LABOR and DELIVERY

Also known as Parturition, childbirth, birthing. Is the process by which the fetus & placenta are expelled from the uterus and the vagina into the external environment. PROSTAGLANDIN THEORY A parturient is a woman in labor. It has been known that when fetus has Toco - and toko- !r." are combining reached maturity, the fetal membranes forms meaning childbirth. produce large amount of arachidonic acid Eutocia # normal labor which is converted by maternal decidua Dystocia # difficult labor into a prostaglandin, a hormone that $ormally, labor begins when the fetus is initiates uterine contractions. sufficiently mature, yet not too large to ,uring labor the level of arachidonic acid cause difficulties in delivery. in the amniotic fluid is very high resulting In some instances, labor begins before in increased productions of the fetus is mature premature birth"% in prosttaglandin. others labor is delayed postmature birth". It is unknown why this occurs& 1. THEORY OF THE AGING PLACENTA As the placenta *ages+, it becomes less THEORIES ON THE ONSET OF LABOR efficient, producing decreasing amount of progesterone. 1. FETAL ADRENAL RESPONSE THEORY -his progesterone decline allows the Hippocrates, the father of medicine, concentration of prostaglandin and was the first person to propose this estrogen to rise steadily. theory which states that certain hormones produced by the fetal adrenal and pituitary gland initiates' labor contraction. 1. OXYTOCIN STIMULATION THEORY (tudies have shown that as pregnancy near term, oxytocin production by the posterior pituitary gland while the production of oxytocinase by the placenta . )xytocin stimulates uterine contractions while oxytocinase inhibits uterine contractions. As a result the uterus becomes increasingly sensitive to oxytocin. 1. UTERINE STRETCH THEORY According to this theory *any hallow organ stretched, will always contract & expel its content.+ A pregnancy advances, the uterus becomes increasingly distended by the growing fetus, placenta and amniotic fluid, distention of the uterus creates pressure on the nerve endings which stimulates uterine contractions. 1. PROGESTERONE DEPRIVATION THEORY Progesterone helps maintain pregnancy by its relaxant effect on the smooth muscles of the uterus, thereby, preventing uterine contractions. RELI!INARY SI"NS OF LABOR ." /I!0-1$I$! # *-he baby dropped+" or descent of the fetal presenting part into the pelvis, occurs approximately .2 # .3 days before labor begins. En#a#e$ent # descent of the biparietal
plane of the fetal head to a level below that of the pelvic inlet. Fixation # is descent of the fetal head to the inlet to a level below that of the pelvic inlet. F%oatin# # 4hen head is still movable above the pelvic inlet on palpation

As pregnancy nears term, the production of progesterone by the placenta decreases, this decline in progesterone allows uterine contraction to occur.

5" h I$ /161/ )7 A8-I6I-9 :" 41I!0- /)(( # 5 wks before labor, the woman experience sudden weight loss of about 5-: lbs. 3" ;<A=-)$ 0I8>( 8)$-<A8-I)$ ?" <IP1$I$! )7 -01 81<6I= *goodell's sign+

SI"NS OF TR&E LABOR &terine contractions # *surest sign+ S'o( # *;loody show+, blood mixed with mucus operculum". Rupture o) t'e $e$*ranes

;ending of the head onto the chest making the smallest anterior-posterior diameter suboccipitobregmatic" present to the birth canal. E))ace$ent # softening & thinning of cervix. # @se + in unit of measurement Primigravidas usually efface more Auickly than they dilate. Bultiparas typically will experience effacement and dilatation at the same time. Di%atation # widening of cervix. # @nit used is c$,

1,

3,

5, 6, -,

I$-1<$A/ <)-A-I)$ )cciput rotates until it is superior or Dust below the symphysis pubis bringing the head into the best relationship with the pelvic outlet% shoulder enterd the pelvic inlet. 1=-1$(I)$ 1xtension of the head% face and chin are born. .s o) LABOR /Factors o) La*or0 1=-1<$A/ <)-A-I)$ ASSA"ES / e%2ic Area0 or 8Restitution9 0ard passagesC ;ony pelvis 0ead rotates back to diagonal or (oft passagesC /ower uterine segment, transverse position, shoulders cervix, vagina, pelvic floor and enter the outlet and are born. perineum. 1=P@/(I)$ O4ER <est of the baby is born. Primary forceC Involuntary uterine contractions. !ANE&VER (econdary forceC 6oluntary use of thoracic, diaphragm and abdominal .. RIT"EN.S !ANE&VER # Insertion muscles when the mother *bears of the hand and application of down+. upward pressure on the fetal chin ASSEN"ER /;aby0 and as to the other hand applies 7etal positions, presentation gentle downward pressure on the and attitude. fetal occiput to a%%o( contro%%e: ERSON /Bother0 :e%i2ery o) t'e )eta% 'ea:, Baternal attitude during labor OSITION 5. BRANDT ANDRE4.S !ANE&VER Baternal position during labor # is a manual techniAue to help and delivery facilitate the delivery of the placenta. -he techniAue is coiling the umbilical cord through forcep. up, down and side techniAue." 5, !ODIFIED 7REDE.S !ANE&VER is a manual techniAue to help facilitate the delivery of the placenta. !entle pressure on the contracted uterine fundus by the PhysicianEmidwife.

!E7HANIS! OF LABOR Remember: ED FIRE ERE E # 1ngagement D # ,escent F # 7lexion I # Internal R # <otation E # 1xtension E # 1xternal R # <otation E # 1xpulsion 1$!A!1B1$(etting of the fetal head into the pelvis. ,1(81$,ownward movement of the biparietal diameter of the fetal head to within the pelvic inlet. 7/1=I)$

STA"ES OF LABOR 7I<((18)$, -0I<, 7)@<-0 C 7ERVI7AL DILATATION STA"E C E; &LSIVE STA"E C LA7ENTAL STA"E

3, E; &LSIVE STA"E

;egins with full dilation and cervical effacement to delivery of an infant. 8ontraction change from characteristic crescendo to decresendo pattern to an overwhelming *uncontrolable urge+ to push or bear down with each contraction as if to move her bowels. Bay experience nausea and vomiting because pressure is no longer exerted on her stomach as fetus descends in pelvis. ;egins with birth of the infant and ends with separation and expulsion of the placenta. @sually ? minutes after the birth of an infant. to :2mins"

C RE7OVERY STA"E

1, 7ERVI7AL DILATATION STA"E

;egins with the %a*or contraction and ends with co$p%ete :i%ation o) t'e cer2ix. (10cm) HASES

5,
LA-1$- 2-3 cm" A8-I61 3-F cm" T<A$(I-I)$A/ F-.2 cm"

LA7ENTAL STA"E

1.

2.

LATENT (0-4 cm) Contractions are MILD and SHORT ! 10 min"tes inter#a$ %&ases $ast a''ro(imate$) * &rs + ,"$$i'ara -. &rs M"$ti'ara ACTIVE (4-8 cm) Cer#ica$ di$ation occ"r more R.%IDL/0 increase in d"ration I1 2O3 not )et r"'t"red: 3oman can ta4e a bat&5 #oid. 2e6in to ca"se tr"e discom1ort. E(citin6 time 1or 7oman. .bdomina$ breat&in6 (.d#ice) Intensit): Moderate to stron6 %&ases $ast a''ro(imate$) 8 &rs ,"$$i'ara 9&rs + M"$ti'ara

SI"NS OF LA7ENTAL SE ARATION ." /engthening of the umbilical cord 5" @terus become firm an globular :" (udden gush of blood from the vagina 3" 7irm contraction of uterus ?" Appearance of placenta from the vaginal opening. SI"NS OF LA7ENTAL E; &LSION -he placenta is deliveredC $atural bearing effort of the mother or !entle presure on the contacted uterine fundus by PhysicianE );. (Modi1ied Crede<s Mane"#er)

:.

TRANSITIONAL (8-10 cm) Ma(im"m di$ation o1 :;10cm. Mood o1 t&e mot&er s"dden$) c&an6es and t&e nat"re o1 contraction intensi1ied.

6, RE7OVERY STA"E

;egins from expulsion of the placenta to 5 hours after delivery.

SE7OND LETTER< ,enotes fetal landmark O for occiput ! for mentum S for sacrum A for acromium LAST LETTER< 4hether the landmark points anteriorly A", posteriorly ", or transversely T".

FETAL ASSESS!ENTS
FETAL LIE # <elationship of fetal long axis to maternal long axis spine". a. -ransverse # (houlder presents b. /ongitudinal # 6ertex or breech. RESENTATION # 7etal part entering the pelvic inlet first. a. 8ephalic 6ertexE ;rowE 7ace" b. ;reech 8ompleteE 7rankE 7ootling"

ATTIT&DE # <elationship of fetal parts to one another. degree of flexion" A. 8omplete flexion. ;. Boderate flexion. 8. Poor flexion. ,. 0yperextension STATION # <elationship of the presenting part of a fetus to the level of the ischial spine.
1ach presenting part has the possibility of six positions. -hey are normally recogniGed for each position--using HocciputH as the reference point.

.. 5. :. 3. ?. I.

/eft occiput anterior /)A". /eft occiput posterior /)P". /eft occiput transverse /)-". <ight occiput anterior <)A". <ight occiput posterior <)P". <ight occiput transverse <)-".

OSITION # <elationship of presenting fetal part to the Auadrants of maternal pelvis. O!R "!A#RANTS$ a, Ri#'t Anterior *, Le)t Anterior c, Ri#'t osterior :, Le)t osterior e. <ight -ransverse f. /eft -ransverse
%OSITION i& in'icate' () an a((re*iati+n +, - .etter&$

OBSERVATIONS ABO&T OSITIONS a" LOA an: ROA positions are the most common and permit relatively easy delivery. b" LO an: RO positions usually indicate labor may be longer and harder, and the mother will experience severe backache. =NO4IN" OSITIONS 4ILL HEL YO& TO IDENTIFY 4HERE TO LOO= FOR FHT>s, 1, BREE7H, -his will be upper < or / Auad, above the umbilicus. 3, VERTE;, -his will be lower < or / Auad, below the umbilicus.

FIRST LETTER< 4hether the landmark is pointing to the mothers right R" or left L".