REVIEW

 CARDIOVASCULAR SYSTEM – Heart displaced upward to the left and

forward
Enlarges uterus increases pressure to blood
vessels, slows circulation
Prone to developed edema and varicosities
Left/sims lateral position to avoid impeding the
vena cava
Hematologic system –iron supplement physiologic anemia
Respiratorysystem – hyperventilate, respiratory alkalosis; tingling
sensation, lightheadedness ( paper bag, cupped hands)
GI
tract – PICA , a medical disorder non-nutritive, inedible
substance
 Renalsystem – prone to UTI , relaxation of
renal pelvis and ureter leading to urine
stagnation
 Musculoskeltalmuscle –placenta is capable
of producing relaxin
Physiologic lordosis – pride of pregnancy, increased
outward curvature, there is a back pain
Drugs to be avoided during pregnancy

 Chloramphenicol
 Chloramphenicol is an antibiotic that’s usually given as an
injection. This drug can cause serious blood disorders and
gray baby syndrome.
 Ciprofloxacin (Cipro) and levofloxacin
 Ciprofloxacin (Cipro) and levofloxacin are also types of
antibiotics. These drugs could cause problems with the
baby’s muscle and skeletal growth as well as joint pain
and potential nerve damage in the mother.
Ibuprofen (Advil, Motrin)
 High doses of this OTC pain reliever can cause many serious problems,
including:
 miscarriage
 delayed onset of labor
 premature closing of the fetal ductus arteriosus, an important artery
 jaundice
 hemorrhaging for both mother and baby
 necrotizing enterocolitis, or damage to the lining of the intestines
 oligohydramnios, or low levels of amniotic fluid
 fetal kernicterus, a type of brain damage
 abnormal vitamin K levels
 Common exercises taught in pregnancy
to strengthen perineal muscle
 Squatting
 Tailor sitting
 Pelvic floor contractions Kegel exercises
 Abdominal muscle contractions
 Abdominal muscle contraction
 Pelvic rocking strengthen the abdominal muscle and helps relieve backache
Methods to manage pain in childbrith
 Bradley Method – pregnancy and childbirth are joyful, natural processes, pts
partner should play a role during pregnancy, labor and early newborn period.
 Dick Read’s method of fear leads to tension which leads to pain, focus on
abdominal breathing during contractions ( Grantly Dick Read)
 Psychosexual method – ( Sheila Kitsinger) conscious relaxation, active
calming of the mind, while in the state of discomfort as well as level of
progressive breathing that encourage the pt to flow with rather than
struggle against contraction.
 Hypnobirthing – meditative practices (Dick Read ) meditation during
pregnancy
Lamaze method psycho- prophylactic preventing pain in labor, prophylaxis by
the use of mind Psyche
Theories of labor
 Uterine Stretch Theory – any hollow body organ when stretched to
capacity will necessarily contract and empty
 Oxytocin Theory – labor, 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. The
fetus presses on the cervix which stimulates the release of oxytocin
from th e posterior pituitary gland
 Progesterone Deprivation Theory – progesterone, being the hormone
designed to promote pregnancy, is believed to inhibit uterine motility.
Since its amount is now decreasing, uterine contractions will then occur.
 Prostaglandin Theory – initiation of labor results from the
release of arachidonic acid produced by steroid action on lipid
precursors. Arachidonic acid is said to increase prostaglandin
synthesis which, in turn, increases uterine contractions

 Theory of Aging Placenta – because of the decrease in blood

supply to the placenta, the uterus contracts.
Labor is defined as;

• The time and processes that occur during parturition from

the beginning of cervical dilatation to the delivery of the
placenta
• Onset of rhythmic contractions
• Relaxation of the uterine smooth muscles
• Effacement of the cervix
• Dilation or dilatation of the cervix
• Expulsion of the fetus and products of conception from the
uterus.
Signs of True Labor
 a. Uterine contractions - the surest sign that labor
has begun is the initiation of effective, productive
uterine contractions.
 Phases of Uterine Contraction
1. Increment or Crescendo- the time when contraction is starting
and intensity is building up. The first phase is when during which
intensity of contraction increases. This is the longest phase.
2. Acme or Apex- the peak or highest intensity of contraction. The
height of the uterine contractions.

3. Decrement or Decrescendo- the time when muscles start to relax.

The last phase during which the intensity of contraction
Parameters of Uterine Contraction

 Interval- from the end of one contraction to the beginning

of the next contraction.
• Early labor- 10 to 20 minutes between
contractions
• Late labor-
3 to 5 minutes
between
contractions
 Duration- from the beginning of one contraction to the end of the
same contraction
• Early labor- 20 second long contraction
• Late labor-
40 to 80
second long
contraction
 Frequency - from the beginning of one contraction to the beginning of the
next contraction.
Time for 3-4 contractions to be able to get a good
picture of the
frequency.
 To compute for interval;
 Frequency minus duration= interval

 Quality/ Intensity– refers to the strength of a

contraction at acme.
Early labor- uterus can be dented
 (poor quality)
Late labor- uterus is hard
 (good quality)
Differences between False and True
Labor Pains
 FalseLabor Pains
1. Remain irregular
2. Generally confined to the abdomen
3. No increase in duration, frequency and
intensity
4. Often disappears if the woman ambulates
5. Absent of cervical changes
True Labor Pains
 1.Maybe slightly irregular at first but become
regular and predictable within a
matter of hours.
2. First felt in the lower back and sweep around
to the abdomen in a girdle-like fashion.
3. Increase in frequency, duration and intensity.
4. Continue no matter what the woman’s level of
activity is.
5. Accompanied by cervical effacement and
dilatation (the most important difference)
Signs of true labor
TRUE LABOR FALSE LABOR

Starts at lumbar or back Confined to hypogastric area

Regular interval Irregular interval

Progressive cervical dilation and effacement No cervical dilation and effacement

Intensity is increasing No change in intensity

Ambulation intensifies uterine contraction Ambulation stops the contraction

in true labor

Sedation has no effect Sedation stops false labor

 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
up to 10 cm. primarily as a result of uterine
contractions and also because of the pressure of both
the fetal presenting part and the bag of water.
• In primis, effacement occurs before dilatation.
• In multis, dilatation precedes effacement.
Assessing Cervical Dilatation

• 1 finger = 1.25 cm
• 2 fingers = 3 cm
• 3 fingers = 4.5 cm
• 4 fingers = 5.5 cm
• 5 fingers = 7 cm
• 6 fingers = 8.5 cm
• 7 fingers = 9.5 cm
Condition of the cervix
(hard, soft, close, open,
effacement , dilatation ,
position of the cervix)
 d. Uterine change
Retraction refers to the permanent shortening of the
muscles fibers that occurs with each uterine contraction.
Retraction causes the uterus to differentiate into two
portions:
1. Upper uterine segment – becomes thick and active in
order to expel the fetus; is the only part which contracts.
2. Lower uterine segment – becomes thin-walled, supple
and passive so that the fetus can be pushed out easily.
 Physiological retraction ring is formed at the boundary of the
upper and lower uterine segments. In difficult labor, when the
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.

Bandl’s pathological retraction ring is a danger sign of labor

signifying impending rupture of the uterus if obstruction is not
relieved.
Stages of Labor

1. First stage (Cervical Dilatation

Stage) - begins with true labor
contractions and ends with
complete dilatation of the cervix.
 Three Phases of the First Stage
1. Latent Phase
• Ends when cervix is dilated 4 cm.
• Contractions more frequent.
• The duration becomes longer.
• Intensity - moderate.
• Mother is usually alert and talkative, can walk
• Contractions last from 30 to 45 seconds
• The frequency of contractions is from 5 to 20
minutes.
• True labor is considered to be at 4 cm.
• Duration varies
 2. Active Phase

• Begins when cervix is dilated 4 cm, ends when
the cervix is dilated 8 cm.
• Contractions occur every 3 to 5 minutes with
duration of 40 to 60 seconds.
• Intensity progresses to strong.
• The client focuses more on breathing techniques
in contractions, less talkative.
• Unable to walk
• This phase is considered the onset of true labor.
 3. Transition Phase

• Begins when cervix is dilated 8 cm, ends when cervix is

dilated 10 cm.
• Contractions occur every 2 to 3 minutes
• Duration of 60 to 90 seconds.
• The intensity of contractions is strong.
• Completion of this phase marks the end of the first stage of
labor.
• Urge to push or to have a BM
 
 Characteristics of the Transition Phase

a. The mood of the woman suddenly changes and

the nature of the contractions intensify.

b. 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 of the BOW does not
occur, amniotomy (snipping of the BOW with a
sterile, pointed instrument to let amniotic fluid
drain out) is done by the doctor to prevent fetus
from aspirating the amniotic fluid into the lungs as
he makes different position changes.

• Amniotomy, however, is not done if station is still

“minus” because this can lead to cord compression.
 c. Show becomes prominent
d. There is an uncontrollable urge to push with
contractions (a sign that second stage of labor is
very near) so that profuse perspiration and
distention of neck veins are seen.
e. Nausea and vomiting is a reflex reaction due to
decreased gastric motility and absorption.
f. In primis, baby is delivered within 20
contractions (40 minutes); in multis, after about
10 contractions (20 minutes).
 2. Second Stage of Labor- Stage of
Expulsion/Expulsive Stage- begins when cervical
dilatation is complete and ends with birth of the
baby.
Impending Signs
• Bulging of the perineum.
• Dilatation of the anal orifice.
• Nausea, Irritability and uncooperativeness.
• Complaints of severe discomfort.
• Dilatation and effacement is complete - patient
is instructed to push with each contraction to
bring the presenting part down into the pelvis.
Second Stage of Labor
 3. Third Stage of Labor- Placental Stage
• The period from birth of the baby through delivery of
the placenta.
• Dangerous time because of the possibility of
hemorrhaging.
Signs of the placental separation
a. Uterus become round and firm again, rising high to the
level of the umbilicus (Calkin’s Sign) the earliest sign of
placental separation.
b. The uterus rises in the abdomen.
c. The umbilical cord descends three inches or more
further out of the vagina.
d. Sudden gush of blood.
4. Fourth Stage of Labor – Immediate postpartum
period
• Also referred to as the Recovery Stage
• Period from the delivery of the placenta until the
uterus remains firm on its own.
• Uterus makes its initial readjustment to the non-
pregnant state.
• The primary goal is to prevent hemorrhage from
the uterine atony and the cervical or vaginal
lacerations.
• Atony is the lack of normal muscle tone.
• Uterine atony is failure of the uterus to contract.
• First 1-2 hours after delivery which is said to be a
dangerous stage for the mother because her vital signs are
still unstable
• Blood loss is usually between 250 ml and 500 ml.
• Uterus should remain contracted to control bleeding,
positioned in the midline of the abdomen, level with the
umbilicus.
• Mother may experience shaking chills.
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