9/14/2023

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

OUR LADY OF FATIMA UNIVERISTY

COLLEGE OF NURSING

PRELIMINARY SIGNS OF LABOR

LIGHTENING SUDDEN WEIGHT INCREASE ACTIVITY
LOSS LEVEL

LABOR
 9/14/2023

RIPENING OF THE
BRAXTON HICK’S
CERVIX
SHOW/BLOOD
SHOW
TRUE LABOR AND FALSE LABOR
CONTRACTION
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
RUPTURE OF Begins on lower back and
Pain location Confined on abdomen
MEMBRANE radiates to abdomen
Cervical Changes No cervical changes Effacement and dilation

DURATION OF LABOR Factors affecting Labor & Delivery:

5 P’s OF LABOR

• PRIMIPARA • MULTIPARA
• PASSENGER (FETUS)

: :
• 14 HOURS • 8 HOURS
BUT NOT BUT NOT
MORE MORE
THAN 20 THAN 14
HOURS HOURS
 9/14/2023

• PASSAGEWAY

Anterior-
• POWER
Diagonal
Posterior Transverse
(AP)
Inlet
11cm 13cm 12cm
Cavity
12cm 12cm 12cm
Outlet 13cm 11cm 12cm

• PSYCHOLOGICAL • PLACENTAL
RESPONSE FACTOR
 9/14/2023

FOUR STAGES OF LABOR DILATATION STAGE – begins

with the onset of true uterine
• 1ST STAGE (DILATATION STAGE) contractions and ends when the
cervix is fully dilated.
• 2ND STAGE ( EXPULSION STAGE)
- THREE (3) PHASES
• 3RD STAGE (PLACENTAL STAGE) - LATENT 0 - 3 CM DILATED
- ACTIVE 4 - 7 CM DILATE
• 4TH STAGE (RECOVERY STAGE) - TRANSITION 8 - 10 CM DILATED

LATENT ACTIVE TRANSITION

ASSESSING FETAL ENGAGEMENT AND
DILATATION 0-3CM 4-8cm 8-10cm
STATION
FREQUENCY q 5-10mins q 3-5 min q2-3min
• Relationship of the
DURATION 20-40 secs 30-60 secs 60-90 secs presenting part to the
ischial spine and
INTENSITY MILD MODERATE STRONG denoted in
MOTHER'S
Apprehensive, excited but can
communicate
Fear of losing control of
herself
Sudden behavioral or mood
changes usually accompanied by
centimeters
BEHAVIOR hyperesthesia

Encourage walking to shorten the Medication redied Tired

1st stage of labor, Chest breathing, Assess vital signs, progress Restless
NURSING CARE Encourage to void every 2-3hrs of labor Apply sacral pressure
 9/14/2023

FETAL PRESENTATION BREECH PRESENTATION

SHOULDER

COMPOUND

FETAL FETAL LIE

POSITION
LOA – most common
and favorable birthing
position

LOP and ROP – most

common malposition
and most painful as
well.
 9/14/2023

NURSING MANAGEMENT EXPULSION/DELIVERY OF THE BABY – which

• If the client complains of headache, take the blood pressure encompasses the actual birth, begins when the cervix is fully
dilated and ends with the delivery of the fetus.
• Encourage the client to bathe
• Allow the mother to eat crackers or sip of water or NPO as • CARDINAL MOVEMENTS / MECHANISM OF LABOR
doctor’s order. Observe aspiration precaution D - DESCENT
• Provide perineal care F - FLEXION
• Encourage the mother to maintain left lateral position
IR - INTERNAL ROTATION
• Monitor fetal heart tone
E - EXTENSION
ER - EXTERNAL ROTATION
E - EXPULSION

BULGING OF THE
PERINEUM MOULDING
 9/14/2023

EPISIOTOMY RITGEN’S MANEUVER

(perineotomy)

DEGREE OF PERINEAL LACERATION

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

EPISIORRHAPHY *CONTROLLED CORD TRACTION

WITH COUNTER TRACTION(CCTCT)
 9/14/2023

TYPES OF PLACENTAL SEPARATION RECOVERY STAGE - begins after

delivery of the placenta and the 1st four hours
SCHULTZ DUNCAN after delivery.

Cotyledons

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