The 4 Ps of

Labor
GROUP 1
BSN 2-A-8
 GROUP MEMBERS

Advincula, Sandra Belen, Lei Camille

Alcantara, Perriel Borja, Gabrielle
Balloran, Abegail Cabarle, Roselle
Basilio, Aina Calantog, Rigil
Barrido, Kenneth Castor, Mike
 CASE PRESENTATION
Katherine is a 29 year old G1P0 39 weeks AOG,
who came in to the clinic for irregular uterine
contractions. She said “I am feeling abdominal
cramps, if I were to rate my pain scale is 6/10. I can
01
still manage, I am used to having dysmenorrhea.
This is my first pregnancy, so I went here to have it
checked, just to be sure” The nurse did an internal
examination and it revealed:
• Cervical dilatation: 2-3 centimeters
• Station: Floating
03
• Effacement: 20%
• Membranes: intact.
• Non stress test
reveals:
The doctor ordered may go home for now and
ambulate as much as possible. Advised to come back
to the clinic if uterine contractions become more
regular.
02
Katherine asked the nurse what is about to
happened to her, she is excited and anxious at
the same time and it is much better if she will instruct
her of what to expect and what to do. She said that she
is scared that her baby can’t passed through her pelvis
and that the baby will be at risk of dying. Katherine
showed her latest ultrasound result to the nurse and
04
she said that her baby weighs 3.0 kilograms and is
cephalic presentation. She would also want to know
what does the doctor mean with “come back in the
clinic if contractions become regular” what do you
mean by regular
contractions?
 01
Come up with a health teaching plan for
Katherine regarding her concerns with
her passageway. Create a visual aid that
you can show to best explain the concept
of passage and advice that you can give
Katherine to alleviate her concerns.
 Teaching Plan for Labor

Learning Need:
Proper breathing techniques and bearing down

Learning Goal:
The client will be able to know and apply the proper breathing
techniques, bearing down and decreased anxiousness during
the labor and delivery stage of their babies.
 Objectives Content Time Allotment
After 16 minutes of client teaching 1. Definition of patterned breathing - 2 mins
the clients will be able to: and its benefits.  
1. Know the meaning and benefits
of patterned breathing during 2. Steps on beginning patterned - 2 mins
labor and delivery breathing  
2. Know and demonstrate on how
to begin patterned breathing 3. 3 different patterned breathing - 5 mins
3. Know and demonstrate 3 techniques for the first of labor
techniques on patterned
breathing for the first stage of 4. Proper breathing techniques for the - 2 mins
labor second stage of labor  
4. Know and demonstrate the
proper technique for the second 5. Benefits of laboring down to the - 2 mins
stage of labor mother and child  
5. Know the benefit of laboring
down or bearing down for the 6. Different positions for bearing down - 3 mins
labor and delivery stage
6. Know and demonstrate 3
position for bearing down
 Breathing and Relaxation Techniques for
Labor and Delivery
Basic breathing fundamentals:

• Cleansing breath • Chest breathing

• Abdominal
breathing
 Breathing and Relaxation Techniques for
Labor and Delivery
Basic breathing fundamentals:

• Panting • Breath holding

 Breathing and Relaxation Techniques for
Labor and Delivery
Basic breathing fundamentals:
• Spontaneous “pushing”
- This allows you to follow the natural urge to
bear down. You can enhance this effort through:
o Upright positioning
o Frequent position changes
o Keeping arms and legs relaxed
o Making “noises” rather than prolonged breath
holding and bearing down
o Focusing on pushing efforts
 Relaxation Techniques
Relaxation techniques used with controlled breathing will offer you better control during
your labor and delivery. The ability to relax will conserve energy throughout the first stage of
labor. Consciously relaxing between contractions makes the breaks more restful. You will also
find more strength for the second (pushing) stage of labor. With concentration and practice,
you will recognize even a small amount of tension.
To help with relaxation:
• Allow time and take care of any matter that needs your attention so that you will not be
interrupted.
• Wear loose fitting clothing
• Empty your bladder
• Turn on some relaxing music
• Find a comfortable position in which your body is well supported, using pillows as
necessary
 The Different Breathing Techniques
The breathing techniques that you can use
during pregnancy and labor go far beyond "hee-
hee-who." There are also several different
methods, including:
• The organizing breath.
• Slow breathing.
• Light accelerated breathing.
• Variable or transition breathing.
• Expulsion breathing.
How to Use the Techniques
During the first stage of labor, there were
recommendations that moms switch between slow, light
accelerated, and variable breathing as they feel comfortable
-- the main goal is to help them relax. Stick with a particular
technique for as long as it helps, then move on to another.
Think about incorporating a visual at this stage: The
delivering mom might focus on her partner or a spot on the
wall, or she can call to mind some object or scene that makes
her feel centered and peaceful.
Expulsion breathing should be the primary technique
during the second stage of labor as the moment of delivery
gets closer. This method, as its name implies, is designed to
help the mom push more forcefully. Taking one or two deep,
relaxing breaths between expulsion breaths can help the
mother keep calm and improve oxygen flow.
 02
Come up with visual presentation to
explain Katherine about her baby’s
weight and presentation and how it will
affect her upcoming labor and delivery to
explain the passenger.
 Fetal Growth:

More than 9 out of 10 babies born at term (37 to 40 weeks) weigh

between 2.5 kg and 4.5 kg. If the baby weighs 4.5 kg or more at birth, they
are considered larger than normal. This is also known as ‘fetal
macrosomia and large for gestational age (LGA). if they weigh less than
2.5kg, they may considered smaller than normal.
Based on the latest ultrasound of Katherine her baby’s weight are
considered normal since the normal birth weight ranges from 2.5 kg to
4.5 kg.
Fetal Weight Chart in kg from 28 weeks to 42 weeks
 Presentation:
The baby’s presentation is already in cephalic presentation, it is ideally for labor. The
baby is positioned head-down, facing the mother’s back with the chin tucked to its
chest and the back of the head ready to enter the pelvis. Most babies settle into this
position within the 32nd to 36th weeks of pregnancy.
What does fetal positioning mean?
The position of the baby in the uterus is called the presentation of the fetus.
Throughout the pregnancy, the baby will move around in the uterus. It’s normal for the
baby to be in a variety of positions during most of the pregnancy. Early on, the baby is
small enough to move freely. The larger the baby becomes, however, the more limited
the movement becomes. As the end of the pregnancy approaches, the baby will start
to move into position for birth. This typically involves flipping over so that the baby is
head down in the womb. The baby will start to move down in the uterus, preparing to
go through the birth canal during birth.
 Presentation:
What other positions can the baby be in before childbirth?
• Occiput or cephalic posterior position: Sometimes the baby is positioned head down
as it should be, but other times it is facing the mother's abdomen.
• Frank breech: In a frank breech, the baby’s buttocks lead the way into the birth
canal. The hips are flexed, the knees extended (in front of the abdomen).
• Complete breech: In this position, the baby is positioned with the buttocks first and
both the hips and the knees are flexed (folded under themselves).
• Transverse lie: The baby lies crosswise in the uterus, making it likely that the
shoulder will enter the pelvis first.
• Footling breech: Sometimes, one or both of the baby's feet are pointed down toward
the birth canal.
 Presentation:
Why does the position of the baby at birth matter?
During childbirth, your healthcare provider’s goal is to safely deliver your baby and ensure
your well-being. If the baby is in a different position (not a cephalic presentation), this job
becomes more challenging. Different fetal positions have a range of difficulties and the risks
can vary depending on the position of your child.
Weight is a one factor doctors consider when estimating the chances of a patient
successfully having a vaginal delivery and to anticipate how well the baby will fit in the
pelvis.
Many factors come into play to determine how long a labor will last. A successful labor
depends on four integrated concepts and one of them is the passenger. The labor length is
influenced by the passenger.
The “passenger” refers to the fetus. The baby's weight, size, position, and presenting part
of the baby have a major impact on the length of labor. The size of the baby has to be
compatible with the size of the mother's pelvis. A common reason to do a cesarean is called
CPD, cephalic (baby's head) pelvic (mom's bone) disproportion (the baby's head is too big
for the mother's pelvis).
 Several variables in the fetus influence its journey
through the birth canal.

• Molding
- During a head first birth, pressure on the head caused by
the tight birth canal may "mold" the head into an oblong
rather than round shape. This is a common occurrence that
usually disappears after a few days.

• Engagement
- The infant's head drops down into the lowest part of the
pelvis or 'engages' prior to labor. For first time mother,
engagement will usually occur about two or three weeks prior
to the onset of labor.
 Several variables in the fetus influence its journey
through the birth canal.

• Station
- The fetal station is a measurement of how far
the baby has descended in the pelvis, measured
by the relationship of the fetal head to the ischial
spines (sit bones). The ischial spines are
approximately 3 to 4 centimeters inside the
vagina and are used as the reference point for
the station score. It usually isn't measured until
the last few weeks of pregnancy or this may not
hear it discussed until the mother is in labor.
 Several variables in the fetus influence its journey
through the birth canal.
• Fetal Attitude
The fetal attitude describes the position of the parts of the baby's body. The normal
fetal attitude is commonly called the fetal position. The head is tucked down to the
chest. The arms and legs are drawn in towards the center of the chest. Abnormal
fetal attitudes include a head that is tilted back, so the brow or the face presents first.
Other body parts may
be positioned behind the back. When
this happens, the presenting part will
be larger as it passes through the
pelvis. This makes delivery more
difficult.
 Several variables in the fetus influence its journey
through the birth canal.

• Descent
- This is when the baby's head moves down
(descends) further through the pelvis. Most often,
descent occurs during labor, either as the cervix
dilates or after the mother begin pushing.

• Fetal Lie
- The fetal lie is the relationship of the long axis
of the fetus relative to longitudinal axis of the
uterus. A fetus in longitudinal lie is suitable for
vaginal delivery.
 03
Please create a table or a graph to easily
understand the progress of uterine
contractions to explain the power
of labor.
 The power factor in labor refers to the ability of the uterine muscle to contract. The uterus is an involuntary
muscle. It has to not only start contracting, but it must establish a pattern of contractions. Every time the uterus
contracts it pushes the baby towards the cervix. This is really what labor is all about. The contractions cause the
cervix to stretch open and allow the baby into the birth canal.
Furthermore, Contractions are the tightening of the muscles of the uterus. During contractions, the abdomen
becomes hard. Between contractions, the uterus relaxes and the abdomen becomes soft. The way a contraction
feels is different for each woman, and it may feel different from one pregnancy to the next.
The hormone responsible for this is the Oxytocin that dramatically increases the strength and frequency of
uterine contractions and can be used to initiate labor if labor does not begin spontaneously. During natural labor,
uterine contractions increase in intensity and force the fetus into the birth canal.
Uterine contractions during labor diminish the uteroplacental blood flow. The decrement in blood flow during
contractions is inversely related to the increase in intrauterine pressure, and, at the contraction acme in late labor,
the diastolic velocities in maternal uteroplacental vessels disappear.
• Labor contractions usually cause discomfort or a dull ache in your back and lower abdomen, along with
pressure in the pelvis.
• Contractions move in a wave-like motion from the top of the uterus to the bottom.
• Unlike false labor contractions or Braxton Hicks contractions, true labor contractions don’t stop when you
change your position or relax.
 Contraction exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decrease
(decrement)
At first the contraction only feels tight and as it gets stronger and more painful it heralds the increment stage. Gradually
the contraction reaches its peak (acme), which is when the contraction is really painful. Then it suddenly fades (decrement
phase) and is quickly gone. There is no pain between contractions
If true labour is progressing, there will be adequate uterine contraction, evaluated on the basis of 4 features:
• Duration: from the beginning of one contraction to the end of the same contraction Each contraction lasts 40–60
seconds
• Frequency: from the beginning of one contraction to the beginning of another contraction It occurs 3-5 times in every
10
minute period.
• Interval: resting tine between contraction allows for placental perfusion.
• Intensity: strength of the uterine contraction

For most first-time moms, early labor

will last approximately 8-12 hours. Your
cervix will efface and dilate to 4
centimeters. Contractions will last about
30-45 seconds, giving you 5-30 minutes
of rest between contractions. Contractions
are typically mild and somewhat irregular
but become progressively stronger and
more frequent. Also, labor lasts for about
less than 3 hours.
 The Stages of Labor:
Stage 1: Dilation
During the first stage of labor, the cervix begins to thin and dilate (open) due to the hormones that are released during
labor. The first stage of labor begins from the time the contractions start until the time the cervix is fully dilated. It’s the longest
of the 4 stages and divided into 3 phases:
• Early Labor
- The onset of labor until the cervix is dilated to 3-6 centimeters. It is also called the latent phase. It’s the
longest and can last up to 4-6 hours, 6 hours for (nullipara) and 4.5 hours (multipara). A typical early phase
of labor starts with contractions coming every 5 to 10 minutes and lasting for 20 to 40 seconds each.
Contraction pains are not as severe as the active phase. The fetal membranes often rupture in the early
phase of labor and the amniotic fluid leaks or gushes out. This is called “water breaking” and is painless.
• Active Labor Phase
- Continues from 3 cm until the cervix is dilated to 7 centimeters. Contractions become stronger, more painful,
and the interval occurs every 3-5 minutes lasting 40-60 secs, without much time to relax in between
contractions. The duration is 3 hours (nullipara) and 2 hours (multipara) with 4-6 cm cervical dilation. The
mother often frightened, anxious, irritable, but still can comprehend.
• Transition Phase
- Continues from 7 cm until the cervix is fully dilated to 10 centimeters. Contractions become intense,
occurring about every 2-3 minutes and lasting for 60 seconds or more. At this point, the legs may cramp and
you may feel shaky or nauseated. Some women choose to receive pain medication such as tranquilizers
and regional blocks like epidurals.
 The Stages of Labor:
Stage 2: Delivery
The second stage of labor begins when the cervix is fully dilated to 10 centimeters and ends with the
delivery of the baby. This stage may last between 20 minutes to 2 hours. It may take longer for first-time
mothers and for those who have an epidural.
Strong and regular contractions come every 1-3 minutes and last for 45-75 seconds. As each contraction
increases, you may feel the urge to bear down and push. At the end of stage 2, the top of the baby’s head
emerges at the opening of the vagina. This is called "crowning." As soon as the head crowns, instruct not to
push but to pant The baby’s head will work to stretch out the vagina. An episiotomy may be administered at
this stage.
Stage 3: Afterbirth
It begins after the baby is born and ends with pushing out the placenta through the vagina. Typically, this
occurs between 5-30 minutes after childbirth. It is also known as the placental stage. Contractions begin
again, helping the placenta to separate from the wall of the uterus.
Stage 4: Recovery
Recovery begins during the first 2-3 hours after delivery. During this time, the uterus contracts here and
there, pushing out what’s left inside and reestablishing muscle tone.
 Here are some terms you can use to describe the
pattern of your contractions:
• Regular contractions.
Contractions are considered regular when the duration and frequency are stable over a period of
time. An example is contractions lasting 60 seconds and coming five minutes apart for an hour.
• Irregular contractions.
Contractions are irregular when there isn't a stable pattern. An example is a series of three
contractions lasting between 30 and 45 seconds and coming 10, seven and then 15 minutes apart.
• Progressing contractions.
Contractions that are lasting longer and getting closer together are considered to be progressing.
Over the course of labor, contractions get longer, stronger and closer together.
• Non-progressing contractions.
Contractions that are not getting longer, stronger and closer together. This may mean that the
contractions are not opening the cervix. It usually means that other work is being done, such as
turning your baby to a different position, softening or thinning the cervix.
 How Contractions are Timed
Contractions are intermittent, with a valuable rest period for you, your baby, and your uterus
following each one. When timing contractions start counting from the beginning of one contraction to
the beginning of the next.

Time Contraction Starts Duration of Contraction

10:00 45 seconds

10:10 40 seconds

10:15 60 seconds

10:20 55 seconds
 04
Please create a nursing care plan for
Katherine to help strengthen her psyche
for her upcoming labor and delivery.
 REFERENCES
• https://www.marshfieldclinic.org/specialties/obgyn/pregnancy/delivery/pregnancy-delivery-breathing-relaxation
• https://www.dignityhealth.org/articles/breathing-techniques-that-work-best-for-you-during-labor-and-delivery
• https://www.healthline.com/health/lamaze-breathing
• https://happychildren.life/average-fetal-length-and-weight-chart/
• https://www.pregnancybirthbaby.org.au/having-a-large-baby
• https://my.clevelandclinic.org/health/articles/9677-fetal-positions-for-birth
• https://www.bradenton.com/living/article57776078.html#storylink=cp
• https://library.med.utah.edu/kw/human_reprod/lectures/physiology_labor/
• https://www.bradenton.com/living/article57776078.html
• https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/beginnings/giving-birth/ti
ming-contractions
• https://www.sutterhealth.org/health/labor-delivery/labor-contractions
• https://slideplayer.com/slide/5776039/
• https://www.medicinenet.com/what_are_the_4_stages_of_labor/article.htm
• https://www.ncbi.nlm.nih.gov/books/NBK564403/
THANK
YOU!