NCMA 217 WEEK 7: INTRAPARTAL CARE
➢ Pressure on the cervix, which
INTRAPARTAL CARE
WEEK 7: COURSE UNIT (MODULE)
At the end of this unit, the students are
expected to:
Cognitive:
1. Describe common theories explaining the
onset of labor and the role of passenger, passage,
and powers in labor.
2. Assess a family in labor, identifying the
woman’s readiness, stage, and progression.
3. Understand the components of labor for
successful delivery.
4. Identify areas related to labor and birth that
could benefit from additional nursing research or
application of evidence-based practice.
Affective
1. Listen attentively during class discussions
2. Demonstrate tact and respect of other students
opinions and ideas
3. Accept comments and reactions of classmates
openly.
Psychomotor:
1. Participate actively during class discussions
2. Use critical thinking to identify areas of care
that could benefit from additional research or
application of evidence-based practice.
3. Implement nursing care for a family during
labor such as teaching about the stages of labor
THEORIES OF LABOR ONSET
Labor normally begins when a fetus is
sufficiently mature to cope with extrauterine life
yet not too large to cause mechanical difficulty
with birth. Several theories including a
combination of factors originating from both the
woman and fetus have been proposed to explain
why progesterone withdrawal begins:
➢ Uterine muscle stretching, which
resultsin release of prostaglandins
▪ As pregnancy advances, the uterus
becomes increasingly distended by
growing fetus, placenta and
amniotic fluid.
▪ Prostaglandin - group of lipids
made at the site of tissue damage
and they’re involved dealing with
injury and/or illness.
▪ They control processes such as
induction of labor.
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
stimulates the release of oxytocin from the
posterior pituitary
▪ The uterine distention also causes
pressure on the cervix which
stimulates the release of oxytocin
from the posterior pituitary gland
which stimulates uterine
contraction
➢ Oxytocin stimulation, which works
together with prostaglandins to initiate
contractions
▪ Studies have shown as pregnancy
nears term. Oxytocin production by
the posterior pituitary gland
increases while the production of
oxytocinase by the placenta
decreases
▪ Oxytocin stimulates uterine
contraction while oxytocinase
inhibit uterine contraction
▪ As a result, the uterus become
increasingly sensitive to oxytocin
➢ Change in the ratio of estrogen to
progesterone (increasing estrogen in
relation to progesterone, which is interpreted
as progesterone withdrawal)
▪The progesterone helps maintain
pregnancy by its relaxant effect by
the smooth muscles of the uterus
thereby preventing uterine
contraction.
▪ As pregnancy nears term the
production of progesterone by the
placenta decreases and this decline
in progesterone allows uterine
contraction to occur
➢ Placental age, which triggers
contractions at a set point
▪ As the placenta ages it becomes less
efficient, producing decreasing
amount of progesterone
➢ Rising fetal cortisol levels, which
reduces progesterone formation and
increases prostaglandin formation
▪ Cortisol is a hormone produced by
an adrenal gland and it’s produced
in response to stress or fight and
flight response or when we have
stressful event.
▪ During labor as baby face the event
it sends signal to the adrenal
 NCMA 217 WEEK 7: INTRAPARTAL CARE
glands to produce quantity of
cortisol to reduce the progesterone
formation and increase a
prostaglandin formation
▪ This prostaglandin is being formed
in these tissues in response to
injury, inflammation and pain
through contractions
➢ Fetal membrane production of
prostaglandin, which stimulates
contraction
▪ It has been known that when the
fetus reached maturity, the fetal
membranes produce large amount
of arachidonic acid which is
converted by maternal residual
into prostaglandin. Again,
prostaglandin is a hormone that
initiates uterine contraction.
SIGNS OF LABOR
PRELIMINARY SIGNS OF LABOR - Before
labor, a woman often experiences subtle signs
that signal labor is imminent. It is important to
review these with women during the last
trimester of pregnancy so they can more easily
recognize beginning signs.
➢ Lightening
→ descent of the fetal presenting part
into the pelvis
→ In primiparas, lightening, or descent
of the fetal presenting part into the
pelvis, occurs approximately 10 to 14
days before labor begins.
→ This fetal descent changes a
woman’s abdominal contour, because
it positions the uterus lower and more
anterior in the abdomen.
→ Lightening gives a woman relief from
the diaphragmatic pressure and
shortness of breath that she has been
experiencing and“lightens” her load.
▪ Lightening results in relief of
dyspnea, increase frequency of
urination, increase vaginal
discharge and decrease in fundic
height
➢ Increase in Level of Activity - This
increase in activity is related to an
increase in epinephrine release initiated
by a decrease in progesterone produced
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
by the placenta. This additional
epinephrine prepares a woman’s body for
the work of labor ahead.
▪ Initiated by low progesterone level
and adrenal glands large amount
of epinephrine or adrenaline.
▪ This happens to provide woman
with energy with extraneous work
of delivering a baby. As a nurse
we’re going to advise the mother
not to use her energy for doing
house hold chores but to save it for
labor and delivery
➢ Slight loss of weight - As progesterone
level falls, body fluid is more easily
excreted from the body. This increase in
urine production can lead to a weight loss
between 1 and 3 pounds.
▪ Progesterone promotes fluid
retention but when progesterone is
withdrawn, the fluid acquire
during pregnancy will be excreted
resulting also in weight loss
➢ Braxston Hicks Contraction - woman
usually notices extremely strong Braxton
Hicks contractions. •
▪ Regular painless contraction of
pregnancy becomes stronger,
longer and more frequent when
labor is near
▪ Sometimes its intensity may cause
the mother so much discomfort and
leading her to believe that she has
entered into a true labor
▪ The descent of the presenting part
is referred to as the prelabor and
the increase to uterine activity is
important because it’s responsible
for significant degree of effacement
➢ Ripening of the cervix - At term, the
cervix becomes still softer (described as
“butter-soft”), and it tips forward. Cervical
ripening this way is an internal
announcement that labor is very close at
hand
▪ Before pregnancy, maihalintulad
natin ang cervix na kasing soft ng
ating nose and during pregnancy
soft as our earlobe and during
labor it’s describe as “butter-soft”
 NCMA 217 WEEK 7: INTRAPARTAL CARE
SIGNS OF TRUE LABOR - Signs of true labor
involve uterine and cervical changes.
➢ Uterine Contraction - The surest sign
that labor has begun is productive uterine
contractions. Because contractions are
involuntary and come without warning,
their intensity can be frightening in early
labor. Especially in primis
➢ Helping a woman appreciate that she can
predict when her next one will occur and
therefore can control the degree of
discomfort, she feels by using breathing
exercises offers her a sense of well-being.
▪ How are we going to help women
appreciate that she can predict
when her next contraction is by
sharing them the phases of the first
stage of labor, particularly the
uterine contraction, the interval,
duration of contraction. So we can
set her mind and to prepare herself
if when is her next contraction.
➢ Show - As the cervix softens and ripens,
the mucus plug that filled the cervical
canal during pregnancy (operculum) is
expelled.
▪ Habang nag ddescend ang fetus sa
birth canal, the continuous
pressure exerted by the presenting
part against the soft tissues can
result to the rupture of several
blood vessels in the cervix.
➢ The exposed cervical capillaries seep
blood as a result of pressure exerted by
the fetus. This blood, mixed with mucus,
takes on a pink tinge and is referred to as
“show” or “bloody show.” Women need to
be aware of this event so that they do not
think they are bleeding abnormally.
➢ Rupture of Membranes - Labor may
begin with rupture of the membranes,
experienced either as a sudden gush or as
scanty, slow seeping of clear fluid from the
vagina.
➢ Early rupture of the membranes can be
advantageous as it can cause the fetal head
to settle snugly into the pelvis, shortens
labor.
➢ Two risks associated with ruptured
membranes are intrauterine infection
and prolapse of the umbilical cord,
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
which could cut off the oxygen supply to
the fetus (Lewis et al., 2007). In most
instances, if labor has not spontaneously
occurred by 24 hours after membrane
rupture and the pregnancy is at term, labor
will be induced to help reduce these risks.
COMPONENTS OF LABOR
A successful labor depends on four integrated
concepts:
1. A woman’s pelvis (the passage) is of
adequate size and contour.
2. The passenger (the fetus) is of
appropriate size and in an advantageous
position and presentation.
3. The powers of labor (uterine factors) are
adequate. (The powers of labor are
strongly influenced by the woman’s
position during labor.)
4. A woman’s psychological outlook is
preserved, so that afterward labor can be
viewed as a positive experience.
1. PASSAGE - The passage refers to the
route a fetus must travel from the uterus
through the cervix and vagina to the
external perineum.
→ Two pelvic measurements are
important to determine the adequacy
of the pelvic size: the diagonal
conjugate (the anteroposterior
diameter of the inlet) and the
transverse diameter of the
outlet.
▪ Diagonal Conjugate can be
 NCMA 217 WEEK 7: INTRAPARTAL CARE
obtained through internal
examination and it can be
measured from the anterior
portion of the sacral promontory
up to the inferior margin of the
symphysis pubis.
▪ Accdg. Pilitteri, the diagonal
conjugate measures an average of
11 cm
▪ Transverse diameter particularly
the bi-ischial diameter
▪ Ischial tuberosity diameter is the
distance between ischial
tuberosities or the transverse
diameter of the outlet. The
narrowest diameter at that level
or the most up to cause a misfit??
▪ It’s made at the medial and lower
most aspect of the ischial
tuberosities at the level of the anus
▪ A diameter of 11 is considered
adequate because it will allow the
widest diameter of the fetal head
which is 9 cm to pass freely
through the outlet
→ At the pelvic inlet, the
anteroposterior diameter is the
narrowest diameter; at the outlet, the
transverse diameter is the narrowest.
▪ Pelvic inlet is the entrance through
pelvis; Upper ring of the bone
through which the fetus must pass
to be born vaginally.
▪ It’s at the level of linea terminalis
or is marked by the sacral
prominence at the back
▪ Pelvic outlet – inferior portion of
pelvis; portion bounded in the
back by the coxy, on the sides by
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
the ischial tuberosities and in the
front by the interior aspect of the
symphysis pubis
▪ The passenger will negotiate with
the passage. The biparietal
diameter of the fetus measures 9.25
cm and the suboccipitobregmatic
measures 9.5 cm.
▪ Suboccipitobregmatic,
occipitofrontal & occipitomental –
AP diameters of the fetal head
▪ Suboccipitobregmatic, (smallest AP
diameter) – pag naka fully flex ang
kanyang head, the diameter na
nakapresent and it’s measured
mula sa inferior aspect of the
occiput up until the anterior
fontanel.
▪ Occipitofrontal – diameter
presented when the head is
partially extended and the
presenting part is the anterior
fontanel, it will be measured from
the bridge of the nose up to the
occipital prominence and the
average size is 12 cm
▪ Occipitomental – Diameter
presented when the head is
extended and the presenting part is
the face. It’s measured from the
chin to the posterior fontanel.
▪ Transverse diameter – biparietal;
this is the most important
transverse diameter in the fetal. It
must be the greatest diameter that
must be presented to the pelvis inlet
AP diameter and at the outlet
 NCMA 217 WEEK 7: INTRAPARTAL CARE
transverse diameter
2. PASSENGER - The passenger is the
fetus. The body part of the fetus that has
the widest diameter is the head, so this is
the part least likely to be able to pass
through the pelvic ring. Whether a fetal
skull can pass depends on both its
structure (bones, fontanelles, and suture ● Fetal Attitude - Attitude describes the
lines) and its alignment with the pelvis. degree of flexion a fetus assumes during
● Molding is a change in the shape of the labor or the relation of the fetal parts to
fetal skull produced by the force of each other.
uterinecontractions pressing the vertex of ● A fetus in good attitude is in complete
the head against the not-yet-dilated flexion: the spinal column is bowed
cervix. forward, the head is flexed forward so
▪ Molding is the overlapping of the much that the chin touches the sternum,
skull bones along the suture lines the arms are flexed and folded on the chest,
which caused a change in the the thighs are flexed onto theabdomen, and
shape of the fetal skull to one long the calves are pressed against the posterior
and narrow that facilitates aspect of the thighs.
passage of the rigid pelvis.
▪ It will return eventually into its
normal shape
● 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, a midpoint of the pelvis.
▪ It’s equivalent to Station Zero or
the presenting part settles at the
level of the ischial spine
● Station refers to the relationship of the
presenting part of a fetus to the level of
the ischial spines.
● When the presenting fetal part is at the ▪ full flexion - vertex presentation.
▪ Moderate flexion – sinciput
level of the ischial spines, it is at a 0
presentation; considered as the
station (synonymous with engagement).
military attitude
● If the presenting part is above the ▪ Poor flexion – cephalic
spines, the distance is measured and presentation – brow presentation
described as minus stations, which ▪ Full extension - face presentation
range from 1 to 4 cm.
● If the presenting part is below the
ischial spines, the distance is stated as ● This normal “fetal position” is
plus stations (+1 to +4). advantageous for birth because it helps a
● At a +3 or +4 station, the presenting part fetus present the smallest anteroposterior
is at the perineum and can be seen if the diameter of the skull to the pelvis and also
vulva is separated (i.e., it is crowning). because it puts the whole body into an
ovoid shape, occupying the smallest space
possible.
● A fetus is in moderate flexion if the chin is
not touching the chest but is in an alert or
“military position”.
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
 NCMA 217 WEEK 7: INTRAPARTAL CARE
● A fetus in partial extension presents the
“brow” of the head to the birth canal.
● Descent - means that the widest part of
the fetus (the biparietal diameter in a
cephalic presentation; the
intertrochanteric diameter in a breech
presentation) has passed through the
pelvis inlet or the pelvic inlet has been
proved adequate for birth.
● Fetal Lie - Lie is the relationship between
the long (cephalocaudal) axis of the fetal
body and the long (cephalocaudal) axis of
a woman’s body; in other words, whether
the fetus is lying in a horizontal
(transverse) or a vertical (longitudinal)
position.
▪ There are two presentations under
longitudinal lie. Cephalic
presentation and breech
presentation
▪ In shoulder presentation -
Transverse Lie and Oblique Lie
TYPES OF FETAL PRESENTATION
Fetal presentation denotes the body part that
willfirst contact the cervix or be born first. This
is determined by a combination of fetal lie and
the degree of fetal flexion (attitude).
1. Cephalic Presentation - A cephalic
presentation is the most frequent type
of presentation, occurring as often as
95% of the time. With this type of
presentation, the fetal head is the body
part that will first contact the cervix.
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
→ The four types of cephalic
presentation (vertex, brow, face, and
mentum).
▪ Vertex is the ideal presenting part,
because skull bones are capable of
effectively molding to
accommodate the cervix.
▪ From the bridge of the nose up until
the anterior fontanel is considered
as the sinciput presentation.
▪ From the anterior fontanel to the
prominent part of the occiput is the
vertex
▪ From the prominent part of occiput
up to the base of the occiput –
occiput of the baby
▪ Back of the fetal head up to the base
of the head is considered as the
occiput
▪ Mentum can be the presenting
part, it depends upon with the
degree of extension
▪ Vertex presentation – head is
completely flexed; Chin touches the
chest and it’s the most ideal type of
presentation, because the smallest
diameter of the fetal head which is
the suboccipitobregmatic 9.5 cm,
presented in posterior fontanel as
the presenting part.
▪ Sinciput presentation it occurs
when the head is partially flexed,
the anterior fontanel is the
presenting part. The occipitofrontal
diameter which is 12 cm is
presented for delivery. It also
called as the military position
because it gives an appearance of a
military person at attention.
 NCMA 217 WEEK 7: INTRAPARTAL CARE
▪ Brow presentation, it occurs when
the head is extended and
backward causing the
occipitomental diameter to be
presented for delivery.
▪ Face presentation it occurs when
the head is sharply extended
causing the occiput to come in
contact with the back of the fetus.
▪ Chin presentation or mentum it
occurs when the head
hyperextended with the chin as the
presenting part.
2. Breech Presentation - A breech
presentation means that either the
buttocks or the feet are the first body
parts that will contact the cervix. Breech
presentations occur in approximately
3% of births and are affected by fetal
attitude. A good attitude brings the
fetal knees up against the fetal
abdomen; a poor attitude means that
the knees are extended. Breech
presentations can be difficult births,
with the presenting point influencing
the degree of difficulty.
→ Three types of breech
presentation
(Complete, frank, and footling) are
possible.
▪ Complete breech – leg folded with
feet at the level of the baby’s
bottom
▪ Footling breech – one or both feet
point down so the legs would
emerge first
▪ Frank breech – Leg points up with
feet by the baby’s head so the
bottom emerges first.
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
3. Shoulder Presentation - In a
transverse lie, a fetus lies horizontally in
the pelvis so that the longest fetal axis is
perpendicular to that of the mother. The
presenting part is usually one of the
shoulders (acromion process), an iliac
crest, a hand, or an elbow.
is
FETAL POSITION
• Position is the relationship of the
presenting part to a specific quadrant of
a woman’s pelvis.
• For convenience, the maternal pelvis is
divided into four quadrants according to
the mother’s right and left:
• (a) right anterior,
• (b) left anterior,
• (c) right posterior,
• (d) left posterior.
POSSIBLE FETAL POSITION
• Vertex Presentation (occiput) –
LOA, left occipitoanterior
LOP, left occipitoposterior
LOT, left occipitotransverse,
ROA, right occipitoanterior
ROP, right occipitoposterior
ROT, right occipitotransverse
 NCMA 217 WEEK 7: INTRAPARTAL CARE
▪ Occiput, Sacrum, mentum &
acromion process – fetal point of
direction
▪ First letter indicates whether the
occiput or the fetal points of
direction or denominator of the
baby is in the left of the mother
▪ The “A” in Occiput whether in
anterior part of the mother
▪ When we say fetal points of
direction, this is the point of the
presenting part that is used to
orient into the maternal pelvis
▪ LOA – the occiput of the baby is at
the left side of the baby in anterior
in the mother’s pelvis

• Breech Presentation (sacrum)

LSaA – left sacroanterior
LSaP – left sacroposterior
LSaT – left sacrotransverse
RSaA – right sacroanterior
RSaP – right sacroposterior
RSaT – right sacrotransverse

▪ Sacrum is at the left side of the

mother and it is the anterior LSaA
▪ Sacrum of the baby is at the left
side of the mother and in posterior
part LSaT
• Face Presentation (Mentum)
LMA – left mentoanterior
LMP – left mentoposterior
LMT – left mentotransverse
RMA – right mentoanterior
RMP – right mentoposterior
RMT – right mentotransverse
• Shoulder Presentation (acromion
process)
LAA – left scapuloanterior
LAP – left scapuloposterior
RAA – right scapuloanterior
RAP – right scapuloposterior
MECHANISM OF LABOR
(CARDINAL MOVEMENTS)
• Passage of a fetus through the birth
canal involves several different position
changes to keep the smallest diameter
of the fetal head (in cephalic
presentations) always presenting to the
smallest diameter of the pelvis.
• These position changes are termed the
cardinal movements of labor:
• descent, flexion, internal rotation,
extension, external rotation, and
expulsion.

ANNOTATED BY: JULIANA EDERA & CHESKA DANTING

 NCMA 217 WEEK 7: INTRAPARTAL CARE
● Descent is the downward movement of
the biparietal diameter of the fetal head
to within the pelvic inlet. Full descent
occurs when the fetal head extrudes
beyond the dilated cervix and touches the
posterior vaginal floor.
● Occurs because of pressure on the fetus
by the uterine fundus. The pressure of the
fetal head on the sacral nerves at the
pelvic floor causes the mother to
experience a pushing sensation. Full
descent may be aided by abdominal
muscle contraction as the woman pushes.
▪ In primipara the descent usually
occurs with lightening in about 2
weeks before the labor onset
▪ In multipara the descent usually
takes place with engagement at
the start of labor
● Flexion. As descent occurs and the fetal
head reaches the pelvic floor, the head
bends forward onto the chest, making the
smallest anteroposterior diameter (the
suboccipitobregmatic diameter) present
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
to the birth canal. Flexion is also aided by
abdominal muscle contraction during
pushing.
▪ It measures 9.5 cm
▪ Kapag ang fetal bumababa deeper
into the pelvis, nakaka meet siya ng
resistance simula cervix, pelvic
floor or wall of the pelvis. This
resistance causes for the head of
the baby to flex in order for the chin
to brought close contact with the
chest.
● Internal Rotation. During descent, the
head enters the pelvis with the fetal
anteroposterior head diameter
(suboccipitobregmatic, occipitomental, or
occipitofrontal, depending on the amount
of flexion) in a diagonal or transverse
position.
▪ Kapag ang head na reach na reach
ang level of the ischial spine it will
rotate from transverse diameter to
AP diameter so that its largest
diameter is presented to the largest
diameter of the outlet.
▪ This movement will allow the head
to pass through the outlet
● The head flexes as it touches the pelvic
floor, and the occiput rotates to bring the
head into the best relationship to the
outlet of the pelvis (the anteroposterior
diameter is now in the anteroposterior
plane of the pelvis). This movement brings
the shoulders, coming next, into the
optimal position to enter the inlet, putting
the widest diameter of the shoulders (a
transverse one) in line with the wide
transverse diameter of the inlet.
 NCMA 217 WEEK 7: INTRAPARTAL CARE
● 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.
▪ The combine forces of uterine
contraction, pushing effort of the
mother and the resistance sa pelvic
floor that causes for the head to
extend towards the vaginal
opening. As the head extends, the
chin is lifted up and it’s born
● External Rotation. In 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.
▪ Kapag lumabas na yung head
yung shoulder which enter the
pelvis ay naka transverse position
and it will turn into AP diameter
position for it to become in line
with the anteriorposterior
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING
diameter of the outlet and be able
to pass through the pelvis
● This brings the aftercoming shoulders into
an anteroposterior position, which is best
for entering the outlet. The anterior
shoulder is born first, assisted perhaps by
downward flexion of the infant’s head.
● Expulsion. Once the shoulders are born,
the rest of the baby is born easily and
smoothly because of its smaller size. This
movement, called expulsion, is the end of
the pelvic division of labor
POWERS OF LABOR
● The second important requirements for a
successful labor are effective powers of
labor. This is the force supplied by the
fundus of the uterus, implemented by
uterine contractions, a natural process that
causes cervical dilatation and then
expulsion of the fetus from the uterus.
After full dilatation of the cervix, the
primary power is supplemented by use of
the abdominal muscles. It is important for
women to understand they should not bear
down with their abdominal muscles until
the cervix is fully dilated. Doing so
impedes the primary force and could cause
fetal and cervical damage.
● Uterine Contraction - The mark of effective
uterine contractions is rhythmicity and
progressive lengthening and intensity.
● Phases - A contraction consists of three
phases: the increment, when the intensity
of the contraction increases; the acme,
when the contraction is at its strongest;
and the decrement, when the intensity
decreases
 NCMA 217 WEEK 7: INTRAPARTAL CARE
Power - This is the force supplied by the fundus
of the uterus, implemented by uterine
contractions, a natural process that causes cervical
dilatation and then expulsion of the fetus from the
uterus.
Psyche - refers to the psychological state or
feelings that a woman brings into labor.

● Cervical Changes – Even more marked

than the changes in the body of the uterus
are two changes that occur in the cervix:
effacement and dilatation.
○ Effacement - it is shortening and
thinning of the cervical canal.
Normally, the canal is
approximately 1 to 2 cm long. With
effacement, the canal virtually
disappears.
○ Dilatation refers to the
enlargement or widening of the
cervical canal from an opening a
few millimeters wide to one large
enough (approximately 10 cm) to
permit passage of a fetus

The fourth “P,” or a woman’s psychological

outlook, refers to the psychological state or
feelings that a woman brings into labor. For many
women, this is a feeling of apprehension or fright.
For almost everyone, it includes a sense of
excitement or awe.

TERMINOLOGIES
Passenger - The passenger is the fetus.
Passage - refers to the route a fetus must travel
from the uterus through the cervix and vagina to
the external perineum
ANNOTATED BY: JULIANA EDERA & CHESKA DANTING