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Also known as Parturition, childbirth, birthing. Is the process by which the fetus & placenta are expelled from the uterus and the vagina into the external environment. PROSTAGLANDIN THEORY A parturient is a woman in labor. → It has been known that when fetus has Toco - and toko- (Gr.) are combining reached maturity, the fetal membranes forms meaning childbirth. produce large amount of arachidonic acid • Eutocia – normal labor which is converted by maternal decidua • Dystocia – difficult labor into a prostaglandin, a hormone that → Normally, labor begins when the fetus is initiates uterine contractions. sufficiently mature, yet not too large to → During labor the level of arachidonic acid cause difficulties in delivery. in the amniotic fluid is very high resulting → In some instances, labor begins before in increased productions of the fetus is mature (premature birth); in prosttaglandin. others labor is delayed (postmature birth). It is unknown why this occurs… 1. THEORY OF THE AGING PLACENTA → As the placenta “ages”, it becomes less THEORIES ON THE ONSET OF LABOR efficient, producing decreasing amount of progesterone. 1. FETAL ADRENAL RESPONSE THEORY → This progesterone decline allows the → Hippocrates, the father of medicine, concentration of prostaglandin and was the first person to propose this estrogen to rise steadily. theory which states that certain hormones produced by the fetal adrenal and pituitary gland initiates’ labor contraction. 1. OXYTOCIN STIMULATION THEORY → Studies have shown that as pregnancy near term, oxytocin production by the posterior pituitary gland while the production of oxytocinase by the placenta . → Oxytocin stimulates uterine contractions while oxytocinase inhibits uterine contractions. → As a result the uterus becomes increasingly sensitive to oxytocin. 1. UTERINE STRETCH THEORY According to this theory “any hallow organ stretched, will always contract & expel its content.” A pregnancy advances, the uterus becomes increasingly distended by the growing fetus, placenta and amniotic fluid, distention of the uterus creates pressure on the nerve endings which stimulates uterine contractions. 1. PROGESTERONE DEPRIVATION THEORY Progesterone helps maintain pregnancy by its relaxant effect on the smooth muscles of the uterus, thereby, preventing uterine contractions. PRELIMINARY SIGNS OF LABOR 1) LIGHTENING – (“The baby dropped”) or descent of the fetal presenting part into the pelvis, occurs approximately 10 – 14 days before labor begins. → Engagement – descent of the biparietal
plane of the fetal head to a level below that of the pelvic inlet. → Fixation – is descent of the fetal head to the inlet to a level below that of the pelvic inlet. → Floating – When head is still movable above the pelvic inlet on palpation
As pregnancy nears term, the production of progesterone by the placenta decreases, this decline in progesterone allows uterine contraction to occur.
2) h IN LEVEL OF ACTIVITY 3) WEIGHT LOSS – 2 wks before labor, the woman experience sudden weight loss of about 2-3 lbs. 4) BRAXTON HICKS CONTRACTION 5) RIPENING OF THE CERVIX “goodell’s sign”
SIGNS OF TRUE LABOR • Uterine contractions – “surest sign” • Show – “Bloody show”, blood mixed with mucus (operculum). • Rupture of the membranes
PASSAGES (Pelvic Area) or “Restitution” Hard passages: Bony pelvis Head rotates back to diagonal or Soft passages: Lower uterine segment. – Use % in unit of measurement Primigravidas usually efface more quickly than they dilate. Multiparas typically will experience effacement and dilatation at the same time. PASSENGER (Baby) and as to the other hand applies Fetal positions. EXPULSION 2. Gentle pressure on the contracted uterine fundus by the Physician/midwife. MANEUVER Secondary force: Voluntary use of thoracic. presentation gentle downward pressure on the and attitude. RITGEN’S MANEUVER – Insertion muscles when the mother “bears of the hand and application of down”. Primary force: Involuntary uterine contractions. perineum. Dilatation – widening of cervix. (up. shoulders cervix. EXTENSION Extension of the head. POWER Rest of the baby is born. diaphragm and abdominal 1. fetal occiput to allow controlled 4.Bending of the head onto the chest making the smallest anterior-posterior diameter (suboccipitobregmatic) present to the birth canal. transverse position. 5 P’s of LABOR (Factors of Labor) EXTERNAL ROTATION 1. down and side technique. vagina. PERSON (Mother) delivery of the fetal head. shoulder enterd the pelvic inlet. upward pressure on the fetal chin 3. MODIFIED CREDE’S MANEUVER is a manual technique to help facilitate the delivery of the placenta. POSITION 2. Maternal attitude during labor 5. DESCENT Downward movement of the biparietal diameter of the fetal head to within the pelvic inlet. . FLEXION placenta. Effacement – softening & thinning of cervix. The technique is coiling the umbilical cord through forcep. face and chin are born. – Unit used is cm. pelvic floor and enter the outlet and are born.) 3. BRANDT ANDREW’S MANEUVER Maternal position during labor – is a manual technique to help and delivery facilitate the delivery of the MECHANISM OF LABOR Remember: ED FIRE ERE E – Engagement D – Descent F – Flexion I – Internal R – Rotation E – Extension E – External R – Rotation E – Expulsion ENGAGEMENT Setting of the fetal head into the pelvis. INTERNAL ROTATION Occiput rotates until it is superior or just below the symphysis pubis bringing the head into the best relationship with the pelvic outlet.
5 hrs à Multipara ACTIVE (4-8 cm) Cervical dilation occur more RAPIDLY. 2. Abdominal breathing (Advice) Intensity: Moderate to strong Phases last approximately 3 hrs à Nullipara 2hrs à Multipara SIGNS OF PLACENTAL SEPARATION 1) Lengthening of the umbilical cord 2) Uterus become firm an globular 3) Sudden gush of blood from the vagina 4) Firm contraction of uterus 5) Appearance of placenta from the vaginal opening. • • • • • • • LATENT (0-4 cm) Contractions are MILD and SHORT 5 – 10 minutes interval Phases last approximately 6 hrs à Nullipara 4. . SIGNS OF PLACENTAL EXPULSION The placenta is delivered: Natural bearing effort of the mother or Gentle presure on the contacted uterine fundus by Physician/ OB. Usually 5 minutes after the birth of an infant. Begin to cause true discomfort. (10cm) 3 PHASES • • • • • • 3. increase in duration If BOW not yet ruptured: Woman can take a bath/ void. Exciting time for woman. Contraction change from characteristic crescendo to decresendo pattern to an overwhelming “uncontrolable urge” to push or bear down with each contraction as if to move her bowels. • Mood of the mother suddenly changes and the nature of contraction intensified. TRANSITIONAL (8-10 cm) • Maximum dilation of 8-10cm.STAGES OF LABOR FIRST SECOND THIRD FOURTH : CERVICAL DILATATION STAGE : EXPULSIVE STAGE : PLACENTAL STAGE : RECOVERY STAGE 2. PLACENTAL STAGE LATENT (0-4 cm) ACTIVE (4-8 cm) TRANSITIONAL (8-10 cm) 1. Begins with birth of the infant and ends with separation and expulsion of the placenta. EXPULSIVE STAGE Begins with full dilation and cervical effacement to delivery of an infant. RECOVERY STAGE Begins from expulsion of the placenta to 2 hours after delivery. (Modified Crede’s Maneuver) 3. (to 30mins) 1. 4. May experience nausea and vomiting because pressure is no longer exerted on her stomach as fetus descends in pelvis. CERVICAL DILATATION STAGE Begins with the labor contraction and ends with complete dilation of the cervix.
C. (degree of flexion) A. FIRST LETTER: Whether the landmark is pointing to the mothers right (R) or left (L). Left Transverse POSITION is indicated by an abbreviation of 3 letters: OBSERVATIONS ABOUT POSITIONS (a) LOA and ROA positions are the most common and permit relatively easy delivery. Hyperextension • STATION – Relationship of the presenting part of a fetus to the level of the ischial spine. 4. 1. a. BREECH. (b) LOP and ROP positions usually indicate labor may be longer and harder. Right occiput transverse (ROT). Complete flexion. below the umbilicus. Moderate flexion. posteriorly (P). . KNOWING POSITIONS WILL HELP YOU TO IDENTIFY WHERE TO LOOK FOR FHT's. Each presenting part has the possibility of six positions. FETAL ASSESSMENTS • FETAL LIE – Relationship of fetal long axis to maternal long axis (spine). and the mother will experience severe backache. Longitudinal – Vertex or breech. D. Left occiput anterior (LOA). Poor flexion. Left occiput posterior (LOP). Left Anterior c. Left Posterior e. or transversely (T). 2. They are normally recognized for each position--using "occiput" as the reference point. a. Breech (Complete/ Frank/ Footling) • ATTITUDE – Relationship of fetal parts to one another. 1. 5. B. 6. Right occiput anterior (ROA). Left occiput transverse (LOT). Right occiput posterior (ROP). This will be upper R or L quad. 3. Right Anterior b. Right Posterior d. • POSITION – Relationship of presenting fetal part to the quadrants of maternal pelvis. above the umbilicus. Transverse – Shoulder presents b. This will be lower R or L quad.SECOND LETTER: Denotes fetal landmark O for occiput M for mentum S for sacrum A for acromium LAST LETTER: Whether the landmark points anteriorly (A). Cephalic (Vertex/ Brow/ Face) b. FOUR QUADRANTS: a. VERTEX. 2. • PRESENTATION – Fetal part entering the pelvic inlet first. Right Transverse f.
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