LABOR AND

DELIVERY

OUR LADY OF FATIMA UNIVERISTY

COLLEGE OF NURSING

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OBJECTIVES
• Meaning of labor
• Theories of the onset of labor
• Ways in which labor can be stimulated
• Signs and symptoms of labor
• Stages and cardinal movements of labor
• Nursing responsibilities during labor and birth
including ways to provide comfort and support

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LABOR

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PRELIMINARY SIGNS OF LABOR
LIGHTENING SUDDEN WEIGHT INCREASE ACTIVITY
LOSS LEVEL

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 RIPENING OF THE SHOW/BLOOD
BRAXTON HICK’S
CERVIX SHOW
CONTRACTION

RUPTURE OF
MEMBRANE

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TRUE LABOR AND FALSE LABOR
CRITERIA FALSE LABOR TRUE LABOR
Frequency of contractions Irregular Regular

Intensity of contractions no increase Increases

Pain is relieved by Pain is intensified by
Pain relief
walking walking
Begins on lower back
Pain location Confined on abdomen and radiates to
abdomen
Cervical Changes No cervical changes Effacement and dilation
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DURATION OF LABOR
• PRIMIPAR • MULTIPAR
A: A:
• 14 HOURS • 8 HOURS
BUT NOT BUT NOT
MORE MORE
THAN 20 THAN 14
HOURS HOURS 7
Factors affecting Labor & Delivery:
5 P’s OF LABOR
• PASSENGER (FETUS)

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• PASSAGEWAY

Anterior- Transvers
Posterio Diagonal
r(AP) e
Inlet
11cm 13cm 12cm
Cavit
y 12cm 12cm 12cm

Outlet 13cm 11cm 12cm

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• POWER

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• PSYCHOLOGICAL
RESPONSE

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• PLACENTAL
FACTOR

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FOUR STAGES OF LABOR
• 1ST STAGE (DILATATION STAGE)

• 2ND STAGE ( EXPULSION STAGE)

• 3RD STAGE (PLACENTAL STAGE)

• 4TH STAGE (RECOVERY STAGE)

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DILATATION STAGE – begins
with the onset of true uterine
contractions and ends when the
cervix is fully dilated.

- THREE (3) PHASES

- LATENT 0 - 3 CM DILATED
- ACTIVE 4 - 7 CM DILATE
- TRANSITION 8 - 10 CM DILATED

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 LATENT ACTIVE TRANSITION

DILATATION 0-3CM 4-8cm 8-10cm

FREQUENCY q 5-10mins q 3-5 min q2-3min

DURATION 20-40 secs 30-60 secs 60-90 secs

INTENSITY MILD MODERATE STRONG

Apprehensive, excited but can Fear of losing control of Sudden behavioral or mood
MOTHER'S communicate herself changes usually accompanied
BEHAVIOR by hyperesthesia

Encourage walking to shorten the Medication redied Tired

1st stage of labor, Chest Assess vital signs, Restless
NURSING
breathing, Encourage to void progress of labor Apply sacral pressure
CARE every 2-3hrs
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ASSESSING FETAL ENGAGEMENT AND
STATION
• Relationship of the
presenting part to the
ischial spine and
denoted in
centimeters

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FETAL PRESENTATION

SHOULDER

COMPOUND

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BREECH PRESENTATION

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 FETAL
POSITION
LOA – most common
and favorable birthing
position

LOP and ROP – most

common malposition
and most painful as
well.

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FETAL LIE

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NURSING MANAGEMENT
• If the client complains of headache, take the blood pressure
• Encourage the client to bathe
• Allow the mother to eat crackers or sip of water or NPO as
doctor’s order. Observe aspiration precaution
• Provide perineal care
• Encourage the mother to maintain left lateral position
• Monitor fetal heart tone

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EXPULSION/DELIVERY OF THE BABY – which
encompasses the actual birth, begins when the cervix is fully
dilated and ends with the delivery of the fetus.

• CARDINAL MOVEMENTS / MECHANISM OF LABOR

D - DESCENT
F - FLEXION
IR - INTERNAL ROTATION
E - EXTENSION
ER - EXTERNAL ROTATION
E - EXPULSION

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BULGING OF THE
PERINEUM MOULDING

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EPISIOTOMY
(perineotomy)

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RITGEN’S MANEUVER

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DEGREE OF PERINEAL LACERATION

EPISIORRHAPHY
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PLACENTAL STAGE - begins
immediately after the neonate is delivered and ends
when the placenta is delivered
• SIGNS OF PLACENTAL
SEPARATION
• Rising of fundus
• CALKIN'S SIGN
• SUDDEN GUSH OF BLOOD
• LENGTHENING OF THE
CORD
*CONTROLLED CORD TRACTION
WITH COUNTER TRACTION(CCTCT)
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TYPES OF PLACENTAL SEPARATION
SCHULTZ DUNCAN

Cotyledons

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RECOVERY STAGE - begins after
delivery of the placenta and the 1st four hours
after delivery.

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NURSING INTERVENTIONS
• Monitor vital signs every 15mins for 1 hour and
every 30mins until the client transferred to the
ward
• Monitor vaginal bleeding
• Monitor if the uterus is contracted
• Observe the episiorraphy site
• Monitor the baby’s vital signs

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References
• Pillitteri, Adele (2014). Maternal and Child Health Nursing: Care of
the Childbearing and Childbearing Family, 7th edition, vol 2.
Philadelphia: Lippincott Williams and Wilkins. 618.20231 P64 2014,
v1, c10

• Hockenberry, Marilyn J. (2015). Wong’s Nursing Care of Infants and

Children, Vol. 1. Singapore: Elsevier. 610.736 H65 2016 v1, c6

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