LABOR & DELIVERY

DEFINITION OF TERMS

LABOR - is the process of moving

the fetus, placenta and
membranes out of the uterus and
through the birth canal.
Synonymous with childbirth and
parturition.

Delivery – is the actual birth of

baby
 TRUE LABOR FALSE LABOR
CONTRACTION
Regular increasing frequency, Irregular
duration & intensity No change in frequency,
Shortening of interval duration & intensity
DISCOMFORT
Radiates from back around the Pain at abdomen
abdomen
REST /ACTIVITY
Contraction does not decrease Contraction may lessen with
with rest or activity/ walking activity or rest
CERVIX
Progressive effacement and Cervical changes does not
dilatation of cervix occur yet
 Escent of fetus into pelvic inlet -
Lightening
pening cervical OS -
Dilatation
oftening of the cervix

ontraction of uterus that are progressive

& regular
upture of BOW
ffacement – progressive thinning &
shortening of cervix
pprehension

Ucus plug expulsion – bloody

A. First Stage

- Stage of dilatation
- Begins with true labor pain and
ends with complete dilatation of
the cervix
PHASES DILITATION DURATION/ INTENSITY
INTERVAL

LATENT 0-3 CM 10-30 sec, Mild to

5-30 mins. moderate

ACTIVE 4-7 CM 30-40 sec. Moderate to

3-5 mins strong

TRANSITION 8-10 CM 45-90 sec. Strong

2-3 min
Duration – from the beginning of
one contraction to the end of same
contraction
(A-B)
Interval – from the end of one
contraction to the beginning of the
next contraction
(B-C)
Frequency – from the beginning of
contraction to the beginning of
next contraction
(A-C)
Nursing Care
A. Hospital admission – provides
privacy and reassurance from
the very start.
Personal data – name, age,
address, civil status
Obstetrical data – determine
EDC, obstetrical score, amount
& character of SHOW, whether
BOW have ruptured or not
2. General physical
examination, internal exam
and leopold’s are done to
determine:
EFFACEMENT AND DILATATION
STATION
PRESENTATION
PRESENTING PART
POSITION
3. Monitoring and evaluating
Uterine contraction
Blood Pressure
Fetal Heart Rate

4. Emotional Support is
provided
5. Health teachings
B. Second Stage
Stage of Expulsion
Begin with complete dilatation of
the cervix and ends delivery of baby
Contractions change from the
characteristic crescendo-
decrescendo pattern to
overwhelming uncontrollable urge to
push or bear down with each
contraction as if to move her bowels
Woman perspire and the blood
vessels in her neck may become
distended
Crowning takes place
The need to push become
intense and the woman cannot
stop herself
6 Cardinal Movements of the
Mechanism of labor ED FIRE
ERE
Engagement – presenting fetal
part at station or below

Descent – downward movement

of the biparietal diameter of the
fetal head to within the pelvic
inlet
◦ full descent occurs and the fetal
head extrudes beyond the dilated
cervix and touches the posterior
vaginal floor
Flexion – the head bends forward
onto the chest, making the
smallest anteroposterior
diameter

Internal Rotation – the occiput

rotates until it is superior, or just
below the symphysis pubis,
bringing the head into the best
relationship to the outlet of the
pelvis
Extension – as the occiput is born,
the back of the neck stops beneath
the pubic arch and acts as a pivot
for the rest of the head. The head
extends, and the foremost parts of
the head, the face and chin are
born.
External Rotation – almost
immediately after the head of the
infant is born, the head rotates
(from the anteroposterior position
it assumed to enter the outlet)
Expulsion – the rest of the baby
is born easily and smoothly
because of its smaller part size.
The end of the pelvic division of
labor.
Nursing Care:

Put both legs at the same time

when positioning to the lithotomy
position

Instruct mother to push as fetal

head crowns. If hyperventilation
occurs, let patient breathe into a
brown paper or a cupped hand.
C. Stage 3
  Placental Stage – begins from the
delivery of the baby up to the
delivery of the placenta

2 Phases:

a. Placental Separation
Signs:
◦ Lengthening of the cord
◦ Sudden gush of blood
◦ Change of shape of the uterus
Types of Placental
Presentation
Schultze’s – appearing shiny
and glittering from the fetal
membranes
Duncan – it looks raw,
dirty, meaty, red and
irregular(maternal surface)
b. Placental Expulsion
- Brandt Andrew’s Maneuver –
tract the cord slowly, winding it
around the clamp until placenta
spontaneously comes out
rotating it slowly so that no
membranes are left
Nursing Care:
Don’t hurry the expulsion of the
placenta, just watch for the signs
of placental separation
Take note of the time of placental
delivery
Inspect for the completeness of
the placenta
Palpate the uterus to determine
degree of contraction. If relaxed,
massage gently and apply ice cap
Inspect for lacerations
Stage 4
(Puerperium Stage)
– first 4 hours after delivery of
placenta
 
Degrees of Perineal Lacerations:

1. First Degree – skin and superficial

to muscle
2. Second Degree – muscles of the
perineum
3. Third Degree – continues to anal
sphincter
Episiotomy – incision made to the
perineum to enlarge the vaginal
opening for easy delivery

Types:
a. Midline/Median
b. Mediolateral
c. Lateral
Advantages:

1. Enlarging of the vaginal opening

2. Shortening of the second stage
of labor
3. Minimizing the stretching of the
perineal muscle
4. Preventing perineal tearing
POST PARTUM
ASSESSMENT