MATERNAL & FETAL RESPONSES DURING LABOR

PSYSIOLOGIC EFFECTS OF LABOR ON 5. Fluid Balance

THE MOTHER ● increase in rate and depth of
respirations (which causes
1. Cardiovascular System moisture to be lost with each
● Labor involves strenuous breath) and diaphoresis,
work and effort, causing an insensible water loss
increase in increases during labor.
cardiac output ● affected by the withholding of
blood pressure oral intake to only sips of
pulse rate. fluid or ice cubes or hard
candy.
2. Hemopoietic System ● The combination of
● leukocytosis or a sharp increased losses and
increase in the number of decreased intake
circulating white blood cells, ● intravenous fluid replacement
● At the end of labor, the necessary if labor is
average woman has a white prolonged
blood cell count of
25,000/mm3 to 30,000/mm3 6. Urinary System
cells (normal of 5,000/mm3 ● kidneys begin to concentrate
to 10,000/mm3 urine to preserve both fluid
and electrolytes.
3. Respiratory System ● Specific gravity: high normal
● hyperventilation. level of 1.020 to 1.030.
● Using appropriate breathing ● not unusual for protein (trace
patterns helps to avoid to 1+)
severe hyperventilation. ● reduce bladder tone or the
● Total oxygen consumption ability of the bladder to sense
increases about 100% during filling.
the second stage of labor.
● comparable to that of a 7. Musculoskeletal System
person performing a ● relaxin
strenuous exercise such as ● A week before labor,
running. considerable additional
softening causes the
4. Temperature Regulation symphysis pubis and
● slight elevation in sacral/coccyx joints to be
temperature. even more relaxed and
● Diaphoresis movable, allowing them to
stretch apart to increase the
 size of the pelvic ring by as
much as 2 cm.
● increased back pain or
irritating nagging pain at the
pubis as the woman walks or
turns in labor
8. Gastrointestinal System
● fairly inactive during labor.
● probably due to the shunting
of blood to more
life-sustaining organs and
also to pressure on the
stomach and intestine from
the contracting uterus.
● Digestive and emptying time
of the stomach is prolonged
● some experience a loose
bowel movement
9. Neurologic and Sensory Responses
● responses related to pain
(increased pulse and
respiratory rate).
➢ Early in labor= registered in uterine
and cervical nerve plexuses (at the
level of the 11th and 12th thoracic
nerves).
● At birth, the pain is centered
on the perineum as it
stretches to allow the fetus to
move past it.
● Perineal pain is registered at
S2 to S4 nerves
FETAL RESPONSES TO LABOR
1. Neurologic System
● Uterine contractions exert
pressure on the fetal head,
so the same response
involved with that of any
instance of increased
intracranial pressure occurs.
● The fetal heart rate (FHR)
decreases by as much as 5
bpm during a contraction as
soon as contraction strength
reaches 40 mm Hg. This
decrease appears on a fetal
heart monitor as an early
deceleration pattern.
2. Cardiovascular System
● unaffected by the continual
variations of heart rate that
occur with labor—a slight
slowing and then a return to
normal (baseline) levels.
● During a contraction, the
arteries of the uterus are
sharply constricted
● nutrients, including oxygen,
exchanged during this time is
reduced, causing fetal
hypoxia.
● Increased intracranial
pressure from uterine
pressure on the fetal head
serves to keep circulation
from falling below normal
during the duration of a
contraction.
3. Integumentary System
petechiae or ecchymosis
caput succedaneum
cephalhematoma
4. Musculoskeletal System
full flexion.
5. Respiratory System
● The process of labor appears
to aid in the maturation of
 surfactant production by
meconium loss, it should always
alveoli in the fetal lung. be reported immediately so its
● The pressure applied to the cause can be investigated.
chest from contractions and
passage through the birth
canal clears it of lung fluid.
3. Hyperactivity
● Ordinarily, a fetus is quiet
FETAL DANGER SIGNS
and barely moves during
labor.
1. High or Low Fetal Heart Rate.
● Fetal hyperactivity may be a
● FHR of more than 160 bpm
sign that hypoxia is occurring
(fetal tachycardia) or less
because exertion is a
than 110 bpm (fetal
common reaction to the need
bradycardia) is a sign of
for oxygen.
possible fetal distress.
● An equally important sign is
4. Fetal Acidosis.
a late or variable
● scalp capillary technique, the
deceleration pattern on the
finding of acidosis (blood pH
fetal monitor.
below 7.2) is a certain sign
➢ The fetal heart rate may return to a
that fetal well-being is
normal range in between these
becoming compromised
irregular patterns and give a false
sense of security if FHR is assessed
MATERNAL DANGER SIGNS
only between contractions
1. Rising or Falling Blood Pressure
2. Meconium Staining.
● Normally, rises slightly in the
● a green color in the amniotic
second (pelvic) stage of labor
fluid, is not always a sign of
due to her pushing effort.
fetal distress but is highly
● A systolic pressure greater
correlated with its
than 140 mm Hg and a
occurrence.
diastolic pressure greater
● It reveals that the fetus has
than 90 mm Hg, or an
had an episode of loss of
increase in the systolic
sphincter control, allowing
pressure of more than 30
meconium to pass into the
mm Hg and a diastolic
amniotic fluid.
pressure of more than 15
NOTE: mm Hg (the basic criteria for
● It may indicate that the fetus has pregnancy-induced
or is experiencing hypoxia, which hypertension), should be
stimulates the vagal reflex and
reported.
leads to increased bowel motility.
● meconium staining may be normal
in a breech presentation, as NOTE:
pressure on the buttocks causes ● falling blood pressure - the first

sign of intrauterine hemorrhage.
● A falling blood pressure is often
associated with other clinical signs
of shock such as apprehension,
increased pulse rate, and pallor.
2. Abnormal Pulse.
● Most pregnant women have
an average pulse rate of 70
to 80 bpm.
● Pulse normally increases
slightly during the second
stage of labor due to the
exertion involved.
● A maternal pulse greater
than 100 bpm during the
normal course of labor is
unusual and should be
reported.
● It may be another indication
of hemorrhage.
3. Inadequate or Prolonged
Contractions.
● Uterine contractions normally
become more frequent,
intense, and longer as labor
progresses.
● If they become less frequent,
less intense, or shorter in
duration, this may indicate
uterine exhaustion (inertia).
● cannot be corrected, a
cesarean birth may be
necessary.
● A period of relaxation must
be present between
contractions
● uterine contractions lasting
longer than 70 seconds
should be reported because
contractions of this length
may begin to compromise
fetal well-being by interfering
with adequate uterine artery
filling.
4. Pathologic Retraction Ring.
● An indentation across the
woman’s abdomen where the
upper and lower segments of
the uterus join may be a sign
of extreme uterine stress and
possible impending uterine
rupture.
● For this reason, it is
important to observe the
contours of the abdomen
periodically during labor.
● Fetal heartbeat auscultation
automatically provides a
regular opportunity to assess
the woman’s abdomen.
● If an electronic monitor is in
place, it is necessary to
make this observation
deliberately.
5. Abnormal Lower Abdominal Contour.
● A full bladder during labor
may be manifested as a
round bulge on the lower
anterior abdomen.
➢ This is a danger signal for two
reasons:
first, the bladder may be
injured by the pressure of the
fetal head
second, the pressure of the
full bladder may not allow the
fetal head to descend
6. Increasing Apprehension.
● Warnings of psychological
danger during labor
● A woman who is becoming
increasingly apprehensive
despite clear explanations of
 unfolding events may only be 4. Abdominal muscle contractions
approaching the second ● Prevents constipation
stage of labor. ● Restore abdominal tone
● Strengthen abdominal
muscles
● She may, however, not be
● Effective in the 2nd stage
“hearing” because she has a
–pushing during labor
concern that has not been met.
● Using an approach such as, “You
5. Pelvic rocking
seem more and more concerned.
● Helps relieve backache
Could you tell me what is worrying
● Done 5 x
you?” may be helpful.

● Increasing apprehension also METHODS FOR PAIN MANAGEMENT

needs to be investigated for
physical reasons because it 1. Bradley ( Partner-coached)method
can be a sign of oxygen ● Develop by Robert Bradley
deprivation or internal ● Stresses the important role of
hemorrhage. husband during pregnancy,
labor and early newborn
period.
PREPARATION FOR CHILDBIRTH AND ➢ Pain is reduced in labor by :
PARENTING abdominal breathing
walking during labor

PERINIAL AND ABDOMINAL EXERCISES

2. Psychosexual method
● Develop by Shiela Kitzinger
1. Tailor sitting
● Stresses that pregnancy ,
● Done 15 minutes/day
labor and birth and early
newborn period are important
2. Squatting
points in the woman’s life
● Stretches perineal muscles
cycle.
● Useful position in the 2nd
● Includes programs of
stage of labor
contentious relaxation and
● Done 15 minutes/day
levels ofbreathing that
encourages woman to flow
3. Pelvic floor contraction (kegel
with rather than struggle
exercise)
against contractions.
● Muscle strengthening,
promote perineal healing,
3. Dick-Read Method
increased sexual
● Propose by Grantly
responsiveness, prevents
Dick-Read
stress incontinence
● Fear leads to tension
 ● Reduced pain by using
abdominal breathing during
contraction
4. Lamaze method
● By Ferdinand Lamaze
● Based on the theory that
through stimulus response
conditioning women can
learn to use controlled
breathing and therefore
reduces pain during labor.
➢ Psychoprophylactic method =
preventing pain labor ( prophylaxis)
by the use of the mind ( psyche)
● Helps the woman to relax
and to make labor
manageable exercise
NONPHARMACOLOGIC TECHNIQUE
FOR PAIN RELIEF IN LABOR
1. Conscious relaxation
● learning to relax body
portions for the woman no to
be tense and cause
unnecessary muscle strain
and fatigue.
2. Consciously controlled breathing
● set breathing patterns at
specific rates
● prevents putting pressure to
the growing uterus
● inhales and exhales
3. Effleurage
● Light abdominal massage
● Serves as distraction
technique and decreases
sensory stimuli transmission
from the abdominal wall
● Helping limit local discomfort
4. Focusing, imagery
● Focusing intently on an
object
● Sensate focus
● Using a picture of her partner
or children, concentrates on
looking at the picture during
contraction
● Don’t ask question during
concentration
5. Hydrotherapy
ALTERNATIVE METHODS OF BIRTH
1. Leboyer method
● Birthing room is dark to
prevent sudden contrast of
light, warm , with soft music
playing.
● Infant should be handles
gently
● Cord is cut late
● Infant is placed immediately
into a warm water bath
2. Hydrotherapy and water birth
● Baby is born under water and
immediately brought to the
surface for the first breath