Chapter 16: Labor and Birth Processes

Learning Objectives
Explain the five major factors that affect the labor process.
Describe the anatomic structure of the bony pelvis.
Recognize the normal measurements of the diameters of the pelvic inlet, cavity, and outlet.
Explain the significance of the size and position of the fetal head during labor and birth.
Summarize the cardinal movements of the mechanism of labor for a vertex presentation.
Examine the maternal anatomic and physiologic adaptations to labor.
Describe factors thought to contribute to the onset of labor.
Describe fetal adaptations to labor.
Factors Affecting Labor:

Passenger: fetus

Size of the fetal head Fetal lie: the relation of the long axis (spine) of
the fetus to the long axis (spine) of the mother

Bones in the fetal skull

Longitudinal

Fontanels
Transverse

Molding
Fetal attitude: the relation of the fetal body
parts to one another
Presentation of the fetus: the part of the fetus
that enters the pelvic inlet first and leads
through the birth canal during labor General flexion

Cephalic Critical measurements of fetal head

Breech Biparietal diameter

Shoulder Suboccipitobregmatic diameter

Fetal position: the relationship of a reference point on the presenting part

to the four quadrants of the mother’s pelvis
 Position is denoted by a three-part letter abbreviation

Fetal station: a measure of the degree of descent of the presenting part of the fetus through the birth canal

Fetal engagement: usually corresponds to 0 station

Passageway: Birth canal

Bony pelvis: 4 types

Gynecoid Anthropoid

Android Platypelloid

Soft tissues

Powers

Primary powers: contractions

Frequency, duration, intensity

Effacement

Dilation

Ferguson reflex

Secondary powers: bearing-down efforts

Valsalva maneuver

Position of laboring woman Psychologic state of laboring woman

Discussed in depth in Chapter 19 Discussed in depth in Chapter 19

Process of Labor

Labor: process of moving fetus, placenta, and membranes out of the uterus and through the birth canal
 Signs preceding labor

Lightening

Bloody show

Onset of labor

Cannot be ascribed to a single cause

Stages of labor

First stage Second stage

Latent phase Third stage

Active phase Fourth stage

Transition phase

Mechanism of labor

Turns and adjustments necessary in human birth process

Seven cardinal movements of mechanism of labor

Engagement Extension

Descent Restitution and external rotation

Flexion Expulsion

Internal rotation

Physiologic Adaptation to Labor

Fetal adaptation
 Fetal heart rate (FHR): reliable and predictive information about the condition of the fetus related to oxygenation

Fetal circulation

Fetal respiration

Maternal adaptation

Woman exhibits both objective and subjective symptoms

Cardiovascular changes Musculoskeletal changes

Respiratory changes Neurologic changes

Renal changes Gastrointestinal changes

Integumentary changes Endocrine changes

Cardiovascular Changes Respiratory Rate

Cardiac output ’s 10% to 15% in first stage and 30% Respiratory rate increases due to greater need for O2
to 50% in second stage, peaks 10-30 minutes after both consumption
vaginal or c-section and returns to pre-labor within first
PP hr.
May hyperventilate which can lead to resp alkalosis (
pH)
HR ↑’s in first and second stage& B/P↑’s during contx,
systolic more than diastolic
Anxiety can increase O2 consumption

WBC counts increase & Temp may be slightly elevated

Renal Changes Minute tears may occur

Spontaneous voiding maybe difficult d/t tissue edema

from pressure of presenting part, overall discomfort,
analgesia, and embarrassment
Musculoskeletal Changes

Proteinuria (+1) may occur as result of muscle tissue

breakdown from strenuous process of labor Marked increase in muscle activity

Integumentary Changes Backache and joint aches occur as a result of increased

joint laxity at term

Great stretching of vaginal tissue and perineum occurs

Gastrointestinal and Endocrine
 Gastric motility and absorption of solid food decreases; Blood glucose levels decreases
nausea and vomiting may occur

Key Points

Labor and birth are affected by the five Ps: passenger, passageway, powers, position of the woman, and psychologic response.

Because of its size and relative rigidity, the fetal head is a major factor in determining the course of birth.

The diameters at the plane of the pelvic inlet, the midpelvis, and the outlet plus the axis of the birth canal determine whether
vaginal birth is possible and the manner in which the fetus passes down the birth canal.

Involuntary uterine contractions act to expel the fetus and placenta during the first stage of labor; these are augmented by
voluntary bearing-down efforts during the second stage.

The first stage of labor lasts from the time dilation begins to the time when the cervix is fully dilated.

The second stage of labor lasts from the time of full cervical dilation to the birth of the infant.

The third stage of labor lasts from the infant’s birth to the expulsion of the placenta.

The fourth stage of labor begins with the delivery of the placenta and includes at least the first 2 hours after birth.

The cardinal movements of the mechanism of labor are engagement, descent, flexion, internal rotation, extension, restitution
and external rotation, and expulsion of the infant.

Although the events precipitating the onset of labor are unknown, many factors, including changes in the maternal uterus,
cervix, and pituitary gland, are thought to be involved.

A healthy fetus with an adequate uterofetoplacental circulation is able to compensate for the stress of uterine contractions.

As the woman progresses through labor, various body systems adapt to the birth process.
Question

With regard to fetal positioning during labor, nurses should be aware that:

Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal.

Birth is imminent when the presenting part is at +4 to +5 cm, below the spine.

The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter.

Engagement is the term used to describe the beginning of labor.

A Incorrect: Position is the relation of the presenting part of the fetus to the four quadrants of the mother’s pelvis; station is
the measure of degree of descent.

B Correct: The station of the presenting part should be noted at the beginning of labor so that the rate of descent can be
determined.

C Incorrect: The largest diameter usually is the biparietal diameter. The suboccipitobregmatic diameter is the smallest,
although one of the most critical.

D Incorrect: Engagement often occurs in the weeks just before labor in nulliparas and before or during labor in multiparas.