INTRAPARTUM

PROCESS OF LABOR AND DELIVERY

PREPARATION FOR LABOR AND
DELIVERY
1. Teaching methods
individual teaching and counseling ; group and classes structured as
informational classes; counseling or group discussion
 The birth process
 Breathing techniques and relaxation exercises
 Creating a birth plan
 understanding fetal monitoring
 Hydration during labor
 Analgesia and anesthesia
 Preparation for possible CS; advantages and disadvantages, risks
 Postpartum care- self care, newborn care, sleeping
and waking patterns newborn safety, bathing and
feeding techniques, cord care; maternal nutrition,
exercise and rest needs; recognition of danger signs
and symptoms, which include heavy vaginal bleeding
after lochia has become dark red brown discharge
(foul smelling) swollen, tender, red or hot area on one
leg(breast) painful urination, perineal or pelvic pain.
APPOACHES OF CHILD BIRTH
EDUCATION
1. GRANTLY DICK- READ method
based on the premise that education decreases fear , tension and
pain; teaches exercise to improve muscle tone and increase relaxation;
stresses slow breathing muscle relaxation and pushing techniques

2. LAMAZE METHOD ( psychoprophylactic)

combines relaxation, concentration, focusing and complex, well-paced
breathing pattern to reduce the perception of pain through a conditioned
response to labor contractions
3. BRADLEY TECHNIQUE
similar to Dick-Reads approach with addition of labor coach; focuses
on slow breathing and deep relaxation for labor; focuses on reduced
responsiveness to external stimuli; focuses on the role of the male
partner as coach

4. WRIGHT OR “NEW CHILD BIRTH”METHOD

involves slower but more complex breathing patterns than Lamase
method
5. KITZINGER (PSYCHOSEXUAL) METHOD
uses sensory memory as an aid to understanding and working with
the body in preparation for childbirth; pregnancy, labor and birth are
considered continuing points in the women’s life cycle

6. YOGA
teaching relaxation, concentration and “complete breathing”
combination of chest and abdominal breathing

7. Hypnosis
 NURSING IMPLEMENTATION
1. Reduce the couple’s anxiety and fears related to pregnancy and child
birth
 Maintain an open non judgmental atmosphere
 Promote realistic goals and expectation regarding the entire childbirth
experience
2. Provide family teaching; childbirth preparation course
3. Promote prenatal care compliance in the pregnant woman and her
partner
 Stress the importance of prenatal care
 Address the couple’s questions and concerns honestly and promptly
 Encourage attendance at childbirth education program
4. Integrate the partner into preparation for childbirth
 How to coach the mother during labor and delivery
 Importance of helping the mother keep antepartum
appointments
 How to participate in preparing the home for the newborn
 Preparing sibling for the newborn
INTRAPARTUM CARE
• 1. period extends from the beginning of contractions that cause
cervical dilatation to the first 1 to 4 hours after delivery of the new
born and placenta
• 2. refers to the medical and nursing care given to pregnant woman
and her family during labor and delivery.
GOAL OF INTRAPARTUM CARE
• 1. to promote physical and emotional well being in the mother and
fetus
• 2. to incorporate family-centered care concepts into the labor and
delivery experience
FACTORES AFFECTING THE INTRAPARTUM
1. Previous experience with pregnancy
2. Prepregnant health and biophysical preparedness for
childbearing
3. motivation for childbearing
4. socioeconomic readiness
5. age of mother
6. cultural and personal expectations
• a) touch- may or may not be acceptable in the labouring
woman’s culture. N. I. determine early in the labor process
whether therapeutic touch ( back rub, effleurage) is an
acceptable comfort measure
• b) pain response – may be stoic and nonverbal; may scream or
actively verbalized her discomfort, may moan softly; may thrash
about; N.I. Assess facial expression, body posture and tension, activity
level, and verbalization of pain to determine the level of discomfort
• c) support person- may be the husband, mother, sister, relatives or
friends; N.I. respect the woman’s choice of support person.
• d) language – may not speak or understand English: N.I. provide
interpreter
• e) placenta – may ask to have the placenta to take home, some
culture may bury it to ensure the child’s health; N.I. respect the
client’s request; observe standard precaution when supplying the
mother with the placenta
 PROCESS OF LABOR AND DELIVERY
• ONSET OF LABOR
LABOR – The process by which the fetus and products of conception are
expelled as the result of regular, progressive, frequent, and strong uterine
contractions.
An involuntary physiologic process whereby the contents of the gravid uterus
are expelled through the birth canal into the external environment
THEORIES OF LABOR
MATERNAL FACTOR THEORIES
• Uterine muscles stretch, causing release of prostaglandin
• Pressure on the cervical stimulates nerve plexus, causing release off
oxytocin by maternal posterior pituitary gland. This is known as the
FERGUSON REFLEX
• Oxytocin stimulation in circulating blood increases slowly during
pregnancy, rises dramatically during labor, and peaks during second
stage. Oxytocin and prostaglandin work together to inhibit calcium and
thus activating contractions.
• Estrogen/ progesterone ratio shift – estrogen excites the uterine
response, and progesterone quiets the uterine response. A decrease of
progesterone allows estrogen to stimulate the contractile response of the
uterus.
• FETAL FACTOR THEORIES
• Placental aging and deterioration triggers initiation of
contractions
• Fetal cortisol, produced by the fetal adrenal glands, rises and
acts on the placenta to reduce progesterone formation and
increase prostaglandin
• Prostaglandin produced by fetal membranes(amnion and
chorion) and the decidua stimulates contractions. When
arachidonic acid stored in fetal membranes is released at
term, it is converted to prostaglandin
• Uterine Stretch Theory – a hollow organ such as the
uterus when full, will empty
• Oxytocin Theory – oxytocin released by the posterior
pituitary gland initiates labor.
• Progesterone Deprivation Theory – contractions are
initiated when progesterone levels are decreased as
such at the end of pregnancy
• Prostaglandin Cascade Theory – labor is initiated due
to the production of prostaglandin as a result of the
interplay between adrenal, fetus, and uterus.
FACTORS AFFECTING LABOR/FIVE
ESSENTIAL COMPONENTS OF LABOR

•PASSAGEWAY
•PASSENGER
•POWER
•POSITION OF THE WOMAN
•PSYCHE
PASSAGEWAY - refers to the adequacy of the pelvis
and birth canal in allowing fetal descent.
Includes :
• 1.Pelvic Shape
Gynecoid – classic female type
Android – resembling male pelvis
Anthropoid - resembling anthropoid apes
Platypelloid – flat pelvis
• A gynecoid pelvis is oval at the inlet, has a
generous capacity and wide subpubic arch.
This is the classical female pelvis.
• A platypelloid pelvis is flattened at the inlet and
has a prominent sacrum. The subpubic arch is
generally wide but the ischial spines are
prominent. This pelvis favors transverse
presentations.
• An anthropoid pelvis is, like the gynecoid pelvis,
basically oval at the inlet, but the long axis is oriented
vertically rather than side to side.Subpubic arch may
be slightly narrowed. This pelvis favors occiput
posterior presentations
• An android pelvis is more triangular in shape at
the inlet, with a narrowed subpubic arch. Larger
babies have difficulty traversing this pelvis as the
normal areas for fetal rotation and extension are
blocked by boney prominences. Smaller babies
still squeeze through
2.Structure of pelvis
True Pelvis – or lesser pelvis contains the
pelvic inlet and is short, curved canal, deeper on
its posterior than on its anterior wall
False Pelvis – or greater pelvis; part of the
abdominal cavity
Pelvic Dimensions – estimates the true pelvis.
Obstetric conjugate
Diagonal Conjugate
4. Soft Tissues – cervix & vagina
Effacement – shortening and thinning of
the cervical canal
Dilatation – enlargement or widening of
the cervical canal
•2. PASSENGER

Refers to the “fetus”

Ability to move through the passageway
Fetal Skull /Head– most important fetal structure in relation to
labor and birth.
• Structure
• Cranium = 1frontal, 2 parietal, 1occipital; sphenoid, ethmoid, 2
temporal.
Bones of the infant’s skull compose of:
• 2 frontal bones

• 2 parietal bones

• 1 occipital bone
• Suture lines = sagittal, coronal, lambdoidal, and frontal
membranous interspaces that allow the cranial bones to
move and overlap to pass the birth canal readily
• Sutures allow the bones to move during the birth process.
• They act like an expansion joint, allowing the bone to enlarge
evenly as the brain grows and the skull expands, resulting in
a symmetrically shaped head.
• if ever any of the sutures close too early (fuse prematurely),
there may be no growth in that area. This may force growth
to occur in another area or direction, resulting in an
abnormal head shape.
The major sutures of the skull include the following:
• Metopic suture. This extends from the top of the head down the
middle of the forehead, toward the nose. The 2 frontal bone plates
meet at the metopic suture.
• Coronal suture. This extends from ear to ear. Each frontal bone plate
meets with a parietal bone plate at the coronal suture.
• Sagittal suture. This extends from the front of the head to the back,
down the middle of the top of the head. The 2 parietal bone plates
meet at the sagittal suture.
• Lambdoid suture. This extends across the back of the head. Each
parietal bone plate meets the occipital bone plate at the lambdoid
suture.
• Fontanelles = anterior; larger - 3by 2cm, lies at frontal,
coronal and sagittal sutures. It closes by 18 months after birth.
• = posterior; 1cm-2cm, lies at the junction of the
sutures of 2 parietal bones and the occipital bone, is
triangular. It closes 6-8 weeks after birth.
• Diameter of the fetal head should be small enough to allow
the head to travel through the bony maternal pelvis.
• Molding – a process that reduces the diameter of the head;
elongation of the fetal skull. Molding can be extensive but the
heads of most newborns assume their normal shape within 3
days after birth.
• Size of the fetal shoulders may affect passage, their position can be
altered relatively easily during labor, so that one shoulder may occupy a
lower level than the other.
• This creates a shoulder diameter that is smaller than the skull,
facilitating passage through the birth canal. The circumference of the
fetal hips is usually small enough not to create problems.
• Fetal Lie- describes the long axis of the fetus in relation to the
long axis of the pregnant woman.
• Longitudinal/ vertical – the long axis of the fetus is parallel with the
long axis of the mother. It is either cephalic or breech presentation,
depending on the fetal structure that first enters the mother’s pelvis.
• Transverse/horizontal/oblique – the long axis of the fetus is at a
right angle diagonal to the long axis of the mother.
• Fetal Presentation- the foremost part of the fetus that enters the pelvic
inlet.
• a) Cephalic- head
• b) Breech- feet or buttocks
• c) Shoulder- shoulder
• Fetal Position – relationship of the presenting part to a specific quadrant of
a woman’s pelvis.
• MATERNAL PELVIS:
• Right anterior
• Left anterior
• Right posterior
• Left posterior
FETUS:
• Vertex- occiput
• Face- chin (mentum)
• Breech – sacrum
• Shoulder – scapula or acromiom
• Sinciput - forehead
To document fetal position:
• The side of the maternal pelvis in which the presenting part is found :
Right (R), Left (L)
• Reference point on the presenting part (Fetal Landmark)
• O- occiput
• M- Mentum or chin
• Sa- Sacrum
• A- acromiom process
• A- Anterior ( front of pelvis)
• P- Posterior ( back)
• T- transverse (side)
• Ex. ROA (right occiput anterior) - Vertex presentation, facing the right
anterior quadrant of the pelvis.
• Fetal Attitude- the relation of the fetal parts to each other.
• Good/ Well flexed Attitude- General flexion that is advantageous during
birth
• The fetus assumes a characteristic posture in utero partly because the way
the fetus conforms to the shape of the uterine cavity.
• The fetus becomes folded/bent upon itself in such a manner that the back
becomes markedly convex
• The head is sharply flexed so that the chin is almost in contact with the chest.
• Normally, the back of the fetus is rounded so that the chin is flexed on
the chest, the thighs are flexed on the abdomen, and the legs are flexed
on the knees.
• The arms are crossed over the thorax, and the umbilical cord lies
between the arms and legs.
 
• Engagement- refers to the settling of the presenting part of a fetus far
enough to the pelvis to be at the level of the ischial spines, a midpoint
of the pelvis. It is corresponding to station 0.
• It often occurs in the weeks just before labor begins in nulliparas;
and may occur during labor in multiparas.
• Fetal Station- the relationship of the presenting part to the ischial spines.
• Recorded as: 0 (zero)- presenting part is at the level of the ischial spines.
- (1-4)- above the ischial spines
+(1-4) – below the ischial spines
Minus 4 or above – floating & unengaged
Zero (0) – engaged
+ 4 – head is at outlet
3. POWER
• - The involuntary and voluntary powers combine to expel the
fetus and the placenta from the uterus.
• Refers to the frequency, duration, and strength of uterine
contractions to cause complete cervical effacement and dilatation
• - Primary power - supplied by involuntary muscle contractions of the
fundus of the uterus causing DILATION AND EFFACEMENT
(shortening and thinning of the cervix during the first stage of labor.)
• Secondary power - voluntary muscle contractions of the maternal
abdomen during the second stage of labor; the bearing-down efforts
to aid in the expulsion of the fetus as she contracts her diaphragm
and abdominal muscles and pushes
Phases of uterine contractions:
a. Increment- longest; building up of the contraction
b. acme – peak or highest intensity
c. Decrement – letting –up phase; descent or relaxation of the uterine
muscle fiber

Descriptors of Contractions:
a. Frequency- number of contractions, the time from the beginning of one
contraction to the beginning of the next contraction.
b. Duration – interval from the beginning to end; length of contraction
c. Intensity - strength of the contraction; mild, moderate or strong

 
Terms used to describe what is felt on palpation:

a. Mild – feels slightly tensed fundus that is easy to indent

with fingertips. Feels like touching finger to tip of nose.
b. Moderate – the fundus is firm that is difficult to indent with
fingertips. Feels like touching a finger to chin.
c. Strong – there is rigid, boardlike fundus that is almost
impossible to indent with fingertips. Feels like touching finger
to forehead.
4. POSITION OF THE WOMAN
• Frequent changes in position relieves fatigue, increase comfort and
improve circulation.
• Upright position like walking, sitting, kneeling, and squatting are
preferred
• Gravity promotes descent of the fetus. It is beneficial to the mother’s
cardiac output, that improves blood flow to the uteroplacental unit
and maternal kidneys.
• lateral position is suggested if the woman wants to lie down, to
prevent compression of the major blood vessels (ascending vena cava
and descending aorta) that results in supine hypotension that
decreases placental perfusion.
5. PSYCHE
• psychological state or feelings that the woman brings
into labor.
• Factors: current and previous pregnancy experience,
expectations, preparation for birth, support system
and culture.
Placental factors
refers to the site of placental insertion
Signs and symptoms of impending labor
1. LIGHTENING - the descent of the fetus and uterus into the pelvic
cavity 2 to 3 weeks before the onset of labor
2. BRAXTON HICKS contraction are irregular, intermittent contraction
that have occurred throughout the pregnancy, becomes
uncomfortable, and produce a drawing pain in the abdomen and
groin
3. CERVICAL CHANGES include softening, “ripening” and effacement
of the cervix that will cause expulsion of the mucus plug (blood
show) and increase vaginal discharge
4. RUPTURE of amniotic membrane may occur before the onset of
labor, if suspect that her membranes have raptured, she have to
contact health care provider, should be examined for prolapsed cord (a
life threatening condition of the fetus)
5. Burst of energy or increase tension and fatigue may occur right
before the onset of labor
6. Weight loss of about 1 to 3 lbs. may occur 2 to 3 days before the
onset f labor
7. Urinary frequency returns
8. Backache
Characteristics of true labor
1. Regular contraction
2. Progressive frequency and intensity
3. Shorter intervals between contractions
4. Discomfort begins in the back and radiates to the abdomen
5. Activity such as walking increases contractions
6. Contractions continue while the woman is sleeping
7. Sedation does not stop contraction
8. Bloody show usually present
9. Progressive thinning and opening of the cervix
Characteristics of false labor
1. Contractions may be irregular at intervals
2. Decrease in frequency and intensity
3. Longer intervals between contractions
4. Discomfort in lower abdomen and groin
5. Activity such as walking either has no effect or decreases contractions
6. Contractions disappear while sleeping
7. Sedation decreases or stops contractions
8. Bloody show usually not present
9. No appreciable change in the cervix
• Progress of Labor
For a woman experiencing her first baby, labor usually lasts
about 12-14 hours. If she has delivered a baby in the past,
labor is generally quicker, lasting about 6-8 hours. These
averages are only approximate, and there is considerable
variation from one woman to the next, and from one labor
to the next.
• During labor, the cervix dilates (opens) and effaces (thins).
This process has been likened to the process of pulling a
turtleneck sweater over your head. The collar opens (dilates)
to allow your head to pass through, and also thins (effaces)
as your head passes through.
• The process of dilatation and effacement occurs for both mechanical
reasons and biochemical reasons.
• The force of the contracting uterus naturally seeks to dilate and thin
the cervix. However, for the cervix to be able to respond to these
forces requires it to be "ready." The process of readying the cervix on
a cellular level usually takes place over days to weeks preceding the
onset of labor.
• Labor should be progressive. Serial vaginal examinations are used to
plot the course of labor, detect abnormalities and allow for
intervention. While there are no set time intervals for performing
pelvic examinations, the cervix should progressively dilate during
active phase labor at a rate of no less than 1.2 cm/hour (for first
babies) to 1.5 cm/hour (for subsequent babies).
Stages of labor
STAGE 1: Dilatation
Goals:
Complete Dilatation of Cervix,
Descent of Fetus
Phases:
Latent Phase
Active Phase
Transition
LATENT PHASE
• The first stage of labor is that portion leading up
to complete dilatation. The first stage can be
divided functionally into two phases: the latent
phase and the active phase.
• Latent phase labor (also known as prodromal
labor) precedes the active phase of labor.
Women in latent phase labor:
Latent phase
• Cervix 0-3cm dilated
• Dilate only very slow.
• Contractions every 10-20 min; progressing to every 5-7 minutes
• Duration of 15- to 30- seconds ; 30- to 40 seconds
• Mild intensity; mild to moderate
• Have regular, frequent contractions that may or may not be painful.
• Can usually talk during their contractions
• May find this phase of labor lasting hours to days or longer.
Active Phase Labor
Active phase labor is a time of rapid change in cervical dilatation,
effacement, and station.
Active phase labor lasts until the cervix is completely dilated. Women in
active phase labor:
• Are at least 4 cm dilated.
• Have regular, frequent contractions that are usually moderately painful.
• Demonstrate progressive cervical dilatation of at least 1.2-1.5 cm per hour.
• Cervix 4-7 cm
• Contractions every 2-3min
• Duration of 50- to 60- seconds
• Moderate to strong intensity
• Can last approximately 6 hours
TRANSITION PHASE
• The cervix dilates from 8 to 10 cm
• The intensity, frequency, and duration of contractions peak, and there
is an irresistible urge to push.

• Contractions every 2-3min

• Duration of 60- to 90- seconds
• Strong intensity
Second Stage of Labor: Expulsion of Fetus
Maternal changes:
• Perineum bulges
• Contractions are severe at 2 to 3 minute intervals with duration of 50
to 60 seconds
• Pushing w/ contractions
• Grunting sounds
• Behavior changes from great irritability to great involvement & work
• Sleep & relaxation occur between contractions
• Leg cramps
• The new born exits the birth canal
Mechanisms of labor / Cardinal
movements
• 1. DESCENT
• 2. FLEXION
• 3. INTERNAL ROTATION
• 4. EXTENSION
• 5. EXTERNAL ROTATION (RESTITUTION)
• 6. EXPULSION
Mechanisms of labor / Cardinal
movements
• “CROWNING” occurs when the newborn’s
head or presenting part appears at the
vaginal opening
• EPISIOTOMY (surgical incision in perineum)
may be done to facilitate delivery and avoid
laceration of perineum.
Third Stage of Labor:
Expulsion of Placenta
• Placental separation:
• Globular formation of uterus
• Lengthening of umbilical cord
• Gush of blood
• Oxytocic drugs are administered to help the uterus
contract
 FOURTH STAGE: RECOVERY AND
BONDING
• Last from 1 to 4 hours after birth
• Mother and newborn recover from the physical process of birth
• The maternal organ undergo initial readjustment to the nonpregnant state
• the mother’s blood pressure will return to pre-labor level, pulse is decrease
than that of the labor pulse.
• The fundus remains contracted; this is normal and essential. Fundus is
midline 1 – 2 fingerbreadths below the umbilicus (belly button).
• Lochia is scant and red. (Lochia is a discharge from the vagina after birth to
6 weeks and progresses as follows: mostly blood, followed by a more
mucous fluid that contains dried blood, and later a clear-to-yellow
discharge
• Lochia is scant and red. (Lochia is a discharge from the vagina
after birth to 6 weeks and progresses as follows: mostly
blood, followed by a more mucous fluid that contains dried
blood, and later a clear-to-yellow discharge
• Maternal Changes
• Fundus firm in the midline & at or slightly above the
umbilicus
• Moderate, bloody vaginal discharge (lochia rubra)
• Fatigue, thirst, chills, nausea
• Excitement & intermittent dozing
• Regional Analgesia & Anesthesia

• Epidural
• Spinal
• Pudendal
• Local Infiltration
Oxytocics

• Drugs that stimulate the uterus to contract

• Capable of inducing contraction of the
lacteal glands, which aids in let-down reflex
for nursing
• Used to control postpartum uterine atony
COMPLICATIONS OF LABOR &
BIRTH/ DELIVERY
Prolonged Labor
Causes of prolonged Labor:
• Malpresentations:
• Cephalopelvic Disproportion ( CPD ):
• Problems with Uterine Contraction
• Use of Sedatives and Anaesthesia:
• Cervical dystocia or stenosis
• Fundal push???
• “Fundal Pressure During
the Second Stage of Labor”
When is fundal pressure indicated?
1.During artificial rupture of membranes to guide the fetal head against
the cervix if fetal station is high. This may decrease the risk of
prolapsed umbilical cord.
2. During application of fetal scalp electrode if fetal station is high and
there is indication for placement. Fundal pressure may make an easier
application.
3. When the fetal head is crowning and an expeditious birth is
necessary.
Complications
• Maternal – perineal tears, ruptured uterus, inverted
uterus, hypotension, respiratory distress, abdominal
bruising, fractured ribs, ruptured liver and pain.
• Fetal – brachial plexus injuries, fractured humerus and
clavicle, hypoxemia, asphyxia, increased intracranial
pressure, cord compression, subgaleal hemorrhage
and spinal cord injuries.
Premature Rupture of Membranes
(PROM)
• Spontaneous rupture of membranes before onset of
labor
• Maternal implication: ascending infection
Fetal implications:
1. prolapsed cord
2. FHR decelerations caused by cord compression from
lack of amniotic fluid
3. sepsis from ascending infection
Dystocia
• Difficult labor that is prolonged or more painful
• Mechanical factors: CPD; contracted pelvis;
malpresentation or position; multiple gestation
• Maternal complications: cervical trauma,
postpartal hemorrhage, infection, & exhaustion
Preterm Labor
• Contractions begin after the twentieth week but
before the thirty-eighth week of gestation, causing
effacement & dilation of the cervix
• Contributing factors include history, risky lifestyle,
multiple gestation, maternal illness with fever, heroin
& opiate use, bacterial vaginitis, multiple abortions,
pyelonephritis, & asymptomatic bacteriuria
Post term Labor
• Extends beyond the forty-first week of gestation or 2 weeks
beyond expected date of birth
Fetal risk
1. Decreased amniotic fluid may lead to cord compression
during labor
2. Decreased placental function because placental aging
lowers oxygen & nutritional transport
3. Increasing size & hardening of skull may contribute to
cephalopelvic disproportion
Precipitous Labor & Delivery
• Labor that lasts less than 3 hrs.

Inverted Uterus
• Uterus turns inside out, usually during
delivery or after delivery of the placenta
Prolapsed Cord

• The umbilical cord is displaced, either between

the presenting part & the amnion or protruding
through the cervix, causing compression of the
cord & compromising fetal circulation
Breech Birth
• Position of fetus in which buttocks alone (frank breech), buttocks
and feet (complete breech), or one or both feet (footling) descend
through the birth canal first
• Maternal implication: cesarean birth may be required, especially in
primigravida
Fetal implications
1. Increased mortality
2. Occurrence of prolapsed cord leading to asphyxia
3. Birth trauma such as brachial palsy & fracture of the upper
extremities
External Cephalic Version (ECV)
• applying pressure to the abdomen and manually
manipulating the baby into a head- down position.
 Abdominal Delivery
• Birth of infant via transabdominal incision: transverse incision; lower uterine vertical
incision
• Indications:
Cephalopelvic disproportion (CPD)
Dystocia
Placenta previa & abruption placentae
Postmaturity
Growths within the brithcanal
Multiple births
Diabetes
PIH
Rh incompatibility
Fetal distress
Active herpes
Malpresentations such as breech birth
Assisted Birth
• Use of either a vacuum device or forceps to help the baby out of the
birth canal
Post partal Bleeding
• Bleeding in excess of 500mL within the first 24 hrs. following
birth; usually associated with uterine atony; vaginal, cervical,
and perineal lacerations; hematomas; and retained placental
fragments

Episiotomy
Incision into perineum to facilitate birth & prevent
lacerations & overstretching of the pelvic floor