Normal

Labor and Delivery

Physiological Adaptations
Presented by
Ann Hearn
 LABOR

The Process by

which the Products of

Conception are expelled

from the body

 Passenger

Essential
Factors
Passageway Powers
in
Labor

Psychological
 THE
PASSAGEWAY
 THE PELVIS

 Determine if the pelvic cavity is of

adequate size to allow for the
passage of the full term infant

Optimum shaped pelvis is Gynecoid

 THE PELVIS

False Pelvis
 Supports the
weight of the
uterus
 Shallow basin
above the inlet True Pelvis
or brim  Represents
the bony
limits of the
birth canal
True Pelvis vs. False Pelvis

True Pelvis
Inlet - upper margin of pubic bone to

upper margin of sacrum

Outlet - Lower pubic bone to tip of

coccyx. This area is the
smallest portion that the baby
must travel through.
 THE

PASSENGER

And

PPRESENTATION
 Fetal Head

Because of its size and rigidity,

the Fetal Head has a major
impact on delivery.
The bones are not firmly united.
There are sutures between the
bones that allow them to
overlap or MOLD to the birth
canal.
Head also can rotate, flex, and
extend
 Fetal Lie

 Relationship of the long axis of the

fetus to the long axis of the mother.

Longitudinal Lie Transverse Lie

 True or False?

 The optimum lie of the fetus is the

longitudinal lie.
A. True
B. False
 Fetal Presentation

 That portion of the fetus that enters

the Pelvis first and covers the
internal os.
 Three Types:
 Cephalic
 Vertex, Face, Brow
 Breech
 Shoulder
 Reference Points

 Cephalic = Occiput, posterior

fontanel

 Breech = Sacrum

 Face = Mentum
 Attitude

Relationship
Optimum
of fetal body attitude is
parts to flexion or
each other ovoid
POSITION
 POSITION

 Relationship of the Fetal Presenting

Part to the Maternal Pelvis
 Steps:
1. Determine the Presenting Part
2. Divide the mothers pelvis into 4 imaginary quadrants
A
12

R 9 3 L
6

P
 ENGAGEMENT

 Descent of the fetal presenting part

in relation to the ischial spines of the
maternal pelvis = 0 station.
 Engagement

Ballotable
Engagement
-largest diameter of
presenting part has
passed through the
pelvic inlet

- Assessed during
vaginal exam Engaged
 Station

Station- degree that the

presenting part has
descended into the pelvis
in
Relationship to ischial spines

Goal
• Move from – to + stations
 Test Yourself !

 What is the reference point of a

cephalic presentation when the head
is fully flexed?
A. occiput
B. mentum
C. frontal
d. sagittal
 Test Yourself

 Overlapping of the fetal skull to facilitate its

passage through the bony pelvis is ___________.
 Relationship of fetal body parts to each other
is_____________.
 Head first presentation is_________________.
 Relationship of the fetal spine to the maternal
spine is ________________.
 Term that refers to the part of the fetus that
enters the pelvic inlet first is _____________.
 THE

POWERS
 Major Powers Involved

 Involuntary Uterine Contractions or

Primary Powers
 Muscular contractions which lead to dilation
and effacement in the First Stage of Labor

 Voluntary Uterine Contractions or

Secondary Powers
 Abdominal muscles assist in the Second Stage
of Labor with pushing. Increase intra-
abdominal pressure to aid in expulsive forces
 THE
THE

PSYCHOLOGICAL
PSYCHOLOGICAL
 BREAK THE CYCLE !

FEAR
TENSION

PAIN
 Techniques for Assessment

 Abdominal Palpation / Leopold’s Maneuver

 Standing on the Right side, face the woman and
palpate with the palms of the hands.
 Step 1 - Start at upper fundus and palpate for the

head or buttocks
 Step 2 - Go down each side and locate back

 Step 3 - Gently grasp lower portion of uterus and

feel for the head or buttock

 Step 4 - Turn and face the woman feet, using both

hands palpate lower abd. for cephalic prominence

or brow.
 Ausculation

 Assess for the area of greatest

intensity of the FHR.
 Usually best heard at the fetal back
 True or False ?

 If the fetal heart tones (FHT’s) are

heard loudest (PMI) in the patient’s
upper right quadrant of her
abdomen, the fetus would be
assessed for a breech presentation.
A. True
B. False
 Vaginal Examination

 Presentation – presenting part

(head/buttock)
 Position – fetal head (OA, OP etc.)
 Condition of Membranes – ruptured or
intact
 Dilation - enlargement & widening of os (cm)
 Effacement – thinning of the cervix (%)
 Vaginal Examination

 Station- degree that the presenting part

has descended into the pelvis.
Relationship to ischial spines (-, 0, +)
 Engagement -largest diameter of
presenting part has passed through the
pelvic inlet
 Station

Station- degree that the

presenting part has
descended into the pelvis
in
Relationship to ischial spines

Goal
• Move from – to + stations
 Critical Thinking

 If the fetal head did not descend

through the pelvis and stayed at the
same station for a prolonged period
of time, what do you think would be
the treatment of choice?
 Try this !
 When the cervical os widens or opens it is said
to________.

 The level of the ________ _________ (bony structure) is

station zero.

 The most common type of pelvis for a woman

____________.
 When the cervix shortens and thins is _______________.

 For delivery to occur, the fetus must accommodate to this

rigid passageway______________.
 CAUSES OF LABOR

Increase in Estrogen
Decrease in Progesterone

High levels
of
Prostaglandins Degeneration
Over-distention of
of Placenta
Uterus
 Myometrial Activity

Effacement- thinning of the cervix (%)

Dilation – enlargement and widening of the os (cm)
 FORCES OF LABOR

 Contraction -exhibits a wavelike pattern that

begins slowly climbing (increment) to a peak
(acme), and decreases (decrement)

acme
De
n t cr
e em
m
cre en
t
In
 FORCES OF LABOR

acm De
t cr
en e em
m en
cre t
In
Duration
Interval
Frequency

Duration- from beginning of one contraction to the end of the

same
contraction
Frequency- from beginning of one contraction to the beginning of
another contraction
Interval - Resting time between contractions for placental
perfusion
Uterine Contraction - review
 Fill in the blank !
 Length of a uterine contraction__________.

 Strength of a uterine contraction is ___________.

 The time from the beginning of one contraction to

the beginning of the next contraction is _______.

 The time that allows for placental perfusion is __.

 The peak of a contraction is also known as ____.

 When the biparietal diameter of the head passes

through the pelvic inlet it is said to be ________.
 Assessment of Contraction

 1. Subjective symptoms by woman

 2. Palpation and timing by the nurse

 3. Use of Electronic Fetal Monitor

(EFM)
 Duration of Labor

 Resistance of the Cervix

 Presentation and position of the
fetus,
 The woman’s pelvis
 Preparation and relaxation of the
mother
 Primigravida - up to 22 hrs; average 12 1/2 hrs
 Multigravida - 8 - 17 hrs; average 10 hrs.
Premonitory Signs of Labor

The impending signs

that take place the last
several weeks of

pregnancy or even the

last several days
Premonitory Signs of Labor

LIGHTENING

FALSE LABOR PAIN (Braxton Hicks)

SHOW

Rupture of Membranes (ROM)

BACKACHE

DIARRHEA

SUDDEN INCREASE IN ENERGY

 True vs. False Labor

 TRUE LABOR  FALSE LABOR

 Contractions are:  Contractions are:
* Regular
* Increase in intensity and
 * Irregular
duration with walking * No change or decrease
with walking
* Felt in lower back, radiating
* Contractions felt in
to lower portion of abdomen
abdomen above
 Bloody show
umbilicus Braxton Hicks
 Dilation and effacement
 Fetus usually engaged
 No change in cervix
 Fetus is ballotable
 Phases and Stages of Labor

 Stage 1: 0 - 10 cm.
Phase 1 - Latent - dilate 0 - 3 cm.
 Phase 2 - Active - dilate 4 - 7 cm.

 Phase 3 - Transition - dilate 8 - 10 cm

 Stage 2: From complete dilation and

effacement to delivery of the baby
 Stage 3: From delivery of baby to the
delivery of the placenta
 Stage 4: the first hour after delivery
 Signs of Second Stage of Labor

Complete dilatation of cervix

Urge to bear down
Perineum begins to bulge, flatten and
move anteriorly
Increase in bloody show
Rectal pressure
Labia begins to part with each contraction
Mechanisms of Labor/
Cardinal Movements
Signs of Stage Three of Labor
 The End

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