INTRAPARTUM CARE
Membrane spaces – suture lines are important
Theories of Labor Onset
1. Uterine Stretch Theory – any hollow body
organ when stretched to capacity will necessarily
contract and empty.
2. Oxytocin Theory – labor, being considered a
stressful event, stimulates the hypophysis to produce
oxytocin from the posterior pituitary gland. Oxytocin
causes contraction of the smooth muscles of the body,
e.g. Uterine muscles
3. Progesterone Deprivation Theory –
progesterone, being the hormone designed to promote
pregnancy, is believed to inhibit uterine motility.
Thus, if its amount decreases, labor pains can occur.
4. Prostaglandin Theory – initiation of labor is
said to result from the release of arachidonic an acid
produced by steroid action on lipid precursors.
Arachidonic acid, is said to increase prostaglandin
synthesis which, in turn, causes uterine contractions.
5. Theory of Aging Placenta – because of the
decreased blood supply, the uterus contracts.
INTRAPARTUM (Process of
Labor and Delivery)
1. Passenger
THE FETAL SKULL
A. Importance – from an obstetrical point of view
the fetal skull is the most important part of the fetus
because:
1. it is the largest part of the body
2. it is the most frequent presenting part
3. it is the least compressible of all parts
B. Cranial Bones – the first 3 are not important
because they lie at the base of the cranium and,
therefore, are never the presenting parts:
1. Sphenoid 2. Ethmoid
3. Temporal 4. Frontal
5. Occipital 6. Parietal
C.
because they allow the bones to move and overlap;
changing the shape of the fetal head in order to fit
through the birth canal, a process called
MOLDING.
1. Sagittal suture line – the membranous inter-
space which joins the 2 parietal bones.
2. Coronal suture line – the membranous inter-
space which joins the 2 frontal bone and parietal
bones
3. Lambdoid suture line – the membranous inter-
space which joins the occiput and the parietals.
D. Fontanelles – membrane covered spaces at the
junction of the main suture lines:
1. Anterior fontanelle – the larger, diamond-
shaped fontanelle which closes between 12-18
months in an infant
2. Posterior fontanelle – the smaller, triangular
shaped fontanelle which closes between 2-3 months
in the infant.
E. Measurements – the shape of the fetal skull
causes it to be wider in its anteroposterior (AP)
diameter than in its transverse diameter.
1. Transverse diameter of the fetal skull:
a. Biparietal – 9.5 cm
b. Bitemporal – 8 cm
c. Bimastoid – 7 cm
2. Anteroposterior diameter:
a. Suboccipitobregmatic – from below the
occiput to the anterior fontanelle-9.5 cm (the
narrowest AP diameter)
b. Occipitofrontal – from the occiput to the mid-
frontal bone – 11 cm c. Occipitomental – from the
occiput to the chin – 13.5 cm (the widest AP
diameter)
2. PASSAGEWAY (VAGINA AND PELVIS)
A) 4 MAIN PELVIC TYPES:
1. GYNECOID - ROUND, WIDE, DEEPER
MOST SUITABLE FOR PREGNANCY.
2. ANTHROPOID - OVAL, APE-LIKE PELVIS.
THE APD: IS WIDE AND TD: IS NARROW.
3. ANDROID - HEART SHAPE “MALE PELVIS”.
THE ANTERIOR PART: IS POINTED WHILE THE
POSTERIOR: SHALLOW.
4. PLATYPELLOID – FLAT. THE APD: IS
NARROW AND TD: WIDE
Pelvic Measurements – preferably done after 6th
lunar month. X-RAY pelvimetry is the most effective
since X-rays are teratogenic, the procedure can be
done only 2 weeks before EDC.
3. POWER - THE FORCES ACTING TO EXPEL
THE FETUS AND PLACENTA.
1. INVOLUNTARY CONTRACTIONS.
2. VOLUNTARY BEARING DOWN EFFORTS.
3. CHARACTERISTICS: WAVE-LIKE.
4. TIMING: FREQUENCY, DURATION,
INTENSITY.
4. PSYCHE AND PERSON -
PSYCHOLOGICAL STRESS EXISTS WHEN THE
MOTHER IS FIGHTING
THE LABOR EXPERIENCE
1. CULTURL INTERPRETATION
2. PREPARATION
3. PAST EXPERIENCE
4. SUPPORT SYSTEM
5. PLACENTA
NORMAL LABOR AND
DELIVERY
Preliminary/Prodromal Signs of Labor
A. Lightening – the settling of the fetal head into
the pelvic brim. In primis, it occur 2 weeks before
EDC; in multis, on or before labor onset.
B. Increased Activity Level – due to increase in
epinephrine secreted to prepare the body for the
coming “work” ahead. Advise the pregnant woman
not to use this increased energy for doing household
chores.
C. Loss of weight – of about 2-3 lbs one to days
before labor onset, probably due to decrease in
progesterone production, leading to decrease in fluid
retention.
D. Braxton Hicks Contraction – painless,
irregular practice contractions.
E. Ripening of the cervix – from Goodell’s sign,
the cervix becomes “buttersoft”
F. Rupture of the membranes – it is
IMPORTANT to remember that once membranes that
once membranes (BOW) have ruptured:
1. Labor is inevitable. It will occur within 24 hours
2. The integrity of the uterus has been destroyed.
Infection, therefore, can easily set in. That is why
once membranes have ruptured, aseptic techniques
should be observed in all procedures, doctors do less
obstetric manipulations (e.g. IE) and enema is no
longer ordered.
3. Umbilical cord compression and/or cord prolapse
can occur (especially in breech presentation.
Nursing action depends on the specific situation cord
compression:
a. A woman in labor seeking admission to the hospital
and saying that her BOW had ruptured should be put
to bed immediately and the fetal heart tones taken
consequently.
b. If a woman in the Labor room says that her
membranes have ruptured, the initial nursing is to
take the fetal heart tones.
c. IF A WOMAN IN LABOR SAYS THAT SHE D. Uterine changes – the uterus is gradually
FEELS A LOOP OF THE CORD COMING OUT OF differentiated into 2 distinct portions.
THE VAGINA (CORD PROLAPSE, THE FIRST
NURSING ACTION IS TO PUT HER ON a. upper uterine segment – becomes thick and
TRENDELENBURG POSITION (LOWER THE active to expel out the fetus.
HEAD OF THE BED) IN ORDER TO REDUCE
b. lower uterine segment – becomes thin-walled,
PRESSURE ON THE CORD
supple and passive so that fetus can be pushed out
• (REMEMBER: ONLY 5 MINUTES OF CORD easily
COMPRESSION CAN ALREADY LEAD TO
IRREVERSIBLE BRAIN DAMAGE OR EVEN
DEATH).

• IN ADDITION, APPLY A WARM SALINE-

SATURATED OS ON THE PROLAPSED CORD
TO PREVENT DRYING OF THE CORD.

G. Show – due to pressure of the descending

presenting part of the fetus which causes rupture of
minute capillaries in the mucous membrane of the
cervix. Blood mixes with mucus when the operculum
is released. Show, therefore, is only a pinkish vaginal
discharge.
B. Difference between false and
true labor
A. Uterine Contractions – the surest sign that
labor has begun is the initiation of effective,
productive uterine contractions.
Physiological retraction ring is formed at the
boundary of the upper and lower uterine segments. In
difficult labor when fetus is larger than the birth
canal, the round ligaments of the uterus become tense
during dilatation and expulsion, causing an
abdominal indentation called BANDL’s
pathological Retraction Ring, a danger sign of
labor signifying impending rupture of the uterus if the
obstruction is not relieved.

2. Phases of Uterine contractions: STAGES OF LABOR

First stage (Stage of Dilatation) – begins with
a. Increment – first phase during which the
true labor pains and ends with complete dilatation of
intensity of contraction increases; also known as a
the cervix.
crescendo.
1. Power/Forces – involuntary uterine contractions
b. Acme – the height of the uterine contraction; also
known as apex. 2. Phases:

c. Decrement – last phase during which intensity of
contraction decreases; also known as decrescendo.
B. Effacement – shortening and thinning of the
cervical canal from 1-2 cm to one in which no canal
as distinct from the uterus exists. It is expressed in
percentage.
C. Dilatation – enlargement of the external cervical
OS to 10 cm primarily as a result of uterine
contractions and, secondarily, as a result of pressure
of the presenting part and the BOW.
a. Latent – early time in labor
● cervical dilatation is minimal because effacement is
occurring
● cervix dilates 0-3 cm only
● contractions are of short duration and occur
regularly 5-10 minutes apart (during which time the
pregnant woman may seek admission to the hospital)
● Mother is excited, with some degree of
apprehension but still with ability to communicate.
● takes up 8 of the 12-hour first stage B.
Active/Accelerated
● cervical dilatation reaches 4-8 cm
● rapid increase in duration, frequency, and intensity
of contractions
● Mother fears losing control of herself Nursing Care
a. Hospital admission – provide privacy and
reassurance
● Personal data – name, age, address, civil status
● Obstetrical data – determine EDC, obstetrical
score, amount, and character of the show
b. General physical examination,
IE, and Leopold’s maneuvers are
done to determine:
● Effacement and dilatation
Station – relationship of the fetal presenting part to
the level of the ischial spines.
1. Station 0 – at the level of the ischial spines,
synonymous to engagement
2. Station -1 – presenting part above the level of
ischial spines
3. Station +1 – presenting part below the level of
the ischial spines
4. Station +3 or +4 – synonymous to crowning
(encirclement of the largest diameter of the fetal head
by the vulvar ring)
Presentation – relationship of the long axis of the
fetus to the long axis of the mother; also known as
LIE. Presenting part – the fetal part which enters the
pelvis first and covers the internal cervical OS Types
of Presentation:
I. Vertical
A. Cephalic – head is the presenting part
□ Vertex – head sharply flexed, making the parietal
bone the presenting part
□ Face- poor flexion
□ Brow- if in poor flexion
□ Chin- the fetus is in hyperextension
NORMAL POSITION OF THE BABY
In most full-term pregnancies, the baby is positioned
head down, or in cephalic presentation, in the uterus.
TYPES OF BREECH
PRESENTATION
Complete breech is when both of the baby's knees
are bent and his feet and bottom are closest to the
birth canal.
Incomplete breech is when one of the baby's knees
is bent and his foot and bottom are closest to the birth
canal.
Frank breech is when the baby's legs are folded
flat up against his head and his bottom is closest to
the birth canal.
Footling breech where one or both feet are
presenting.
COMPLICATIONS OF
BREECH
A prolapsed umbilical cord is common in breech
deliveries. The umbilical cord slips down through the
cervix before the baby does. The cord is then
compressed during contractions, which cuts down on
blood flow to the baby. An emergency cesarean
section is usually needed.
Monitoring and Evaluation of important aspects
Uterine Contractions – fingers should be spread
lightly over the fundus
1. Duration – from the beginning of one contraction
to the end of the same contraction (A to B)
● Duration during early labor – 20-30 seconds
● Duration late in labor – 60 to 70 seconds
(SHOULD NEVER BE LONGER)
2. Interval – from the end of one contraction to the
beginning of the next contraction (B to C)
● Interval early in labor – 40-45 minutes
● Interval late in labor – 2 to 3 minutes
3. Frequency – from the beginning of one
contraction to the beginning of next contraction (A to
C)
● Time – 3 to 4 contractions to have a good picture of
the frequency of contractions.
4. Intensity – strength of contractions. Maybe mild,
moderate or strong. Intensity is measured by the
consistency of the fundus at the acme of the
contraction. When estimating intensity, check the
fundus at the end of contractions to determine
whether it relaxes.
5. Blood pressure – should not be taken during a
contraction as it tends to increase. Because no blood
supply goes to the placenta during a contraction, all
of the blood is in the periphery that is why there is
increased BP during uterine contractions.
● BP readings should be taken at least every hour
during active labor.
● When a woman in labor complains of a headache,
the first nursing action is to take the BP. If it is
normal, it is only a stress headache; if the BP is
increased, refer immediately to the doctor (it could be
a sign of toxemia)
6. Fetal Heart Rate – should not be mistaken for
uterine souffle (synchronizes with maternal pulse
rate)
● Normally 120-160 per minute
● Should not be taken also during a uterine
contraction because it tends to decrease. Compression
of the fetal head when the uterus contracts stimulates
the vagal reflex which, in turn, caused bradycardia.
NON-STRESS TEST(EFHRM)
● Is performed to assess placental function and
oxygenation
● Determines fetal well-being
● Evaluates fetal heart rate (FHR) response to fetal
movement.
WHAT IS FETAL SCALP ELECTRODE?
A FETAL SCALP ELECTRODE OR FSE IS A
SPIRAL WIRE THAT CAN BE PLACED ON THE
SCALP OF THE FETUS TO MONITOR THEIR
HEART RATE AND ENSURE THEIR WELL-
BEING. PLACING A FETAL SCALP ELECTRODE
IS A CRUCIAL PART OF DIRECTLY
MONITORING THE FETUS INSIDE THE WOMB
(INTERNAL FETAL MONITORING).
WHAT IS INTRAUTERINE PRESSURE
CATHETER?
AN INTRAUTERINE PRESSURE CATHETER
(IUPC) IS A DEVICE PLACED INTO THE
AMNIOTIC SPACE DURING LABOR IN ORDER
TO MEASURE THE STRENGTH OF UTERINE
CONTRACTIONS. EXTERNAL
TOCODYNAMOMETERS ARE USED TO
MEASURE TENSION ACROSS THE
ABDOMINAL WALL AND DETECT ONLY
CONTRACTION FREQUENCY AND DURATION.
TOCODYNAMOMETER
A PRESSURE-SENSITIVE DEVICE CALLED A
TOCODYNAMOMETER IS PLACED ON THE
MOTHER'S ABDOMEN OVER THE AREA OF
STRONGEST CONTRACTIONS TO MEASURE
THE LENGTH, FREQUENCY, AND STRENGTH
OF UTERINE CONTRACTIONS.
• TOCOCARDIOGRAPHY
FHT ACCELERATION
• ACCELERATIONS ARE SHORT-TERM RISES IN
THE HEART RATE OF AT LEAST 15 BEATS PER
MINUTE, LASTING AT LEAST 15 SECONDS.
ACCELERATIONS ARE NORMAL AND
HEALTHY. THEY TELL THE DOCTOR THAT
THE BABY HAS AN ADEQUATE OXYGEN
SUPPLY, WHICH IS CRITICAL. • HEART RATE
INCREASES DURING CONTRACTIONS. HEART
RATE RETURNS TO NORMAL AFTER BABY
MOVES OR AFTER A CONTRACTION. YOUR
CONTRACTIONS ARE STRONG AND REGULAR
DURING LABOR.
EARLY DECELERATIONS
• EARLY DECELERATIONS ARE
CHARACTERIZED BY A SLOWING OF THE
FETAL HEART RATE STARTING AT THE
BEGINNING OF THE CONTRACTION, AND
RETURNING TO THE BASELINE BY THE END
OF THE CONTRACTION. THEREFORE THE
FETAL HEART RATE DURING AN EARLY
DECELERATION IS SLOWEST DURING THE
MIDDLE OF THE CONTRACTION.
• EARLY DECELERATIONS ARE GENERALLY
NORMAL AND NOT CONCERNING.
LATE DECELERATION
• A LATE DECELERATION IS A SLOWING OF
THE FETAL HEART RATE DURING A
CONTRACTION, WITH THE RATE ONLY
RETURNING TO THE BASELINE 30 SECONDS
OR MORE AFTER THE CONTRACTION HAS
ENDED. THEY ARE PRESENT WITH EVERY
CONTRACTION. LATE DECELERATIONS
CONTINUE AFTER THE END OF THE
CONTRACTION.
• THEY ARE CAUSED BY DECREASED BLOOD
FLOW TO THE PLACENTA AND CAN SIGNIFY
AN IMPENDING FETALACIDEMIA.
VARIABLE DECELERATIONS
• VARIABLE DECELERATIONS ARE
IRREGULAR, OFTEN JAGGED DIPS IN THE
FETAL HEART RATE THAT LOOK MORE
DRAMATIC THAN LATE DECELERATIONS.
VARIABLE DECELERATIONS HAPPEN WHEN
THE BABY'S UMBILICAL CORD IS
TEMPORARILY COMPRESSED.
Types of Anesthesia:
◊ Paracervical – transvaginal injection into either
side of the cervix. Patient on lithotomy position.
Coupled with a local anesthetic, results in “painless
childbirth” (uterine contractions are not felt by
mother)
◊ Pudendal – through the sacro-spinous ligament
into the posterior areolar tissues to reduce perception
of pain during second stage and make mother
comfortable. Patient on lithotomy.
◊ Low spinal
Epidural – injection of local anesthetic at the
lumbar level outside the dura mater.
Saddle block – injection into the 5th lumbar space,
causing anesthesia into the parts of the body that
come in contact with a saddle (perineum, upper
thighs, and lower pelvis). Blocks nerves that transmit
pain of the first stage of labor. In sitting or side-lying
position, with back flexed.
◊ Forceps are generally needed in the delivery
of patients under anesthesia because of loss of
coordination in second-stage pushing.
A sure sign that the baby is about to be born is the
bulging of the perineum. In general, primigravidas
are transformed from Labor Room to the Delivery
Room when the cervix is fully dilated or when there
is bulging of the perineum; multiparas are transported
at 7- 8 cm cervical dilatation.
If membranes are still intact, this period is marked by
a sudden gush of amniotic fluid as fetus is pushed
into the birth canal. If spontaneous rupture does not
occur, amniotomy (snipping of BOW with a
sterile pointed instrument e.g. Kelly or Allis
forceps or amniohook to allow amniotic fluid
to drain), is done to prevent fetus from aspirating
the amniotic fluid as it makes its different fetal
position changes. Amniotomy, however cannot be if
station is still “minus” as this (can lead to cord
compression).
Second Stage of Labor (Stage of Expulsion) –
begins with complete dilatation of the cervix and
ends with delivery of the baby.
1. Power/Forces – involuntary uterine contractions
and contractions of the diaphragmatic and abdominal
muscles
2. Mechanisms of Labor/Fetal Position changes: (D
FIRE ERE)
Descent (maybe precede by engagement)
Flexion – as descent occurs, pressure from the pelvic
floor causes the chin to bend forward onto the chest
Internal Rotation – from AP to transverse
Extension – as head comes out, the back of the neck
stops beneath the pubic arch. The head extends and
the forehead, nose mouth and chin appear.
External rotation – (also called Restitution) –
anterior shoulder rotates externally to the AP position
Expulsion – delivery of the rest of the body.
Assist in Episiotomy – incision made in the
perineum primarily to prevent lacerations.
Types of Episiotomy:
◊ Median – from middle portion of the lower
vaginal border directed towards the anus
◊ Mediolateral – begun in the midline but directed
laterally away from the anus.
The Modified Ritgen’s Maneuver: ◊ Cover the anus
with sterile towel and exert upward and forward
pressure on the fetal chin, while exerting gentle
pressure with two fingers on the head to control
emerging head. This will not only support the
perineum, thus preventing lacerations, but will also
favor flexion so that the smallest sub-
occipitobregmatic diameter of the fetal head is
presented.
Third Stage of Labor (Placental Stage) –
begins with the delivery of the baby and ends with
the delivery of the placenta.
1. Signs of placental separation:
a. Uterus becoming round and firm again,
rising high to the level of the umbilicus
(Calkin’s sign) – the earliest sign of placental
separation.
b. Sudden gush of blood from the vagina
c. Lengthening of the cord from the vagina
2. Types of placental delivery:
a. Schultz – if placenta separates first at its center
and last at its edges, it tends to fold on itself like an
umbrella and presents the fetal surface which is shiny.
80% of placentas separate in this manner (“Shiny”).
b. Duncan – if placenta separates first at its edges, it
slides along the uterine surface and presents with the
maternal surface which is raw, red, beefy, irregular
and “dirty”. Only 20% of placentas separate this way.
Fourth Stage of Labor (Maternal
Homeostatic Stabilization Stage) – first 1-2
hours after delivery which is said to be the most
critical stage for the mother because of unstable vital
signs.
1. Assessment:
a. Fundus – should be checked every 15 minutes for
1 hour then every 30 minutes for the next 4 hours.
Fundus should be firm, in the midline and, during the
first 12 hours postpartum, is a little above the
umbilicus. First nursing action for a noncontracted
uterus: MASSAGE.
b. Lochia – should be moderate in amount.
Immediately after delivery, a perineal pad can be
completely saturated after 30 minutes.
c. Bladder - a full bladder is evidenced by a fundus
which is to the right of the midline, dark-red bleeding
with some clots.
d. Perineum - is normally tender, discolored and
edematous. It should be clean, with intact sutures.
e. Blood pressure and pulse rate - may be
slightly increased from excitement and effort of
delivery, but normalize within one hour.
2. Lactation - suppressing agents-estrogen-
androgen preparation given within the first hours
postpartum to prevent breastmilk production in
mothers who will not (or cannot) breastfeed. E.g
diethylstilbestrol, TACE or deladumone. These drugs
tend to increase uterine bleeding and retard menstrual
return.
3. Rooming-in Concept - mother and baby are
together while in the hospital. The concept of a
family, therefore, is felt at the very beginning because
parents have the baby with them, thus providing
opportunities for developing a positive relationship
between parents and newborn. Eye-to-eye contact is
immediately established, releasing maternal
caretaking responses.
CARE AND MANAGEMENT
OF INTRAPARTAL WOMAN
Administer Analgesics as ordered. The dosage
is based on the patient’s weight, status of labor and
size and age of gestation.
● Narcotics are the most commonly used, specifically
DEMEROL.
Assist in the administration of Regional
Anesthesia preferred over any other form of
anesthesia because it does not enter maternal
circulation and thus does not affect the fetus.
- Does not depress uterine tone, thus optimal uterine
contraction is achieved.
NON-PHARMACOLOGIC
METHODS OF PAIN
CONTROL FOR THE
LABORING WOMAN
BIRTHING BALLS ARE PROFESSIONALLY
MADE FOR USE IN PHYSICAL THERAPY AND
THE BALL EASILY WITHSTANDS THE
PRESSURE APPLIED BY THE WEIGHT OF THE
LABORING WOMAN.
PATTERNED BREATHING
• THESE BREATHING TECHNIQUES PROVIDE
COMFORT AND FOCUS WHILE ENHANCING
LABOR PROGRESS.
• PATTERNED BREATHING ENHANCES
OXYGEN FLOW TO YOUR BABY AND IS ALSO
VITAL TO THE CONTRACTING UTERUS.
BEVERAGES - YOU SHOULD STAY WELL
HYDRATED WHILE LABORING. LABORING
WOMEN MAY HAVE CLEAR LIQUIDS SUCH AS
WATER, JUICE, BROTH, ICE, AND POPSICLES.
MOVEMENT AND POSITION
CHANGES
• YOU MAY EXPERIENCE LESS PAIN IN SOME
POSITIONS THAN IN OTHERS DURING LABOR.
LABORING WOMEN TEND TO FIND
UPRIGHT POSITIONS MOST COMFORTABLE
SUCH AS SITTING, STANDING, AND
WALKING. MANY CHOOSE A LYING DOWN
POSITION AS LABOR ADVANCES. MOVING
ABOUT DURING LABOR IS USUALLY MORE
COMFORTABLE THAN STAYING STILL AND
CAN HELP LABOR PROGRESS BY THE SIMPLE
EFFECTS OF GRAVITY AND THE CHANGING
SHAPE OF THE PELVIS.
• IT MAY ALSO RELIEVE PAIN BY SHIFTING
PRESSURE AND ALLOWING THE BABY TO
MOVE. YOU MAY TRY SITTING, KNEELING,
STANDING, LYING DOWN, GETTING ON YOUR
HANDS AND KNEES, AND WALKING.
SUPERFICIAL HEAT AND COLD
• HOT COMPRESSES APPLIED TO THE LOWER
ABDOMEN, GROIN OR PERINEUM, A WARM
BLANKET OVER THE ENTIRE BODY AND
ICE PACKS TO THE LOWER BACK OR
PERINEUM CAN HELP ALLEVIATE LABOR
PAIN
• USING HEAT OR COLD ON SEPARATE PARTS
OF THE BODY AT THE SAME TIME CAN
PROVIDE PARTICULARLY EFFECTIVE PAIN
RELIEF. FOR EXAMPLE, APPLY A COOL CLOTH
TO THE FOREHEAD WITH WARMTH ON THE
LOWER BACK.
COUNTER-PRESSURE
• COUNTER-PRESSURE CONSISTS OF
STEADY, STRONG FORCE APPLIED TO ONE
SPOT ON THE LOWER BACK DURING
CONTRACTIONS USING THE HEEL OF THE
HAND, OR PRESSURE ON THE SIDE OF EACH
HIP USING BOTH HANDS. COUNTER-
PRESSURE HELPS ALLEVIATE BACK PAIN
DURING LABOR, ESPECIALLY IN THOSE
WOMEN EXPERIENCING “BACK LABOR.”
HYDROTHERAPY
• HYDROTHERAPY DURING LABOR
(TECHNIQUES USING WATER) CAN BE
EMOTIONALLY SOOTHING AND CAN ALSO
HELP WITH PAIN RELIEF.
• MANY WOMEN ARE COMFORTED BY THE
COMBINATION OF WARMTH, WATER
PRESSURE, AND THE SOUND OF THE WATER.
• IMMERSION IN WATER MAY ACCELERATE
LABOR, DECREASE BLOOD PRESSURE, AND
INCREASE A LABORING WOMAN’S
FEELING OF CONTROL OVER HER BIRTH.
FOCUS AND DISTRACTION
• MANY METHODS OF COPING WITH PAIN
RELY ON THE LABORING WOMAN’S ABILITY
TO FOCUS AND USE MIND-DIVERTING
ACTIVITIES.
• FEAR AND ANXIETY CAUSE THE RELEASE
OF STRESS HORMONES.
• YOU CAN EASE THESE FEELINGS BY
ENVISIONING A PLEASANT SCENE,
VISUALIZING WHAT IS ACTUALLY
HAPPENING SUCH AS THE CERVIX OPENING
OR THE BABY MOVING DOWN.
• FOCUSING ONE’S ATTENTION IS A
DELIBERATE ACTIVITY AND IS AIDED BY
VERBAL COACHING, VISUALIZATION, SELF-
HYPNOSIS, AND CONCENTRATION ON A
VISUAL, AUDITORY, OR TACTILE STIMULUS.
AUDIO-ANALGESIA
• AUDIO-ANALGESIA (MUSIC, TALK) ARE
USED TO CONTROL PAIN IN CHILDBIRTH.
• MANY CHILDBIRTH EDUCATORS USE MUSIC
IN THEIR CLASSES TO CREATE A PEACEFUL
AND RELAXING ENVIRONMENT AND THEY
ADVOCATE FOR ITS USE DURING LABOR AS
AN AID TO RELAXATION.
• AUDIO-ANALGESIA FOR PAIN RELIEF
CONSISTS OF SOOTHING MUSIC BETWEEN
AND DURING CONTRACTIONS.
PARTURITION OR
CHILDBIRTH
B. Transition Period
• Cervix dilates from 8 to 10 centimeters
• Contractions are very strong, lasting 60 to 90
seconds and occurring every few minutes
• Most women feel the urge to push during this phase.
1. If membranes are still intact, this period is marked
by a sudden gush of amniotic fluid as the fetus is
pushed into the birth canal.
If spontaneous rupture does not occur, amniotomy is
performed.
Amniotomy - it is the artificial rupturing of
membranes during labor if they do not rupture
spontaneously to allow the fetal head to contact the
cervix more directly.
VACUUM ASSISTED DELIVERY
• A VACUUM DEVICE IS A SUCTION CUP WITH
A HANDLE ATTACHED. THE SUCTION CUP IS
PLACED IN THE VAGINA AND APPLIED TO
THE TOP OF THE FETUS'S HEAD. GENTLE,
WELL
CONTROLLED TRACTION IS USED TO HELP
GUIDE THE FETUS OUT OF THE BIRTH CANAL
WHILE YOU KEEP PUSHING.
A VACUUM EXTRACTION
POSES A RISK OF INJURY
FOR BOTH MOTHER AND
BABY.
POSSIBLE RISKS FOR THE MOTHER
INCLUDES:
• PAIN IN THE PERINEUM — THE TISSUE
BETWEEN YOUR VAGINA AND YOUR ANUS —
AFTER DELIVERY
• LOWER GENITAL TRACT TEARS
• SHORT-TERM DIFFICULTY URINATING OR
EMPTYING THE BLADDER
• SHORT-TERM OR LONG-TERM URINARY OR
FECAL INCONTINENCE (INVOLUNTARY
URINATION OR DEFECATION)
FORCEPS ASSISTED DELIVERY
• A FORCEPS DELIVERY IS A TYPE OF
ASSISTED VAGINAL DELIVERY. IT'S
SOMETIMES NEEDED IN THE COURSE OF
VAGINAL CHILDBIRTH.
MCROBERTS MANEUVER
• THE TECHNIQUE IS PERFORMED BY
FLEXING THE MOTHER'S THIGHS TOWARD
HER SHOULDERS WHILE SHE IS LYING ON
HER BACK. NO SPECIFIC DEGREE OF
ELEVATION OR FLEXION OF THE PATIENT'S
LEGS HAS BEEN DEFINED FOR THE
MCROBERTS MANEUVER.
SUPRAPUBIC PRESSURE
• THE DOCTOR ATTEMPTS TO RELEASE THE
BABY'S SHOULDER BY APPLYING PRESSURE
TO THE MOTHER'S LOWER ABDOMEN OVER
THE PUBIC BONE. THIS IS DONE BY MAKING
A FIST, PLACING IT JUST ABOVE THE
MOTHER'S PUBIC BONE, AND PUSHING THE
INFANT'S SHOULDER IN ONE DIRECTION OR
ANOTHER.
FUNDAL PRESSURE
• FUNDAL PRESSURE SIMPLY MEANS
MANUALLY APPLYING PRESSURE OR
PUSHING DOWNWARD AT THE TOP OF THE
MOTHER'S UTERUS. FUNDAL PRESSURE
DURING DELIVERY IS ALSO REFERRED TO AS
GENTLE ASSISTED PUSHING (GAP).
Inject Oxytocin (Methergin 0.2 mg/ml or
Syntocinon = 10 U/ml) – Im to maintain uterine
contractions, thus prevent hemorrhage.
Categories of Lacerations (tend
to heal more slowly because of
ragged edges):
First degree – involves the vaginal mucous
membranes and skin Second degree – involves not
only the vaginal mucous membranes and skin, but
also the muscles.
Second degree – involves not only the vaginal
mucous membranes and skin, but also the muscles.
Third degree – involves not only the muscles,
vaginal mucous membranes and skin, but also the
external sphincter of the rectum.
Fourth degree – involves not only the external
sphincter of the rectum, the muscles, vaginal mucous
membranes and skin, but also the mucous membranes
of the rectum.
◊ Assist the doctor in doing episiorrhaphy (repair of
episiotomy or lacerations). In vaginal episiorrhaphy,
packing is done to maintain pressure on the suture
line, thus prevent further bleeding.
NOTE: Vaginal packs have to be removed after 24-48
hrs.
CESARIAN BIRTH
 Birth accomplished through an abdominal incision
into the uterus
 One of the oldest types of surgical procedures
known.
 More hazardous than vaginal birth
 If compared with other surgical procedures, it is
one of the safest.
 It came from the latin word, “Caedore” which
means to cut.
Effects of Cesarean Birth
1. Stress Response  >Body is subject to stress,
this results in the release of epinephrine and
norepinephrine from adrenal medulla.
2. Interference with Body Defense
 >Skin serves as the primary line of defense against
bacterial invasion
 >When skin is incised for surgical procedure, the
important line of defense is lost
 >Sterile technique is important before, during the
surgery and in the days following procedure
3. Interference with Circulatory Function -
Some blood loss always occurs with surgery, even
though vessels were immediately ligated and clamped
after cutting
EFFECTS OF CESAREAN
BIRTH COMPLICATIONS:
Hypovolemia – lowered BP, - ineffective perfusion
of all body tissues
4. Interference with Body Organ Function
> Pressure from edema or inflammation as fluid
moves into are further impairs function of the
primary organs as well as that of the surrounding
organs
> Edema may be the result
 -deprivation of blood flow
 -impaired functions of these organs
5. Interference with self- image or self- esteem
> Incisional scars can be noticed to some extent

TYPES OF CESAREAN BIRTH

1. Classic cesarean Birth – incision is made
through both the abdominal skin and the uterus, made
high on the uterus so that it can be used on a placenta
previa

Disadvantage: leaves a wide skin scar also runs

through the active contractile portion of the uterus

2. Low Segment Incision - Bikini incision or

bikini cut, Plannenstiel incision, made horizontally
across the abdomen just over the cervix,

Disadvantage – takes longer to perform