INTRAPARTAL CARE
LABOR
-care during labor and delivery
LABOR – series of event by which uterine
contraction and abdominal pressure expel a fetus
and placenta from the woman’s body
THEORIES OF LABOR ONSET
1. FETAL ADRENAL RESPONSE THEORY
- fetal adrenal release fetal cortisol that can
increase prostaglandin formation which
initiates contractions.
2. OXYTOCIN SIMULATION THEORY
- oxytocin production by the posterior
pituitary gland increase while the production
of oxytocinase decreases.
3. UTERINE STRETCH THEORY
- any hollow muscular organ when stretched
to capacity will contract and empty.
4. PROGESTERONE DEPRIVATION
THEORY
- as pregnancy nears term, the production of
progesterone by the placenta decreases.
5. PROSTAGLANDIN THEORY
- during labor, the level of arachidonic acid
in the amniotic fluid is very high resulting in
increased production of prostaglandin.
6. THEORY OF THE AGING PLACENTA
- as the placenta ages, it becomes less
efficient producing decreased amount of
progesterone which allows for the
concentration or prostaglandin and estrogen
to rise steadily
SIGNS OF LABOR
Descent
Opening of the cervical os (opening)
Softening of cervix
Contraction of uterus
Rupture of membrane
Effacement (thinning and shortening of cervix)
Apprehension
Mucus plug expulsion
COMPARISON OF FALSE AND TRUE
FALSE LABOR
1. No increase in intensity, duration, and
frequency of contraction
2. Contractions disappear with ambulation of
sleep
3. Discomfort remains in the abdomen
4. Absence of cervical dilation
5. Absence of show
TRUE LABOR
1. Uterine contractions increase in intensity
duration and frequency.
2. Continue no matter what level and activity
3. Discomfort radiates to the lower back and
lumbosacral area
4. Progressive cervical dilation
5. Presence of show
STAGES OF LABOR
1st Stage: Cervical Stage
- Period from the onset of true labor contraction
until full dilatation & effacement is achieved
3 Phases
1. Latent phase
-cervical dilatation: 0-3cm
2. Active phase
- cervical dilatation: 4-7 cm
- lasts approximately 6 hrs
- uterine contractions are moderate,
3-5 min apart, & last 40-60 sec
3. Transition phase
- cervical dilatation: 8-10 cm
- lasts 1-2 hrs
- uterine contractions are strong, 2-3
min apart and last 60-70 sec
2nd Stage: Expulsive Stage
- occurs from full cervical dilatation until the birth
of the baby
3rd Stage: Placental Stage
- period from delivery of the baby to the expulsion
of the placenta
Types of Pelvis
4th Stage: Immediate Postpartum Period 1. Gynecoid
- period from delivery of placenta until the  female type of pelvis
condition of the woman has stabilized  inlet is round shaped, straight side
walls, with transverse diameter larger
than anteroposterior diameter, has a
wide pubic arch.
2. Android
 male type of pelvis
 AP diameter is wider than its transverse
diameter
3. Anthropoid
 deepest type of pelvis
 inlet is oval shaped with AP diameter
wider than transverse diameter
4. Platypelloid
 flat pelvis
 transverse diameter is wider than AP
diameter

DURATION OF LABOR
Stage of Primis Multi
Labor

1st Stage 10-12 hrs 6-8 hrs

2nd Stage 30 mins- 2 hrs 20-90 mins

3rd Stage 5-20 mins 5-20 mins

4th Stage 2-4 hrs 2-4 hrs

Essential Factors of Labor
Passages
hard passages: bony pelvis
soft passages: lower uterine segment, cervix,
vagina, pelvic floor & perineum
Functions of the pelvis:
1. Provides protection to the in the pelvic
cavity. organs found
2. Provides attachment to muscle, fascia &
ligaments.
3. Supports the uterus during pregnancy.
4. Serves as birth canal.
Passenger
- Head of the fetus is the most important part of its
body because:
1. Being the largest part of the fetal body, it is the
part that would most like encounter difficulty during
delivery.
2. It is always the presenting part so its
measurements, position & presentation are
important factors that affect labor outcome.
3. It is the least compressible of all fetal parts.
Cranial Bones of the fetal skull
1 frontal bone, one occipital bone 2 parietal bones,
one sphenoid bone 2 temporal bones, one ethmoid
bone
 Attitude
Suture Lines
- Describe the degree of flexion a fetus assumes
1) Sagittal > located between 2 parietal bones during labor or the relation of the fetal parts to each
2) Frontal > located between 2 frontal bones other

3) Coronal > located between frontal and parietal  Good attitude> in complete flexion
bones  Moderate flexion > chin is not touching the
chest
4) Lambdoidal > located between parietal &
 Partial extension > poor flexion, the back is
occipital bones
arched, the neck is extended
 Complete extension > presents
Fontanels occipitomental diameter of the head to the
birth canal
- Are membrane covered spaces located between the
intersections of suture lines
Presentation
1. Anterior fontanel - Determined by fetal lie and attitude
- formed by the intersection of the sagittal, frontal &
coronal sutures Types of Fetal Presentation
1. Cephalic Presentation
2. Posterior fontanel
a) Vertex presentation
- formed by the intersection of sagittal &
- occurs when the head is completely flexed
lambdoidal sutures
that the chin touches the chest
- most ideal type of presentation
Fetal Lie - occipitobregmatic part is presented
- presenting part is posterior fontanel
-Refers to the relationship of the long axis of the
fetus to the long axis of the mother
b) Sinciput presentation
a) Longitudinal Lie
- occurs when the head is partially flexed
- long axis of the fetus is parallel to the long axis of & the anterior fontanel is the presenting
the mother part
b) Transverse Lie c)Brow presentation
- long axis of the fetus is at right angle to the long - occurs when the head is extended or bent
axis of the mother backward causing the occipitomental
diameter to be presented for delivery
c) Oblique Lie
- fetus assuming this lie usually rotates to transverse d) Face presentation
or longitudinal lie during labor
- occur when the head is sharply extended
causing the occiput to come in contact
with the back of the fetus

e) Chin presentation
- occur when the head is hyperextended
with the chin as the presenting part

2. Breech
- feet or buttocks come out first during delivery
a) Complete breech
b) Frank breech
c) Footling
 5. Expulsion

Person in Labor
- Maternal attitude and behavior
during labor depend on:
1. Perception and meaning of childbirth
2. Readiness & preparation for childbirth
3. Past experiences
4. Coping skills
5. Cultural & social background
3. Shoulder presentation 6. Presence of significant others & support
system
> fetus is lying perpendicular to the long axis of the
mother & the shoulder is the presenting part
Powers of Labor

Causes Primary power: Uterine Contractions

1. Relaxed abdominal walls due to grand Characteristics:

multiparity 1. Involuntary
2. Pelvic contraction
3. Placenta previa 2. Intermittent
4. Compound presentation - occurs when there 3. Involve discomfort
is prolapse of the fetal hand alongside the a) compression of nerve ganglia in the
vertex, breech or shoulder cervix
b) stretching of the cervix during
dilatation
Attitude c) stretching of the peritoneum overlying
- Refers to the degree of flexion of the fetal body, d) the uterus
head & extremities, or the relationship of fetal parts e) hypoxia of the contracted
to each other myometrium
f) stretching of ligaments

Station
Phases of Uterine Contractions
- Relationship of the presenting part of the fetus to
an imaginary line drawn at the level of the ischial
spines of the mother 1. Increment
- the time when contraction is starting, and
intensity is building up
2. Acme
- peak of contraction
3. Decrement
- the time when muscle start to relax

Intensity
- Refers to the strength of uterine contractions

Classifications:
1. Mild> slightly tense fundus that is easy to
Mechanisms of Labor indent with fingertips
1. Engagement, descent with flexion 2. Moderate > firm fundus that is difficult to
2. Internal rotation indent with fingertips
3. Extension
4. External rotation 3. Strong> rigid boardlike fundus
 4. Active phase
Frequency
5. Transitional phase
Measured from the beginning of a contraction to the
beginning of the next
1. Latent phase
a) establish rapport
Duration b) encourage verbalization of feelings
Measured from the beginning of contraction to the c) promote comfort & relief measures
end of the same contraction
2. Active phase
Interval a) coach woman on breathing & relaxation
techniques
Measured from the end of a contraction to the
b) inform the patient of the progress of labor
beginning of the next contraction
& well-being of the fetus
c) discourage the woman from bearing down
Secondary Forces d) let woman stay in bed if BOW has ruptured
The force created by increased intra- abdominal e) provide relief measures
pressure which is achieved when the mother “bears
down” or “pushes”
3. Transition Phase
a) reassure woman that although this the most
Position difficult period of labor, this is also the
shortest.
1. Lithotomy b) do not give narcotics
Indication: used when surgical procedures are to be c) discourage bearing down
performed d) do not let woman fall asleep

Advantage: control of delivery because perineum

can be seen Internal examination
Disadvantage: muscle strain when legs are Purpose:
improperly placed on the stirrups
To assess status of amniotic fluid, consistency of
cervix, effacement, dilatation, presentation, station,
& obtain pelvic measurement.
2. Dorsal recumbent
Indication: home delivery Guidelines when doing I.E.
Advantage: good control of delivery because 1. It is performed in between contractions
perineum can be seen when the uterus is relaxed.
Disadvantages: may be uncomfortable 2. Less IE is done once membranes have
ruptured.
3. Side-Lying
3. IE is not done in the presence of vaginal
Indication: heart disease
bleeding & cord prolapse.
Advantages: increase comfort to mother
4. IE is a sterile procedure, wash hands and
Disadvantages:
5. Wear sterile gloves.
1. less control of delivery 6. Place patient in dorsal recumbent position.
2. an assistant is needed during IE
for escaping fluid & cord
Responsibilities of Nurses During Labor prolapse before inserting fingers
insert middle and index finger
First Stage of Labor is divided into 3 Phases
assess cervical consistency
3. Latent phase
assess effacement
 assess dilatation
3. Too Long Labor

EXERCISE DURING PREGNANCY

1. Prenatal Yoga
2. Perineal and Abdominal Exercises
3. Tailor Sitting
4. Squatting
5. Kegel Exercises
6. Pelvic Rocking

Danger Signs during Labor

POSTPARTAL PERIOD
- Refers to the 6-week period after birth
1. Water breaks but labor does not
PUERPERIUM
Start
- Borrowed from Latin puerperium (“childbed,
- Most women will start labor within 24 hours after
childbirth”), from puerpera (“woman in labor or
their waters break. If labor has not started after I day
childbed”) + -ium (nominal suffix), from puerperus
and I night, the woman and her baby could get a
(“parturient, bringing forth children”), from puer
serious infection.
(“child, boy”) + pariō (“to bring forth, bear”) + -us
What to do? (adjectival suffix).
Mother must not put anything in the vagina

- If she has a fever or there is a bad smell in Behavioral Adjustment: Phases of the
the vagina, an infection is starting. She Puerperium
needs intravenous (IV) antibiotics. Even if
1. Taking-in Phase
labor starts, the woman and her baby could
die. Go to a health center or hospital. Largely a time of reflection
- Try to get labor started. The woman should
2. Taking-Hold Phase
swallow 2 tablespoons of castor oil, roll her
nipples, or have someone suck them for a A woman begins to initiate action

while every few hours until labor starts 3. Letting-Go Phase

A woman finally redefines her new role

2. Baby Lying Sideways

- A baby lying sideways cannot be born without an

operation. Development of Parental Attachment, Bonding,
and Positive Family Relationship
What to do?
1. Rooming-In
Take the mother to the hospital
• Newborn remain at his/her mother 24/7
 2. Visitation •Hydronephrosis or increase size of ureters remains
present for about 4 weeks

Maternal Concerns and Feelings in the

Postpartal Period Temperature

1. Abandonment May show a slight increase in temperature during

2. Disappointment the 24 hours after birth because of dehydration
3. Postpartal Blues

Pulse
Physiologic Changes of the Postpartal Period
• Rate during the postpartal period is usually
Uterus slightly lower than usual

Involves two process

1. The area where the placenta was implanted is Blood Pressure

sealed off
Oxytocic drugs can increase blood pressure
2. Reduced to its approximate pregestational size

Four Phases of Lactogenesis

Vagina
Lactogenesis I
After vaginal birth it feels soft, with few rugae and
• Milk Synthesis
it's diameter is considerably greater than normal
Begins around 16 weeks gestation
• Hymen is permanently torn
Lactogenesis II

Triggered at birth by the delivery of the

Perineum
placenta
• Edematous and tender immediately after birth
• Termed as “Transitional Milk”
• With Ecchymosis
• Occurs from birth to 5-10 days postpartum

Lactogenesis III
Hormonal System
• Can occur day 10 until weaning
• Pregnancy hormones begin to decrease as soon as postpartum
the placenta is no longer present
Lactogenesis IV

• Occurs after complete weaning and the

Urinary System breast involute to their prelactation state

•Extensive diaphoresis and diuresis begin almost

immdiately after birth
Nursing Interventions

- Provide Pain Reliefs

- Administer Cold and Hot Therapy
- Promote Perineal Exercises
- Give Episiotomy Care
- Provide Perineal Care
- Promote Rest
- Promote Adequate Fluid Intake
- Promote Urinary Elimination
- Prevent Constipation
- Assess Peripheral Circulation
- Prevent/Alleviate Breast Engorgement
- Teach Method to Promote Uterine
Involution (the process where the
reproductive organ return to its non-pregnant
stage)