Intrapartum

What is labor?
• Labor is the series of events by which uterine
contractions and abdominal pressure expel
the fetus and placenta from the woman’s
body and causing progressive dilation of the
cervix and sufficient muscular force to allow
the baby to be pushed to the outside.
Factors affecting labor and deliver
process

3 “P”
 1. Passage – the route
• Size of maternal pelvis (diameters of the pelvic
inlet, midpelvis, and outlet)
• Type of the maternal pelvis (gynecoid, android,
anthropoid, platypelloid or a combination)
• Ability of the cervix to dilate and efface and
ability of the vaginal canal and the external
opening of the vagina (the introitus) to distend
Perlvic type Pertinent Characteristic
Gynecoid Inlet rounded with all inlet
diameters adequate
Midpelvis diameters adequate with
parallel side walls
Outlet adequate
Android Inlet hear-shaped with short
posterior sagittal diameter
Midpelvis diameters reduced
Outlet capacity reduced
Implication for birth
Favorable for vaginal birth
Not favorable for vaginal
birth
Descent into pelvis is slow
Fetal head enters pelvis in
transverse or posterior
position with arrest of
labor frequent
Pelvic type Pertinent characteristics Implication for birth
Anthropoid Inlet oval in shape, with Favorable for vaginal birth
long anteroposterior
diameter
Midpelvis diameters
adequate
Outlet adequate
Platypelloid Inlet oval in shape, with Not favorable for vaginal
long transverse diameters birth
Midpelvis diameters Fetal head engages in
reduced transverse position
Outlet capacity inadequate Difficult descent through
midpelvis
Frequent delay of progress
at outlet of pelvis
 2. Passenger – the fetus
• Fetal head (size and presence of molding)
• Fetal attitude (flexion or extension of the fetal
body and extremities)
• Fetal lie
• Fetal presentation (the body part of the fetus
entering the pelvis in a single or multiple
pregnancy)
Suture

1.Sagittal suture: - The sagittal suture lies between the

parietal bones. It runs in an anteroposterior direction
between the anterior and posterior fontanelles.

2.Coronal sutures: - The suture uniting the parietal bones to

the frontal bones is called the coronal suture. It’s extend
transversely from the anterior fontanels and lies between the
parietal and frontal bone.

3.Frontal suture: - The frontal suture is between the two

frontal bones. It is an anterior continuation of the sagittal
suture.

4.Lambdoidal suture: - Is between the parietal and occiptal

bones.
MOULDING OF THE FETAL SKULL

MOULDING is the ability of the fetal

head to change its shape and so to
adapt itself to the unyielding maternal
pelvis during the progress of labor.

This property is of the greatest value in

the progress of labor
 A

F
B
 3. Power – uterine contraction +
maternal pushing
Uterine contractions: Additional force

1.Initiate by pacemakers ~ uterotubal junction

2.Contraction waves meet at the fundus “maternal pushing”
3.Contraction waves progress downward

 Intra abdominal pressure

 Shortening of muscle fibers
 Retractions
 Intra uterine pressure

EXPULSION OF THE FETUS

 Functional relationship of presenting
part
• Engagement – occurs when the largest
diameter of the presenting part reaches or
passes through the pelvic inlet
• Station – relationship of the presenting part of
the fetus to the level of the ischial spines
• Fetal position – relationship of the presenting
part to one of the 4 quadrants of the maternal
pelvis
 Theories of labor onset
• Uterine muscle stretching
• Pressure on cervix
• Oxytocin stimulation
• Change in ratio of estrogen and progesterone
• Placental age
• Rising fetal cortisol levels
• Fetal membrane production of prostaglandin
• Seasonal and time influences
 Common signs in labor
1. Lightening – descent of the fetal presenting part into the pelvis
In primiparas:
• Occurs 10-14 days before labor begins
• Changes in abdominal contour: uterus becomes lower and more
anterior
• Gives relief from the diaphragmatic pressure and shortness of
breath
In multiparas:
• Occurs on the day of labor or even after labor has begun
• Abdominal pressure increase
• Complaints of shooting leg pains, increase amounts of vaginal
discharge, urinary frequency from pressure on the bladder
2. Increase in level of activity
A woman awake on the morning of labor full of
energy, in contrast to her feelings the previous
month.
3. Braxton Hicks contraction
Woman interprets as true labor contractions
4. Ripening of the cervix
The cervix becomes softer than normal and
distensible
 Differentiation between TRUE and
FALSE labor contraction
False Contraction True Contraction
• Begin and remain irregular • Begin irregularly but
• Felt first abdominally and become regular and
remain confined to the predictable
abdomen and groin • Felt first in lower back and
• Often disappear with sweep around to the
ambulation and sleep abdomen in wave
• Don’t increase in duration, • Continue no matter what
frequency or intensity the woman’s level of
• Don’t achieve cervical activity
dilatation • Increase in duration,
frequency and intensity
• Achieve cervical dilatation
 Stages of labor and delivery
1st stage
• Latent phase
- Begins at the onset of regularly perceived uterine
contractions and ends when rapid cervical
dilatation begins
- Mild and short contractions last to 20-40 sec
- Cervical effacement occurs
- Cervix dilates from 0-3cm
- Last 6 hours in nullipara and 4.5 hour in multipara
• Active phase
- Cervical dilatation occurs more rapidly from 4cm-
7cm
- Contraction are stronger, last 40-60 sec, occur
every 3-5 min
- Last 3 hour in nullipara and 2 hours in multipara
- Show (increase vaginal secretions) and perhaps
spontaneous rupture of the membranes may
occur
• Transition phase
- Maximum dilatation of 8-10cm occurs
- Contraction reach their peak, occur every 2-3 min
- Dilatation continues at a rapid state
- By the end of this phase, full dilatation and
complete cervical effacement have occurred
- Experiencing intense discomfort or pain,
accompanied by nausea, vomiting; a feeling of
loss of control, anxiety, panic and irritability
2nd stage
• Period from full dilatation and cervical effacement to
birth of the infant
• Contraction change from characteristic crescendo-
decrescendo pattern to an overwhelming
• Uncontrollable urge to push as if she were moving her
bowels
• Experience momentary nausea or vomiting
• Perineum begins to bulge and appear tense
• The anus may appear everted
• Stool may be expelled from the pressure
exerted on it
• As the fetal head is pushed still tighter against
the perineum, the vaginal introitus opens and
the fetal scalp becomes visible at the opening
to the vagina
3rd stage – begins with the birth of the infant and ends
with the delivery of the placenta
• Placental stage
- Occurs automatically as the uterus resumes
contractions
- Active bleeding on the maternal surface of the
placenta begins with separation
- The bleeding helps to separate the placenta by pushing
it away from its attachment site
- When the separation complete, the placenta sinks to
the lower uterine segment or the upper vagina
3 signs that indicate that the placenta has
loosened and ready to deliver:
1. Lengthening of the umbilical cord
2. Sudden gush of the vaginal blood
3. Change in the shape of the uterus
Duncan placenta and Schultze’s
placenta
• Placental expulsion
- Delivered by the natural bearing down effort of
the mother or by gentle pressure on the
contracted uterine fundus by the physician or
nurse midwife
 58 steps in delivering in Indonesia
1. Hearing & Seeing Signs of Labor existence Kala Two.
2. Ensure complete delivery assistance tools including breaking and
entering oxytocin ampoules disposable syringes 2 ½ ml to the container
parturition sets.
3. Wearing a plastic apron.
4. Ensure no jewelry, wash your hands with soap and water.
5. Using sterile glove on his right hand that will be used for the
examination.
6. Taking the syringe with his gloved hand, fill with oxytocin and put back
into the container sets parturition.
7. Cleaning the vulva and perineum with a wet cotton that has been
moistened by water ripe (DTT), start from the vulva to the perineum.
8. Checks in - make sure the opening is complete and the membranes have
ruptured.
9. Dipping his gloved right hand into a 0.5% chlorine solution, open the glove upside
down and soak in 0.5% chlorine solution.
10. Check the fetal heart rate after contractions completed - make sure DJJ within the
normal range (120-160 x / min)
11. Tell the mother opening is complete and the state of fetal well, ask the mother to
meneran moment there when his mother had felt like meneran.
12. Ask for help families to prepare mothers for meneran position (At the time of his,
help the mother in half-sitting position and make sure she feels comfortable).
13. Doing leadership meneran when the mother has a strong urge to meneran.
14. Encourage the mother to walk, crouch or take a comfortable position, if the
mother has not felt the urge to meneran within 60 minutes.
15. Put a clean towel (to dry the baby) in the mother's stomach, if the baby's head has
been opened the vulva within 5-6 cm in diameter.
16. Put the clean cloth folded one third under the mom’s buttock
17. Open the parturition set and check the completeness set of tools
and materials
18. Wear sterile gloves on both hands.
19. When the fetal head is visible at the vulva with a diameter of 5-6
cm, put on a clean towel to dry the baby on the mother’s stomach.
20. Check for winding the cord on the neck of the fetus
21. Wait until the fetal head is outside the pivot round finished
spontaneously.
22. After doing the rounds pivot head outside, hold it biparental. Tell
the mother to meneran when there’s contractions, gently move the
head towards the bottom and front of the shoulder distal to appear
under the pubic arch and then move towards the top and back of the
shoulder distal to give birth.
23. After the shoulders out, slide the hand down towards the mother's perineum to refute
the head, lower arms and elbows. Use hand over to browse and hold the upper hand and
elbow.
24. After the body and arm is out, left hand down the back towards the buttocks and lower
limbs of the fetus to hold the lower leg (put your left pointed finger between the fetus’
knees)
25. Conduct an assessment briefly:
a. Is the baby crying or breathing strong and without difficulty?
b. Does the baby move actively?
26. Drying the baby's body from the face, head and other body parts except the hands
without cleaning vernix. Replace wet towel with a dry towel. Let the baby over the mother's
abdomen.
27. Check the uterus to make sure there is no longer a baby in the uterus.
28. Tell the mother that she would be injected oxytocin so that the uterus contracts well.
29. Within 1 minute after the baby is born, inject10 units of oxytocin IM (intramuskuler) in
the one third over the distal lateral thigh (do aspiration before injecting oxytocin).
30. 2 minutes after delivery, clamp the umbilical cord with clamp approximately 3 cm from
the center of the baby. Pushing content to the distal cord (mother) and flip back the
umbilical cord at 2 cm distal from the first clamp.
31. With one hand. Hold the umbilical cord that has been clamped (protect
the baby's belly), and do the cutting of the umbilical cord between the two
clamps.
32. Tying the umbilical cord with DTT or sterile threads on one side and then
put back the string and tie it with a key node on the other side.
33. Cover the mother and baby with a warm cloth and put a hat on the baby's
head.
34. Move up the clamp on the umbilical cord within 5 -10 cm from the vulva
35. Put one hand on cloth on the mother's abdomen, at the upper edge of
the symphysis, to detect. Other hand tense cord.
36. After the uterus contract, tense cord with right hand while the left hand
presses the uterus carefully towards dorsocrainal. If the placenta is not born
after 30-40 seconds, stop cord traction and wait until the next contraction
arise and repeat the procedure.
37. Perform tension and boost dorso-cranial until the placenta separates, ask the
mother to meneran while the nurse pull cord parallel-ly to the floor and then upward,
following the axis of the birth canal (still do dorso-cranial pressure).
38. After the placenta appears on the vulva, continue delivery of the placenta
carefully. If necessary, hold the placenta with both hands and doing rounds in the
direction to help prevent tearing of the expulsion of the placenta and membranes.
39. Immediately after delivery of the placenta, do massage on the fundus circularly
scrubbing using 4 fingers palmar of left hand until the uterine contraction is well
already (fundus palpable hard)
40. Check the maternal and fetal part of the placenta with the right hand to make sure
that the entire cotyledon and membranes have been born complete, and put it into
plastic bags.
41. Evaluate the possibility of laceration of the vagina and perineum. Perform the
sewing when lacerations cause bleeding.
42. Ensuring the uterus to contract properly and no vaginal bleeding.
43. Letting the baby skin-to-skin contact on the mother's chest for at least 1 hour.
44. After one hour, do the weighing / measuring the baby, give prophylactic antibiotic
eye drops, and 1 mg of vitamin K1 IM left anterolateral thigh.
45. After an hour of administration of vitamin K1 given Hepatitis B immunization
injections in the right anterolateral thigh.
46. Continue monitoring and preventing the contraction of vaginal bleeding.
47. Teach mothers / families how to perform massage and assess uterine contractions.
48. Evaluation and estimation of the amount of blood loss.
49. Mother’s pulse checked and state of the bladder every 15 minutes during the first
hour after delivery 1 and every 30 minutes during the second hour after delivery.
50. Check again the baby to ensure that the baby breathes well.
51. Put all equipment that has been used in 0.5% chlorine solution for
decontamination (10 minutes). Wash and rinse equipment after decontamination.
52. Dispose all contaminated materials into the appropriate bins.
53. Clean the mom using sterile water. Clean the rest of the amniotic fluid, mucus and
blood. Help the mother to wear a clean and dry cloth.
54. Ensuring the mother feels comfortable and let the family to
help if the mother wants to drink.
55. Decontaminate the delivery place with 0.5% chlorine
solution.
56. Clean the gloves in 0.5% chlorine solution remove the gloves
upside down and soak it in a 0.5% chlorine solution.
57. Wash hands with soap and running water.
58. Complete partographs.
 High risk factor in intrapartum
• Problems in passenger
a. Fetal malposition
Occipito posterior – the head is usually
incompletely flexed and the occipitofrontal
diameter presents - ie a larger diameter is involved.
Causes:
• android-shaped pelvis
• anthropoid-shaped pelvis
• epidural analgesia
 Management
• It is necessary to maintain the patient's morale and ensure
that she does not become dehydrated. The patient will
require sufficient analgesia, and despite the risk of causing
poor levator tone and problems with rotation of the fetal
head, epidural analgesia is often used. The strength of
uterine contractions must be adequate and syntocinon may
be required. Regular monitoring of the fetal heart and
inspection of the liquor must be undertaken.
• If spontaneous delivery does not occur then delivery via the
use of forceps or caesarian section may be required. Note
that in this condition there is an increased likelihood of the
development of caput and it is incorrect to assume that
because the cervix is fully dilated that the baby is ready to,
and able to, be delivered vaginally.
 Fetal malpresentation
• Breech malpresentation – either the buttocks
or feet are the first body parts to contact the
cervix
• Shoulder presentation – the fetus is lying
horizontally in the pelvis so that its long axis
perpendicular to that of the mother
 Diagnose and management
• On abdominal palpation, no fetal pole is presenting to the
pelvis, and the head is palpable in either the right or left
iliac fossa
• On vaginal examination, may palpate ribs, scapula, clavicle
• In advance labor, fetal hand and arm may prolapse to the
vagina

• Consider ECV prior to labor

• If diagnosed in labor, deliver by caesarean section
• Caesarean may need to be classical, as lower segment
often inadequate
• Compound presentation – when a fetal
extremity prolapses alongside the presenting
part, and both enter the maternal pelvis at the
same time
Management:
• Exclude cord prolapse
• Otherwise expectant
– Mostly doesn’t interfere with normal delivery
– Vertex foot: try to gently reposition the lower
extremity
– If arm prolapses in vertex hand, wait and see if it
moves as head descends; if it converts to shoulder
presentation, deliver by CS
• Prolapse umbilical cord – cord below the
presentating part with intact or ruptured
membrane
 Management
• Recognize non-reassuring tracing
• Inspect and palpate cord to diagnose
• Assess fetal status (CTG, ultrasound)
• Assess labor progress (dilatation, station)
• Do not attempt to replace cord within uterus
• Consider replacing cord within vagina, or wrap in
• Warm moist packs, if external
• Hold presenting part off cord
• Position change (Trendelenburg or knee-chest)
• Prepare for urgent delivery
 Problems with the passageway
• Shoulder dystocen – the fetus’ head is stuck
during the second stage
 Psyche
• Refers to the psychological state or feelings that women ring into
labor with them.
• Woman who manage best in labor typically are those who have a
strong sense of self-esteem and a meaningful support person.
These allow women to feel in control of sensations and
circumstances they have not experienced previously and are not at
all what they pictured as happening.
• Encourage women to ask questions at prenatal visits and attend
preparation for childbirth classes helps prepare them for labor
• Encourage them to share their experience after labor serves as
debriefing time and helps them integrate the experience into their
total life
Common discomfort of the woman
during labor and delivery
Pain
• During the first stages
dilatation or streching of the cervix
• During the second stages
hypoxia of the contracting uterine muscle cells,
distention of the vagina and perineum, pressure
on adjacent structures including the lower
back,buttocks and thighs
• During the third stages
uterine contractions and cervical dilatation as the
placenta is expelled
 Danger sign during labor and delivery
 Fetal danger signs:
a. High or low fetal heart rate
As a rule, an FHR of more than 160 bpm (fetal tachycardia)
or less than 120 bpm (fetal bradycardia) is a sign of fetal
distress
b. Meconium Staining
a green color in the amniotic fluid, although not always a
sign of fetal ditress is highly correlated with its
occurrence. It reveals that the fetus has had an episode of
loss of sphincter control allowing meconium to pass into
the amniotic fluid. It may indicate that the fetus has or
experiencing hypoxia,which stimulates the vagal reflex
and leads to increased bowel motility.
c. Hyperactivity
Ordinarily, a fetus is quiet and barely moving
during labor. Fetal hyperactivity may be a sign
that hypoxia is occuring because exertion is a
common reaction to the need for oxygen
d. Fetal acidosis
When blood analyses are made on the fetus
during labor by use of a scalp capillary
technique, the finding of acidosis (blood pH
below 7,2) is a certain sign that fetal well being
is becoming compromised
 Maternal danger signs :
a. Rising or falling blood pressure
Normally, maternal blood pressure rises slightly
in the second (pelvic) stage of labor due to her
pushing effort. A systolic pressure greater than
140 mmHg and a diastolic pressure greater than
90 mmHg or an increase in the systolic pressure
more than 30 mmHg and a diastolic pressure of
more than 15 mmHg should be reported
because it may be the first sign of intrauterine
hemorrhage. A falling blood pressure is often
associated with other clinical sign of shock such
as apprehension,increased pulse rate and pallor.
• Abnormal pulse
Most pregnant women have an average pulse
rate of 70 to 80 bpm. A maternal pulse greater
than 100 bpm during the normal course of labor
is unusual and should be reported. It may be a
possible indication of hemorrhage
• Inadequate or prolonged
Uterine contractions normally become more
frequent, intense and longer as labor progresses.
As a rule, uterine contractions lasting longer than
70 seconds should be reported because
contractions of this length may begin comprimise
fetal well-being by interfering with adequate
uterine artery filling
• 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
• 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 reason :
1. The bladder may be injured by the pressure of
the fetal head
2. The pressure of the full bladder may not allow
the fetal head to descend
• Increasing apprehension
A woman who is becoming increasingly
apprehensive despite clear explanations of
unfolding may only be approaching the
second stage of labor. She may, however, not
be hearing because she has a concern that has
not been met. It can be a sign of oxygen
deprivation or internal hemorrhage
 Appropriate Nursing diagnoses
1. Powerlessness r/t change in labor pattern
and increase in contraction intensity and
frequency
2. Risk for infection r/t early rupture of
membranes
3. Risk for ineffective breathing pattern r/t
breathing exercises
4. Anxiety r/t stress of labor
5. Pain r/t labor contractions
Care of clients experiencing labor and
delivery process
• The first stage of labor :
Helping the woman feel confident in her
ability to control the pain and progress of
labor and maintain physiologic stability and
also :
- respect contraction time
- promote change of positions
- promote voiding and provide bladder care
• The second stage of labor:
Preparing the place of birth :
- birthing room
- positioning for birth
- promoting effective second stage pushing
- perineal cleaning
- episotomy
Physical and psychological preparation
of the client
• Explanation the procedure :
1. Orientation to a birthing room
2. TPR and BP assesment
3. Nursing and medical history and physical examination
4. Assesment of fetal heart rate
5. Vaginal examination
6. Urine specimen and necessary blood samples
obtained
7. Explanation of fetal or uterine monitoring equipment
to be used; connecting this equipment
 Vaginal examination
1. Wash your hands, explain procedure to client. Provide privacy
2. Assess client status and adjust plan to individual client need
3. Assemble equipment :
- sterile examining gloves
- sterile lubricant
- antiseptic solution
Ask the woman to turn onto back with knees flexed (a dorsal recumbent
position). Put on sterile examining gloves
4. Discard one drop of clean lubricating solution and drop an ample supply
on tips of gloved fingers
5. Pour antiseptic solution over vulva using nondominant hand
6. Place nondominant hand on the outer edges of the woman’s vulva and
spread her labia while inspecting the external genitalia for lesions. Look
for red, irritated mucous membranes, open,ulcerated sores clustered,
pinpoint vesicles
7. Look for escaping amniotic fluid
or the presence of umbilical
cord or bleeding
8. If there is no bleeding or cord
visible, introduce your index nd
middle fingers of dominant
hand gently into the vagina,
directing them toward the
posterior vaginal wall
9. Touch the cervix with your
gloved examining fingers
a. Palpate for cervical
consistency and rate if
firm or soft
b. Measure the extent of
dilatation; palpate for
an anterior rim or lip of
cervix
10. Estimate the degree of
effacement
11. Estimate whether membranes are intact
12. Locate the ishicial spines. Rate the station of the
presenting part. Identify the presenting part
13. Establish the fetal position
14. Withdraw your hand. Wipe the perineum
front to back to remove secretions or
examining solution. Leave client comfortable
and turned to side
15. Document procedure and assessment findings
and how client tolerated procedure
• Securing informed consent
• Provision of safety
• Comfort and privacy
-proper positioning
-draping
-constant feedback
-therapeutic touch
 Monitoring of Progress of Labor
Delivery
1. Respect Contraction Time.
2. Promote Change of Positions.
3. Promote Voiding and Provide Bladder Care.
 Provision of Personal Hygiene, Safety
& Comfort Measures
• Perineal Care
The perineum is cleaned with a warmed
antiseptic and then rinsed with a designated
solution before birth by the physician, nurse-
midwife, or nurse according to the agency’s
policy.
• Breast Care
a. Use ice packs on the breast for 15 or 20
minutes.
b. Try a warm washcloth on the breast if the ice
does not help.
c. Put your baby to the breast for a few minutes
d. Call your doctor or clinic if you have chills or
fever and your breasts are still swollen and
uncomfortable after two days
• Comfort Measures

Assist the support person to provide to the

woman in labor the usual comfort measures
that are provided for anyone with pain, such
as reassurance or change in a position.
 Exercise
First Stage of Labour Positions Pictures

•If pain and disability with

gait, adopt an upright
position and restrict
unnecessary movement.

•Avoid asymmetrical
postures that compromises
the sacroiliac joints.

•A birthing pool or exercise

ball can be recommended.
Second Stage of Labour Positions Pictures

•Upright and forward

leaning.

•4 point kneeling.

•Assisted squatting.
The following
positions can aid •Lying on the back,flexed
in maintaining position of the lower
pelvic balance limbs with the patient
during delivery. supporting her own legs
helps to increase the
pelvic outlet
 Mechanisms of woman’s partner and family of the
stresses of pregnancy, labor and delivery &
puerperium

When you were pregnant, from whom did you

get the most support?
• Husband : 55%
• Family : 28%
• Friends : 14%
 Mechanisms of woman’s partner and family of the
stresses of pregnancy, labor and delivery &
puerperium
Pregnancy
• Go with your partner to her prenatal visits.

• Watch videotapes, listen to audiotapes, check out the Internet, or read books
about prenatal development, birthing, and becoming a parent.

• Help plan for the baby. Talk with your partner about what you both want for your
baby.

• Go to classes that will teach you and your partner about childbirth.

• Help your partner stay healthy during pregnancy. Help her eat many different
foods.

• Help your partner stay away from street drugs.

• Make sure your partner stays away from dangerous household products.

• Exercise during pregnancy. Walk or swim together.

• Be sure your partner gets enough rest.

• Understand the different changes both you and your partner are
going through as you prepare for parenthood.

• Support your partner's choice on how to feed the baby.

• To attach with your baby, take time to learn about the

developmental stages and how nutrition, lifestyles, and stress can
affect prenatal growth.

• Find an infant massage class and attend with your partner. Infant
massage is a wonderful way to soothe a baby.

• Learn how to bathe, feed, diaper, hold, and comfort a baby. All of
these activities will build a father's confidence and enhance
bonding with the child.
Labor
• Massage her face to help release stress and
relax her.
• Remind her to go to the bathroom every hour.
A full bladder is not only uncomfortable but
can stall labor.
• Try cool compresses on her neck and face.
Even lightly washing her face can feel good
when she's working so hard.
• Help her change positions to encourage the
progress of labor. Some positions will provide
pain relief, others may feel more painful. Do what
works for her.
• If her back is hurting do counter pressure with
your hands on the small of her back (or wherever
she says to do it) as hard as she likes. Doing this
in the hands and knees position will also help
with the pain.
• Be there for her. Even when she may say that she
doesn't wish to be touched, being there for her is
very important. Just stand near her so that she
can feel your presence and verbally encourage
her.
 Preparation of the labor & delivery
room
• Birthing Room
Drapes and material used for birth are sterile
so no microorganisms are accidentally
introduced into the uterus.

• The Equipment
Sponges, drapes, scissors, basins, calmps, bulb
syringe, vaginal packing, glove, towel, and
sterile gowns
 Purpose of oxytocin
• Oxytocin, often referred to as the “Love Hormone,” is a
hormone that is produced in the brain and release into
the bloodstream during labor causing the uterus to
contract.
• In addition to the role it plays during contractions, oxytocin
is also released during the physical stimulation of a
woman’s nipples.
• The release of oxytocin creates feelings of contentment,
reduces anxiety and increases feelings of security and
calm.
• Naturally, due to these factors, there is much evidence that
the Love Hormone is important to mother-baby bonding as
it enables an increase trust and decrease in fear.
• Synthetic oxytocin - pitocin and syntocinon
• Pitocin is used to induce (start contractions
before labor begins naturally) or augment
(strengthen weak contractions during labor)
labor.
 Purpose of methergine
(methylergonovine)
• affects the smooth muscle of a woman's
uterus, improving the muscle tone as well as
the strength and timing of uterine
contractions.
• used just after a baby is born, to help deliver
the placenta (also called the "afterbirth"). It is
also used to help control bleeding and to
improve muscle tone in the uterus after
childbirth.