SDM INSTITUTE OF NURSING

SCIENCES SATTUR, DHARWAD

CLINICAL SPECIALITY-1
OBSTETRIC AND GYNAECOLOGICAL
NURSING
UNIT-4
NORMAL LABOUR AND NURSING MANAGEMENT

SUBMITTED TO
Mrs. MRS. BIJLEE MUNDINMANI
ASST. PROFESSOR
HOD DEPT. OF OBSTETRIC &
GYNECOLOGICAL NURSING
SDM UNIVERSITY OF NURSING
SCIENCES, SATTUR, DHARWAD.

SUBMITTED BY:
MISS. SAVITA S. HANAMSAGAR
1ST YESR MSc. STUDENT
SDM UNIVERSITY OF NURSING
SCIENCES, SATTUR, DHARWAD.

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 SECOND STAGE OF LABOUR

TOPIC CONTENT

1. PHYSIOLOGY
2. INTRAPARUM MONITORING
3. NURSING MANAGEMENT
4. RESUSITATION
5. IMMEDIATE NEWBORN CARE AND INITIATE BREST FEEDING

(GUIDELINES OF NATIONAL NEONATOLOGY FORUM OF INDIA)

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 SECOND STAGE OF LABOUR
 PHYSIOLOGY:

The second stage is that of expulsion of the fetus. It begins when the cervix is fully dilated
and the woman feels the urge to expel the baby. It is complete when the baby is born. So, this
stage is concerned with the descent and delivery of the fetus through the birth canal. Its
average duration is 2 hours in primigravidae and 30 minutes in multipara.

EVENTS IN SECOND STAGE OF LABOUR

Second stage has two phases:

1. Propulsive – From full dilatation until head touches the pelvic floor.

2. Expulsive – Since the time mother has irresistible desire to bear down and push until the
baby is delivered.

 CLINICAL COURSE OR PHYSIOLOGY OF SECOND STAGE OF LABOUR

 Second stage begins with full dilatation of the cervix and ends with expulsion of the
fetus.
 Pain The intensity of the pain increases. The pain comes at intervals of 2-3 minutes
and lasts for about 1- 11/2 minutes. It becomes successive with increasing intensity in
the second stage.
 Bearing down efforts It is the additional voluntary expulsive efforts that appear during
the 2nd stage of labour. It is initiated by nerve reflex (Ferguson Reflex) set up due to
stretching of the vagina by the presenting part. In majority, this expulsive effort start
spontaneously with full dilatation of the cervix. Along with uterine contraction, the
woman is instructed to exert downward pressure as done during straining at stool.
Sustained pushing beyond the uterine contraction is discouraged. Premature bearing
down efforts may suggest uterine dysfunction. There may be slowing of FHR during
pushing and it should come back to normal once the contraction is over.
 Membrane status Membranes may rupture with a gush of liquor per vaginam. Rupture
may occasionally be delayed till the head bulges out through the introitus. Rarely,

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 spontaneous rupture may not take place at all, allowing the baby to be “ born in a
caul”.
 Maternal signs There are features of exhaustion. Respiration is, however, slowed
down with increased perspiration. During the bearing down efforts, the face becomes
congested with neck veins prominent. Immediately following the expulsion of the
fetus, the mother heaves a sigh of relief.
 Fetal effects Slowing of FHR during contractions is observed which comes back to
normal before the next contraction.

MECHANISM OF NORMAL LABOUR

The series of movements teat occur on the head in the process of adaptation, during its
journey through the pelvis, is called mechanism of labour.

Principles of mechanism of labour

1. Descent takes place throughout labour.

2. Whichever part leads and first meets the resistance of the pelvic floor will rotate forward
until it comes under the symphysis pubis

3. Whatever emerges from the pelvis will pivot around the pubic bone.

MECHANISM

The series of movements that occur on the head in the process of adaptation, during its
journey through the pelvis, is called mechanism of labour.

Presentation- cephalic

Lie- longitudinal

Attitude- flexion

Presenting part- vertex

Position- ROA or LOA

In normal labour, the head enters the brim more commonly through the available transverse
diameter (70%) and to a lesser extend through one of the oblique diameters. Left occipito –
anterior is little commoner than right occipito –anterior as the left oblique diameter is
encroached by the rectum .the engaging antero-posterior diameter of the head is either

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subocciopito bregmatic 9.5 cm or in slight deflexion the subocciopito frontal 10 cm.The
engaging transverse diameter is biparietal 9.5 cm. As the occipito-lateral position is the
commonest, the mechanism of labor in such position will be described.

The principal movements are:

1. Engagement

2. Descent

3. Flexion

4. Internal rotation

5. Crowning

6. Extension

7. Restitution

8. External rotation and

9. Expulsion of the trunk.

Engagement:

The term 'Engagement' is used when the largest diameter of the fetal head is at the level of
the smallest diameter of the mother's pelvis. Head brim relation prior to the engagement it is
either deflected anteriorly towards the symphysis pubis or posteriorly towards the sacral
promontory. Such deflection of the head in relation to the pelvis is called asynclitism. When
the sagittal suture lies anteriorly, the posterior parietal bone becomes the leading presenting
part and is called posterior asynclitism or posterior parietal presentation.

Descent:

Descent is a continuous process when there is no undue bony or soft tissue obstruction. It is
slow or insignificant in 1st stage but pronounced in 2nd stage. It is completed with the
expulsion of the fetus. In primigravidae, with prior engagement of the head, there is
practically no descent in the first stage, while in multipara, descent starts with engagement.
Head is expected to reach the pelvic floor by the time the cervix is fully dilated.

Factors facilitating descent are:

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 Uterine contraction and retraction

 Bearing down efforts and

 Straightening of the fetal ovoid especially after rupture of membrane.

Flexion:

As the fetal vertex descents, it encounters resistance from the bony pelvis or the soft tissues
of the pelvic floor, resulting in passive flexion of the fetal occiput. The chin is brought into
contact with the fetal thorax and the presenting diameter changes from occipitofrontal (11.0
cm) to suboccipito bregmatic (9.5 cm) for optimal passage through the pelvis.

Internal rotation

As the head descends, the presenting part, usually in the transverse position, is rotated about
45° to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP
diameter of the head in line with the AP diameter of the pelvic outlet.

Crowning

After the internal rotation of the head, further descent occurs until the suboccipito lies
underneath the pubic arch. At this stage, the maximum diameter of the head (biparietal
diameter) stretches the vulval outlet without any recession of the head even after the
contraction is over called crowning.

Extension

Delivery of the head takes place by extension through “couple of force” theory. The driving
force pushes the head in a downward direction while the pelvic floor offers a resistance in
the upward and forward direction. The downward and upward forces neutralize head to be
born through the stretched vulval outlet are vertex, brow and face. Immediately following the
release of the chin through the anterior margin of the stretched perineum, the head drops
down, bringing the chin in close proximity to the maternal anal opening.

Restitution

It is the visible passive movement of the head due to untwisting of the neck sustained during
internal rotation. Movement of restitution occurs rotating the head through 1/8 th of a circle in
the direction opposite to that of internal rotation. The occiput thus points to the maternal
thigh of the corresponding side to which it originally lay.

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External rotation

It is the movement of rotation of the head visible externally due to internal rotation of the
shoulders. As the anterior shoulder rotates towards the symphysis pubis from the oblique
diameter, it carries the head in a movement of external rotation through 1/8 th of a circle in the
same direction as restitution. The shoulders now lie in the antero- posterior diameter. The
occiput points directly towards the maternal thigh corresponding to the side to which it
originally directed at the time of engagement.

Birth of shoulders and trunk

After the shoulders are positioned in antero-posterior diameter of the outlet, further descent
takes place until the anterior shoulder escapes below the symphysis pubis first. By a
movement of lateral flexion of the spine, the posterior shoulder sweeps over the perineum.
Rest of the trunk is then expelled out by lateral flexion.

Signs of Impending Birth

Specific behaviours may suggest that birth is imminent, such as:

Sitting on one buttock

Making grunting sounds

Involuntarily bearing down with contractions

Stating “the baby is coming”

Bulging of the perineum

If birth appears imminent, the nurse should not leave the woman alone, should prepare for
precipitate birth, and summon help with the call bell.

 INTRAPARTUM MONITORING:

Evaluation of progress of labour

Monitoring the progress of labour requires more than the assessment of cervical changes and
fetal descent. Vaginal examinations are only one method of measuring progress in labour.

When vaginal examinations are used, there are six ways to determine progress in labour: -

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the cervix moves from a posterior to an anterior position;

the cervix ripens or softens;

the cervix effaces; - the cervix dilates;

the fetal head rotates, flexes and moulds;

the fetus descends.

The tool used to measure labour in hospital settings is the portogram.

Aims

 To achieve delivery of a normal healthy child with minimal physical and

psychological maternal effects.
 Early anticipation, recognition and management of any abnormalities during labour
course.

Principles

1. To assist in the natural expulsion of the fetus slowly and steadily

2. To prevent perineal injuries.

General measures

 The patient should be in bed

 Constant supervision is mandatory and the FHR is recorded at every 5 minutes
 To administer inhalation analgesics, if available , in the form of gas N 2O and O2 to
relieve pain during contractions.
 Vaginal examination is done at the beginning of the second stage not only to confirm
its onset but to detect any accidental cord prolapsed. The position and station of the
head are once more to be reviewed and the progressive descent of the head is
ensured.

Preparation for delivery

Position – position of the woman during delivery may be lateral or partial sitting. Dorsal
position with 15o left lateral tilt is commonly favoured as it avoids aortocaval compression
and facilitates pushing effort.

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Positioning during labour

 Comfortable.
 Good use of gravity. Good resting position.
 Works well in hospital beds.
 Good visibility at birth for the support team.
 Easy access to fetal heart tones for health-care provider.
 Good for resting. Uses gravity.

Conduction of delivery

 The assistance required in spontaneous delivery is divided into 3 phases:

 Delivery of the head
 Delivery of the shoulders
 Delivery of the trunk
 Delivery of the head

Prevention of perineal laceration

 More attention should be paid not to the perineum but to the controlled delivery of
the head..
 To deliver the head in between contractions.
 To perform timely episiotomy.
 To take care during delivery of the shoulders as the wider bisacromial diameter
emerges out of the introitus.

EPISIOTOMY -

Defined as a surgically planned incision on the perineum and the posterior vaginal wall
during the second stage of labour. Also called perineotomy.

Objectives

To enlarge the vaginal introitus.

To minimize the overstretching and rupture of the perineal muscles and fascia.

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Indications

 Inelastic (rigid) perineum :causing arrest or delay in descent of the presenting part as
in elderly primigravidae.
 Anticipating perineal tear : big baby, face to pubis delivery, breech delivery, shoulder
dystocia.
 Operative delivery: forceps and ventose delivery.
 Previous perineal surgeries: pelvic floor repair, perineal reconstructive surgeries
Timing: it requires judgment. If done early, the blood loss will be more. If done late,
it fails to protect the pelvic floor. Bulging thinned perineum during contraction just
prior to crowning 9when 3-4 cm of head is visible) is the ideal time.

Advantages

Maternal :

A clear and controlled incision is easy to repair and heals better than a lacerated wound that
might occur otherwise. Reduction in the duration of second stage. Reduction of trauma to the
pelvic floor muscles

Fetal:

It minimizes intracranial injuries specially in premature babies or after coming head of

breech.

Types:

1. Mediolateral - the incision is made downwards and outwards from the midpoint of
the fourchette either to the right or left. It is directed diagonally in a straight line
which runs about 2.5 cm away from the anus.
2. Median – the incision commences from the centre of the fourchette and extends
posteriorly along the midline for about 2.5 cm.
3. Lateral – the incision stats from about 1 cm away from the centre of the fourchette
and extends laterally.

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 4. J shaped – the incision begins in the centre of the fourchette and is directed
posteriorly along the midline for about 1.5 cm and then directed downwards and
outwards along 5 or 7O’ clock position to avoid the anal sphincter.

Post operative care

- Dressing: the wound is to be dressed each time following urination and defecation to
keep the area clean and dry. The dressing is done by swabbing with cotton swabs
soaked in antiseptic solution followed by application of antiseptic powder or
ointment.

- Comfort: to relieve pain in the area, MgSO4 compress or application of infra-red heat
may be used. Ice packs reduces swelling and pain also. Analgesic drugs (ibuprofen)
may be given when required.

- Ambulance: the patient is allowed to move out of the bed after 24 hours. Prior to that,
she is allowed to roll over on to her side or even to sit but only with thighs apposed.

- Removal of stitches: when the wound is sutured by catgut or Dexon which will be
absorbed, the sutures need not be removed. But if non-absorbable material like silk or
nylon is used, the stitches are to be cut on 6 th day. The no-of stitches removed should
be checked with the record of the stitches given.

Complications

Immediate

1. Extension of incision

2. Vulval hematoma

3. Infection

4. Wound dehiscence

5. Injury to anal sphincter

Remote

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 1. Dyspareunia

2. Chance of perineal lacerations

3. Scar endometriosis (rare)

 RESUSCITATION:

Resuscitation is the process of correcting physiological disorders (such as lack of breathing or

heartbeat) in an acutely unwell patient. It is an important part of intensive care medicine,
trauma surgery and emergency medicine. Well known examples are cardiopulmonary
resuscitation and mouth-to-mouth resuscitation.

All babies must be assessed for need of resuscitation at birth:

 At least 1 person skilled in providing resuscitation must be present

 Ventilation must start within 1 minute of birth
 First golden minute
 Supplies and Equipment’s

Though the need for resuscitation can be anticipated in some situation, there are occasions
when a baby is born in poor condition without forewarning.

It is essential that resuscitation equipment’s are always available and in working order A

Indications:

 Infant apneic
 Heart rate less than 100bpm.

Procedure:

 The newborn should be on his/ her back with neck slightly extended.
 A tight seal to be formed over the infant’s mouth and nose:
 Ventilate at the rate of 40-50 per minute with 20-25 cm H2O pressure
 Ventilate for 15-30 seconds and evaluate
 Have an assistant to evaluate, listen to the heart rate for 6 seconds and multiply by 10

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Chest Compressions

Chest compressions consist of rhythmic compression of the sternum that compresses the heart
against the spine, increases the intrathoracic pressure and circulates blood to the vital organs.

Chest compressions must always be accompanied by ventilation with 100% oxygen to assure
that the circulating blood is well oxygenated.

Procedure

 Site: Lower third of the sternum below an imaginary line between the two nipples.
 Depth: Depress the sternum to a depth of 1/2 -3/4 inch at a rate of 100-120bpm.
 Rate: 100-120bpm. Coordinate heart compression with ventilation.
 Discontinue when infant can maintain heart rate above 80 by ventilation alone.

 IMMEDIATE CARE OF THE NEWBORN

The goals of care of the new born in the delivery room include the following:

 Soon after the delivery of the baby, it should be placed on a tray covered with clean
dry linen with the head slightly downwards.
 It facilitates drainage of the mucus accumulated in the trachea-bronchial tree by
gravity.
 The tray is placed between the legs of the mother and should be at a lower level than
the uterus to facilitate gravitation of blood from the placenta to the infant.

o Maintaining thermoregulation

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 Maintaining warmth of the new born is important because hypothermia (low body
temperature) forces the new born to use glucose to warm his or her body, thereby
causing hypoglycaemia (low blood sugar). Hypoglycaemia is associated with the
development of neurologic problems. Cold stress also causes an increase in the new-
born’s baseline metabolic rate (BMR) in an effort to warm the body. An increase in
the BMR results in increased oxygen consumption, which can lead to hypoxia (low
blood oxygen level). Therefore, once the baby is born, he or she is immediately dried
with a soft towel and placed on the back or side in a heated crib or radiant warmer,
with the neck slightly extended. A hat may be placed on the head after it is dried to
prevent heat loss from this large body surface area.

o Maintaining cardio respiratory function

The face is gently wiped to remove excess mucus and amniotic fluid. The new born
is an obligate nose breather and will not breathe through the mouth voluntarily if the
nose is obstructed. Therefore, nasal suction with a bulb syringe contributes to a clear
airway. Bulb suctioning of the mouth prevents aspiration of mucus and amniotic
fluid. Oxygen may be given as needed until the infant cries vigorously.

Acrocyanosis (a blue colour to the hands and feet of the new born) is normal because
of sluggish peripheral circulation for the first few hours after birth.

o An APGAR score is assigned at 1 and 5 minutes after birth. A score of 7 to 10

indicates a baby who has good cardio respiratory function with minimal bulb
suctioning assistance.

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 Catego 0 1 Point 2 Points
ry Points

Heart Absen <100 >100

Rate t

Respirat Absen Slow, Good,

ory t Irregula crying
Effort r

Muscle Flacci Some Active

Tone d flexion motion
of
extremi
ties

Reflex No Grimac Vigorou

Irritabili Respo e s cry
ty nse

Colour Blue, Body Comple

pale pink, tely
extremi pink
ties
blue

o Clamping and ligature of the cord –

 The cord is clamped by 2 Kocher’s forceps, the near one is placed 5cm away from the
umbilicus and is cut in between. 2 separate cord ligatures are applied with sterile cotton
threads1cm apart using reef-knot, the proximal one being placed 2.5 cm away from the
navel.
 Squeezing the cord with fingers prior to applying ligatures or plastic cord clamps,
prevents accidental inclusion of embryonic remnants
 The purpose of clamping the cord on the maternal end is to prevent soiling of the bed
with blood and to prevent fetal blood loss of the second baby in undiagnosed
monozygotic twin
 Delay in clamping for 2-3 minutes or till cessation of the cord pulsation facilitates
transfer of 80-100 ml blood from the compressed placenta to a baby when placed below
the level of uterus.
 This is beneficial to a mature baby but may be deleterious to a preterm or a low-birth-
weight baby due to hypervolaemia. But early clamping should be done in cases of Rh-

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 incompatibility (to prevent antibody transfer from the mother to the baby) or babies born
asphyxiated or one of a diabetic mother.

o Documenting urination/passage of meconium: The new-born cannot be discharged to

the home before patency of the gastrointestinal and genitourinary tracts are established. If
the new born urinates or passes meconium in the delivery room, it must be recorded in
the medical record.

o Administering vitamin K: Vitamin K is needed for blood clotting and is naturally

produced by the intestinal flora. However, the new-born has not yet established intestinal
flora and therefore is given an intramuscular dose of vitamin K (phytonadione) by 1 hour
of age before leaving the delivery room.

o Prophylactic eye care: All new-borns are given eye medication to protect against
ophthalmia neonatorum, which is caused by Neisseria gonorrhoea and Chlamydia
trachomatis.

 Promoting parent-new born bonding: As soon as the new-born is dry, warm, and
stable, he or she should be wrapped in a clean blanket and placed in the mother’s arms
Breastfeeding should be started if the mother desires. The alert period of the new-born in
this first period of reactivity lasts only 1 hour; the infant will then sleep for
approximately 4 hours. Therefore, every effort should be made to promote bonding as
soon as possible.

 Breastfeeding:

Help mother to initiate breastfeeding within first hour of birth.

Help mother at first feed.

Ensure

- Good position

- Good attachment

- Effective suckling

 NURSING MANAGEMENT OF PATIENT IN SECOND STAGE OF LABOUR

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 Never leave the patient alone once she has been transferred to the delivery room.

In addition, never turn your back on the perineum because the baby could push through the
vaginal opening while your back is turned.

 Encourage the patient to rest between contractions and to push with contractions.

Only one person should coach. Verbal encouragement and physical contact help reassure and
encourage the patient.

 Position the patient’s legs in the stirrups for the lithotomy position.

This is the most common position for delivery. Facilities using birthing beds have the patient
in an upright position. Positioning also depends upon the type of anaesthesia to be used and
C-section delivery. Each case may be different.

 Prepare the patient’s perineum.

A Betadine scrub and water are used. Clean the perineum by washing the pubic area, down
each thigh, down each side of the labia, down the perineum, and down the rectal area.
Discard used sponges after each wipe. Rinse area with the remaining solution.

 Monitor the patient’s blood pressure and the fetal heart beat every 5 minutes and
after each contraction.
 Breathing exercises

Rhythmic breathing during labour will maximise the amount of oxygen available to mother
and baby. Breathing techniques can also help to handle contractions and be more satisfied
with how mother coped with her labour.

When the contraction ends, relax your body and take one or two calming breaths.

 INFORMATION TO BE RECORDED ABOUT THE DELIVERY

1. Record the following information:

2. Exact date and time of delivery.

3. Sex of the infant.

4. Condition of the infant (APGAR) after birth.

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5. APGAR is the most widely used method of evaluating the condition of a new-born baby.
A value of 0 to 2 is given for each observation (i.e., heart rate, respiratory effort, muscle
tone, reflex irritability, and colour). The values are added giving a total APGAR score. A
baby in excellent condition would score 9 to 10 and a dead baby would score 0. Most
babies score 7 or better. The condition of the infant will be taken at one (1) minute, at five
(5) minutes, and at thirty (30) minutes

6. Position of the infant at delivery.

7. Type of episiotomy, lacerations.
8. Spontaneous or forceps delivery.
9. Use of oxygen and suction on the infant.
10. Number of vessels in the cord.
11. Mother’s name

NURSING DIAGNOSES

1. Acute pain related to effects of labour and delivery process.

2. Ineffective coping regarding fear, anxiety, and feelings of powerlessness.

3. Ineffective tissue perfusion (fetal) relating to impaired gas exchange during

labor and delivery process.

4. Risk for infection related to contamination.

COMPLICATIONS DURING SECOND STAGE OF LABOUR

Even if you’re healthy and well prepared for labour and giving birth, there’s always a chance
of unexpected difficulties.

Slow progress of labour

This could happen with a big baby, a baby that does not present normally or with a uterus
that does not contract appropriately. If the cervix is opening slowly, or the contractions have
slowed down or stopped doctor may say that you labour isn’t progressing. It’s good if patient
can relax and stay calm – anxiety can slow things down more. Give adequate psychological
and emotional support to patient.

The midwife or doctor may suggest some of the following:

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  Change to a position the patient is comfortable in

 Walk around – movement can help the baby to move further down, and encourage
contractions

 A warm shower or bath

 A back rub

 Have a nap to regain her energy

 have something to eat or drink.

 If progress continues to be slow doctor may suggest inserting an intravenous drip
with Syntocinon or Oxytocin to make contractions more effective. If the patient is
tired or uncomfortable, she can be given measures for pain relief.

When the baby is in an unusual position

Most babies are born head first, but some are in positions that may complicate labour and the
birth.

Posterior position

This means the baby’s head enters the pelvis facing the front instead of back. This can mean
a longer labour with more backache.

Breech birth

Multiple pregnancy

When there is more than one baby, labour may be preterm. When the last baby has been
born, the placenta (or placentas) is expelled in the usual way.

Concern about the baby’s condition

Sometimes there may be concerns that the baby is distressed during labour. Signs include:

 a faster, slower or unusual pattern to the baby’s heartbeat

 a bowel movement by the baby ( ‘meconium’ in the fluid around the baby).

If a baby is not coping well, its heart rate will usually be monitored. If necessary, the baby
will be delivered as soon as possible with vacuum or forceps (or perhaps by caesarean).

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Perineal tear

A perineal tear is a spontaneous (unintended) laceration of the skin and other soft tissue
structures which, in women, separate the vagina from the anus. The majority is superficial
and requires no treatment, but severe tears can cause significant bleeding, long-term pain or
dysfunction

Postpartum haemorrhage

It’s normal to bleed a little after the birth. Heavier than normal bleeding after birth is called
‘postpartum haemorrhage’. This is when loss of 500ml of blood or more. The most common
cause is the muscles of the uterus relaxing instead of contracting to prevent bleeding. An
oxytocin injection given after the birth of the baby helps the uterus push the placenta out and
reduces the risk of heavy bleeding. Nurse has to check uterus involution regularly after the
birth to make sure that it is firm and contracting. Postpartum haemorrhage can cause a
number of complications and may mean a longer stay in hospital. Some complications are
severe but they rarely result in death.

Retained placenta

Occasionally the placenta doesn’t come away after the baby is born, so the doctor needs to
remove it promptly. This is usually done with an epidural or a general anaesthesia in theatre

Umbilical Cord Prolapse

The umbilical cord is the connection between the fetus and placenta. Oxygen and other
nutrients are passed from mother to baby through the placenta and the umbilical cord.
Sometimes before or during labor, the umbilical cord can slip through the cervix, preceding
the baby into the birth canal. It may even protrude from the vagina. This is dangerous
because the umbilical cord can get blocked and stop blood flow through the cord. This is an
emergency situation. So adequate management should be done like emergency cesarean.

Umbilical Cord Compression

Because the fetus moves a lot inside the uterus, the umbilical cord can get wrapped and
unwrapped around the baby many times throughout the pregnancy. While there are "cord
accidents" in which the cord gets twisted around and harms the baby, this is extremely rare
and usually can't be prevented Sometimes the umbilical cord gets stretched and compressed
during labor, leading to a brief decrease in the flow of blood within it. This can cause

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sudden, short drops in the fetal heart rate, called variable decelerations, which are usually
picked up by monitors during labor

CONCLUSION

It is essential for any clinician practicing obstetrics to be familiar with the concepts of fetal
lie, attitude, presentation, position, and station. During labor, there will be a series of changes
in the position of the presenting part that are needed for the fetus to pass through the maternal
pelvis. Knowledge of the type of maternal pelvis is critical for proper monitoring of this
process.

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2001.
4. Karpen M, Conrad L, Chitwood L. Essentials of Maternal-Child Nursing, 2 nd edition.
Massachusetts: Western Schools Press ; 1995.
5. Korines SB. High Risk Newborn Infants: The Basis for Intensive Nursing Care, 3 rd
edition. Mosby: St Louis; 1981.
6. Leboyer F. Birth without Violence. New York: Knopf; 1976.
7. Michie MM. The baby at birth in: Bennet RV, Brown KL (Eds) Myles . Textbook for
Midwives, 13th edition. Edinburgh: Churchill Livingstone; 1999.
8. Moore ML. The Newborn and the Nurse. Philadelphia: Saunders; 1972.

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9. Phibbs RH. Evaluation of the newborn. In: Rudolph AM, Hoffman J (Eds). Pediatrics.
Norwalk, CT: Appleton- Century-Crofts; 1977.
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Publishers;1996.

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