The Process of Birth

Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.

The Process of BirthThe Process of Birth

IntroductionIntroduction

Intrapartum\Perinatal PeriodIntrapartum\Perinatal Period

Physiologic Effects of Birth/Adaptation to Physiologic Effects of Birth/Adaptation to LaborLabor

Maternal Response-Alterations in:Maternal Response-Alterations in:

Cardiovascular Cardiovascular Hemopoietic SystemHemopoietic System Respiratory SystemRespiratory System Renal systemRenal system Integumentary SystemIntegumentary System Neurologic System Neurologic System G.I. System G.I. System Endocrine SystemEndocrine System Reproductive SystemReproductive System

Cervical Dilation

B. Fetal Response to Mother’s B. Fetal Response to Mother’s Labor:Labor:

Fetal Heart Rate:Fetal Heart Rate:

Respiratory RateRespiratory Rate

Fetal CirculationFetal Circulation

55Placental Circulation

II. Components of The Birth ProcessII. Components of The Birth ProcessCritical Factors in LaborCritical Factors in Labor

The Five P’s:The Five P’s:

1.The Powers1.The Powers

2. The Passage2. The Passage

3. The Passenger3. The Passenger

4. Mother’s position4. Mother’s position

5. The Psyche5. The Psyche

PowersPowers

1. 1. Primary: Uterine ContractionsPrimary: Uterine Contractions

2. 2. Secondary: Secondary:

Abdominal and Intercostal MusclesAbdominal and Intercostal Muscles The Perineal MusclesThe Perineal Muscles

88Uterine Muscle Layers

Uterine ResponseUterine Response

Contractions Measured in:Contractions Measured in: FrequencyFrequency DurationDuration IntensityIntensity

Phases of ContractionsPhases of Contractions:: IncrementIncrement AcmeAcme DecrementDecrement

Phases of Contractions

B. Passage (The Pelvis)B. Passage (The Pelvis) 1. Landmarks: 1. Landmarks:

The True PelvisThe True Pelvis ( divided into 3 ( divided into 3

sections)sections)

InletInlet CavityCavity OutletOutlet

2. Types of Pelvises2. Types of Pelvises

GynecoidGynecoid AnthropoidAnthropoid AndroidAndroid PlatypelloidPlatypelloid

3. Significant 3. Significant Measurement:Measurement:

Bi-ischial diameterBi-ischial diameter

1212Female Pelvis

Pelvic Measurements

50% 20% 25% 05%

Comparisons of Pelvises Gynecoid Android Anthropoid Platypelloid

C. Passenger ( Baby!)C. Passenger ( Baby!) 1. Fetal head/Fontanels1. Fetal head/Fontanels a. Posteriora. Posterior b. Anteriorb. Anterior c. Bi-Parietal Measurementc. Bi-Parietal Measurement

2. Fetal Presentation2. Fetal Presentation a. Cephalic a. Cephalic b. Breechb. Breech c. Transversec. Transverse

Passenger (Continued)Passenger (Continued) Fetal LieFetal Lie

Fetal AttitudeFetal Attitude

Fetal stationFetal station

Fetal Position:Fetal Position: a. side of Pelvis: a. side of Pelvis:

Referred to as: (R or L)Referred to as: (R or L) b. Fetal Presenting Part b. Fetal Presenting Part

Referred to as:( O,S,M Referred to as:( O,S,M or A)or A)

c. Anterior, Posterior or c. Anterior, Posterior or Transverse Lie : Transverse Lie : Referred to as:( A, P or Referred to as:( A, P or T)T)

2121Fetal Station

Mother’s Position in LaborMother’s Position in Labor Affects anatomical and physiologic Affects anatomical and physiologic

adaptation to labor( standing , adaptation to labor( standing , walking, sitting or squatting)walking, sitting or squatting)

Gravity can assist in the decent of Gravity can assist in the decent of baby/increases effacement and baby/increases effacement and dilation of cervixdilation of cervix

Ferguson’s reflexFerguson’s reflex

Mother’s Psyche !Mother’s Psyche !

Labor and DeliveryLabor and Delivery III. Normal LaborIII. Normal Labor

A. Premonitory Signs A. Premonitory Signs of Laborof Labor

1. Braxton Hicks 1. Braxton Hicks ContractionsContractions

2. Cervical Changes2. Cervical Changes 3.Bloody Show3.Bloody Show 4.Rupture of 4.Rupture of

MembraneMembrane 5. Sudden Burst of 5. Sudden Burst of

EnergyEnergy

B.B. True True vs. vs. False False LaborLaborCharacteristicsCharacteristics

False LaborFalse Labor - no change in cervix- no change in cervix -discomfort in low -discomfort in low

abdomen and groinabdomen and groin -irregular contractions-irregular contractions -no increase in -no increase in

frequency or intensity frequency or intensity of contractionsof contractions

True LaborTrue Labor Progressive cervical Progressive cervical

dilatation and dilatation and effacementeffacement

Discomfort in back Discomfort in back and abdomenand abdomen

Contractions occur at Contractions occur at regular intervalsregular intervals

Progressive increase Progressive increase in frequency and in frequency and intensity of intensity of contractionscontractions

C. Initial Maternal Assessments C. Initial Maternal Assessments During LaborDuring Labor

1.PrenatalHistory ie: 1.PrenatalHistory ie: Gestational Age? Gestational Age? wt.gain,EDD/EDC, Lab wt.gain,EDD/EDC, Lab Values, Bld.TypeValues, Bld.Type

2.Risk Factors: Rubella status; 2.Risk Factors: Rubella status; STD’s, Group B Step. STD’s, Group B Step. StatusStatus

3.Prior Obstetrical3.Prior Obstetrical History( GTPAL)History( GTPAL)

4. Asses Labor Progress4. Asses Labor Progress

5.?Education Preparation5.?Education Preparation

6. Educational needs of 6. Educational needs of this Mother/Familythis Mother/Family

7. ? Support System7. ? Support System

8.Maternal Allergies?8.Maternal Allergies?

9. Base line Vital Signs9. Base line Vital Signs

10. Status of the Baby10. Status of the Baby

E. E. MMeecchhaanniissmm o of f LLaabboorr Cardinal Movements of the babyCardinal Movements of the baby 1. Engagement, Descent, Flexion1. Engagement, Descent, Flexion 2.Internal Rotation2.Internal Rotation 3.Extention-Beginning3.Extention-Beginning 4.Extention Complete4.Extention Complete 5.External Rotation(Restitution)5.External Rotation(Restitution) 6.External Rotation(Shoulder Rotation)6.External Rotation(Shoulder Rotation) 7.Expulsion7.Expulsion

Four Stages of LaborFour Stages of Labor

1.First Stage (Dilation 1.First Stage (Dilation StageStage))

Divided into three Divided into three phases:phases:

a. latenta. latent b. activeb. active c. transitionc. transition

2.Second Stage 2.Second Stage (Stage of Expulsion)(Stage of Expulsion)

3. Third Stage 3. Third Stage (Placental Stage)(Placental Stage)

4. Fourth Stage 4. Fourth Stage

(Recovery Stage(Recovery Stage))

The Process of Birth

stage stage of expulsion3

stage placental stage

stage recovery stage

mothers labor

fetal response

stage dilation stagedivided

fetal presentation

fetal headfontanels

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