COMPONENTS OF LABOR - Cephalic Occipitofrontal, 12 cm,

military attitude
4 P’s
- Cephalic Brow, 12 cm, partial
1. PASSAGE flexion, also called occipitofrontal
- This refers to the woman's pelvis is of - Cephalic face, occipitomental, 13.5
adequate size and contour (birth canal) cm, poor flexion, complete
in allowing fetal descent; factors extension
include:
Breech {frank, single or double footing
- Type of pelvis (e.g. gynecoid,
complete}
android, anthropoid or platypelloid)
- Structure of pelvis (e.g. true vs. - Complete; fetus has thighs tightly
False pelvis) flexed on the abdomen. The
- Pelvic anterior-posterior inlet buttocks present to the cervix.
diameter or its diagonal conjugate - Frank; the hips are flexed but the
- Pelvic transverse outlet diameter knees are extended to rest on the
2. PASSENGER chest. The buttock alone present to
- This refers to the fetus and its the cervix.
ability to move through the - Footling or double footling; neither
passageway, which is based on the the thighs or lower legs are flexed
following:
Shoulder {transverse, lie}
 Size of fetal head
- The fetus lie sideways, the shoulders
- Size of the fetal head and capability
is present to the cervix.
of the head to mold the passageway.
 Fetal Position
- Suboccipitobregmatic – 9.5 cm
(narrowest diameter) - the relationship of a reference
points of the presenting part and
- Occipitofrontal – 12 cm (brow)
- Occipitomental – 13.5 cm (face) the maternal pelvis, described with
a series of three letters.
 Fetal presentation
- Side of the maternal pelvis (L or R)
- the part of the fetus enters to the
- Presenting fetal landmark: O
maternal pelvis first
(occiput), S (sacrum), A (acromion
Cephalic {vertex, face, brow, mentum}
process/scapula), M (mentum).
- Cephalic vertex - Maternal pelvis landmark: A
(suboccipitobregmatic), 9.5 cm, full (anterior), P (posterior), T
flexion (transverse).
Vertex presentation (occiput)
- Left or Right occipitoanterior
- Left or Right Occipitoposterior
- Left or Right occipitotransverse
Breech presentation (sacrum)
- Left or Right sacroanterior
- Left or Right sacroposterior
- Left or Right sacrotransverse
Face presentation (mentum)
- Left or Right mentoanterior
- Left or Right mentoposterior
- Left or Right mentotransverse
Shoulder presentation (acromion process)
- Left or Right scapuloanterior
- Left or Right scapuloposterior
 Fetal attitude
- describes the degree of flexion a
fetus assumes during labor or the
relation of the fetal parts to each
other. A fetus is said to be in good
attitude in complete flexion.
- Complete flexion
(occipitobregmatic/good)= 9.5 cm
- Moderate flexion
(occipitofrontal/military) = 12.0 cm
- Partial extension (brow
presentation) = 12.0 cm
- Complete extension
(occipitomental/face)= 13.5 cm
3. Powers of labor
- Supplied by the fundus of the uterus
- Uterine Contractions rhythmicity
and progressive lengthening and
intensity
- Cervical Changes to complete
cervical effacement and dilatation
that leads to expulsion of the fetus.
4. Psyche
- This refers to the client’s
psychological state or feelings,
available support systems and
preparation that a woman brings
into labor.
- Women without adequate support
can develop a posttraumatic stress
syndrome.
- Encouraging women to prenatal
visits and to attend preparation for
childbirth classes helps prepare
them for labor.
STAGED OF LABOR
1. FIRST STAGE
- Beginning of labor to full cervical
dilation
- 4cm to 10cm
- Mechanism of labor: DFIrEErE
Descent
- Station -1 to -4: above ischial spine
- Station 0: level of ischial spine
- Station +1 to +4: below ischial spine
Flexion
 - Resistance to descent causes head - Mother status: apprehensive
to flex so the chin is close to the  Transition phase
chest. - Cervix open to 8cm to 10cm
- 100% effaced
Internal rotation
- Shortest phase
- Fetal body makes 90 degree rotation
- Mother status: out of control
Extension 2. SECOND STAGE
- Full dilation to delivery of the baby
- Fetal head forces itself to extend
- 45 to 60 mins
enable head to emerge when
- Crowning occurs
cephalic; begins after head emerges
- When baby is out: do essential
and restitutes.
newborn care
External rotation
Nursing management:
- Fetal head returning to it normal
- Positioning
relationship with the shoulders
- Pushing/bearing down techniques
Expulsion - Prevent infection: do perineal care

- Birth of the entire body. - Assisting in episiotomy

3. THIRD STAGE
Three phases:
- From delivery of the baby to the
 Latent phase delivery of the placenta.
- Contractions become progressively - Lasts only a few minutes but may
stronger last up to 30 mins
- Discomfort is minimal
Active management:
- Cervix open to 4 cm
- Longest phase; 12 hrs for first - Administer oxytocin 10 units IM

timers, 5 hrs in subsequent - Apply cord traction and counter

pregnancy traction

- Mother status: cooperative - Massage the fundus

 Active phase Signs of placental separation:

- Cervix open to 4cm to 7cm
 Calkin’s sign
- Women feel the urge to push as
- Globular shape of abdomen
baby descends
- Uterus becomes firmer
- Time: 3 hrs in first timers, 2 hrs in
 Gush of blood
subsequent pregnancy
 Lengthening of the umbilical cord
Placental presentation: membrane, the fascia and muscles
of the perineal body and the anal
 Matthew Duncan
sphincter.
- Maternal surface
4. Fourth degree
- Dirty side
- Involving the fourchette, perineal
 Schultze
skin and vaginal mucous
- Fetal surface
membrane, the fascia and muscles
- Shiny side
of the perineal body and the anal
4. FOURTH STAGE
sphincter and extends through the
- Begins with the delivery of the
rectal mucosa exposing the lumen
placenta and ends 1 to 4 hours after
of the rectum.
delivery.
NOTE: Do Ritgen’s Maneuver immediately
Nursing management:
after episiotomy to prevent tearing.
- Monitor VS
- Fundal height and firmness
- Lochia
- Urinary output
- Bonding activities especially
breastfeeding.

EPISIOTOMY

- Median
- Mediolateral
1. First degree
- Involving the fourchette, perineal
skin and vaginal mucous
membrane.
2. Second degree
- Involving the fourchette, perineal
skin and vaginal mucous
membrane, the fascia and muscles
of the perineal body.
3. Third degree
- Involving the fourchette, perineal
skin and vaginal mucous