LABOR ONSET THEORIES - One of the assumed theory that

explains labor onset because of the

 Fetal Adrenal Response Theory conversion of hormones to
(Hepocrates) prostaglandins that will stimulate
- Releasing ACPH to act on placenta the uterine contraction.
to initiate contraction of uterus
- Combination of maternal and fetal SIGNS OF LABOR
factors
 Increased Braxton-Hicks Contraction
- Initiates labor contraction
- Irregular painless contraction of
 Oxytocin Stimulation Theory
pregnancy
- Life span of placenta: 40-42
- Becomes stronger, longer and more
- Oxytocinase is being secreted from
frequent is a sign of labor
placenta and when placenta is not or
- Causing discomfort to the mother
declining to function, oxytocinase is
- Considered as pre-labor
low then there Is no more control
- Necessary for first stage of labor
for oxytocin
 Lightening or Baby Dropped
- Oxytocin counterattacks
- Occurs 2 weeks before labor onset
oxytocinase
in primipara and just before or
- Lowering level of oxytocinase,
during labor or multipara
increasing of oxytocin which
- Results in relief of dyspnea
stimulates uterine contraction thus
- No more difficulty of breathing
labor begins.
because the baby is dropping and it
 Uterine Stretch Theory
is lighter.
- The uterus reaches its capacity to
- Increased in urination.
stretch, it contracts and eventually
- Leg pain due to stimulation of
empty its content.
nerves in lower extremities.
- Distended because of fetus, placenta
- Pawlik’s maneuver if fetus is
and amniotic fluid.
engaged.
 Theory of the Aging Placenta
 Ripening of the cervix
- All hormones secreted by placenta
- Measured by degree and effacement
such as progesterone and
- Primipara- wait for effacement,
oxytocinase that helps the
cervical opening 10 cm
pregnancy, the contraction is
- Multipara- fast effacement and
eliminated by these hormones. The
dilation
functions that are not produce will
- Ripe if dilated
cause the labor hormones to act up
- Tip of index finger is 1cm, tip of
such as oxytocin.
middle finger is 1.5cm, if inserted
 Progesterone Deprivation Theory
both fingers; the dilation is 3cm if
- Aging of placenta causes low level
the cervix is tight. If fingers is
of progesterone which means there
moveable, it is 3-4 cm; full capacity
is progesterone deprivation.
and separated fingers, it is fully
Oxytocin will start to act up because
dilated and 10 cm.
there is no hormone to inhibit the
 Increased Level of Activity
uterine contraction.
- Low progesterone level stimulate
 Prostaglandin Theory
adrenal glands that secretes
- When fetus is matured
epinephrine or adrenaline.
- Stimulating contraction
- The energy for delivery of the baby.
 Weight Loss - Transition
- 2 weeks before delivery, mother  Dilation: 8-10 cm
gets sudden weight loss because of  Effacement: 100%
lowering progesterone because it is  Contractions: Every 2-3 mins
responsible for fluid retention for 60 to 80 mins
meaning there will be no more fluid  Primipara: 1 hr
in interstitial tissues.  Multipara: 30 hr
 Show  Second Stage (Expulsion)
- Cervical capillaries is ruptured due - Pushing
to contraction secreting bloody - From dilation of cervix up to the
mucus plug. expulsion of the baby
 Rupture of Membranes - Delivery of the baby
- Leaking of bag water due to strong 5Ps
contraction  Power: forceful contractions
- Delivery of the baby must be — Uterine Contractions:
facilitated within the 24 hrs of involuntary,
rupture of membranes otherwise intermittent, discomfort
infection will occur. — Phases: Increment,
- Do not perform IE if membrane is Apex, Decrement
ruptured. — Intensity, Frequency,
Interval
STAGES OF LABOR
— Maternal Pushing
 Cervical, Expulsion, Placental,  Passenger: fetus
Vigilance —
 First Stage (Cervical)  Passage: Route
- Dilation and effacement  Person: Mother’s attitude
- 10cm dilation — Advise the mother
- Ends when cervix is fully dilated about the pain during
- Primipara: 10 hours the delivery
- Multipara: 6-7 hours  Position
- Early Phase (Latent) — Lithotomy position:
 Prodromal Stage hospital
 Primipara: 6 hrs
 Multipara: 4-5 hrs
 Every 5-20 mins contractions
for 20 to 40 seconds
 Irregular contractions
- Regular contractions which leads to
dilation of cervix from 3 to 6 cm
- Active Phase — Dorsal recumbent
 4-7 cm dilation position: lying in/clinic
 Every 3-5 minutes for 40-60 — Side-lying:
seconds contractions gravidocardiac
 Primipara: 3 hrs — Squatting position:
 Multipara: 2 hrs pool/use of gravity
 Intense contractions
 Amniotic sac rupture - Factors that affects the delivery:
 Fetal size — Double footling
 Fetal head
 Fetal attitude
 Chin on chest
 Rounded back
 Flexed arms and legs
 Fetal Lie
 Longitudinal
 Transverse: for caesarean
delivery - Cardinal movements of labor
 Oblique  Descent
 Fetal presentation  Downward movement of
 Cephalic fetus to pelvic inlet
— Vertex  Engagement
— Sinciput/Military  Flexion
— Brow  Internal Rotation
— Face  Fetal shoulders internally
— Chin rotate 45`
 Extension
 Emerges from vagina
 Restitution
 Head externally rotates
 Expulsion
 Anterior shoulder- Posterior
shoulder- Rest of body
- Ends at the delivery of the baby
 Third Stage (Placental)
- Delivery of the baby up to the
expulsion of the placenta
- Ends at the delivery of the placenta
 Vigilance
- Monitoring of the mother
- Adaptation to blood loss
- Start of uterine involution

LABOR INFORMATION
 Breech
 Contractions to delivery
— It is not allowed to
- Primipara: 12-18 hours
facilitate delivery if the
- Multipara: 6-9 hours
presentation is breech
 Pushing should be coached by the
because it requires lots
midwife or nurse when there is
of maneuvers to
contractions. ONLY when there is
perform.
contractions.
— Complete
— Frank
— Single footling
FETAL SUTURE LINES

 Biparietal: 9.5 cm
 Bitemporal: 8 cm
 Bimastoid: 7cm
 Suboccitobregmatic: 9.5cm
 Occipitomental: 13.5 cm
 Occipitofrontal:12.5 cm