Fetal Shoulders internally rotate 45 degrees
Restitution – after head is delivered, the head externally rotates so that the shoulders can pass
through the pelvic inlet and under symphysis pubis
Expulsion- the shoulders slip under the symphysis pubis (anterior followed by posterior
shoulder the rest of the body)
THIRD STAGE OF LABOR
Ends with delivery of Placenta
-After the baby has been delivered
-Uterus contracts firmly and Placenta begins to separate from uterine wall
-Placenta is removed
-Several hours after birth (major physiologic changes)
-Adaptation to Blood Loss
-Start of Uterine Involution – uterus begins to return to its pre-pregnant stage.
“Maternal Care_LAB”
4 Core Steps in EINC