Chapter 17
Dec 27, 2015
Chapter 17
LABOR
The Process by
which the Products of
Conception are expelled
from the body
Contraction-exhibits a wavelike pattern that begins slowly climbing (increment) to a peak, and decreases (decrement)
Incr
emen
tpeak
Decrement
Duration
Frequency
Duration- from beginning of one contraction to the end of the same contraction
Frequency- from beginning of one contraction to the beginning of another contraction
Interval
Interval - Resting time between contractions for placental perfusion
These lead to downward progression of fetus with each contraction
Effacement- thinning of the cervix (%)Dilation – enlargement and widening of the os (cm)
During each contraction, blood flow to the placenta gradually decreases, causing an increase in the woman’s blood volume causing her B/P to increase and slowing of her pulse.
Because these changes occur during a contraction, it is best to assess vital signs between contractions.
During labor a woman is likely to hyperventilate causing:◦ Tingling in hands and feet◦ Numbness◦ Dizziness
Have the woman slow her breathing or breath into a paper bag.
Most woman are limited to clear liquids or NPO during the labor process.
Gastric motility and digestion of food is reduced. Decrease risk of aspiration
Inhibit fetal descent
Most woman lose ~ 500ml blood during a vaginal delivery and ~1000ml during a cesarean birth.
Clotting factors are elevated and Fibrinolyis is decreased to promote coagulation at the placental site
Involuntary Uterine Contractions or Primary Powers
Muscular contractions which lead to dilation and effacement in the First Stage of Labor
Voluntary Uterine Contractions or Secondary Pushing Powers
Abdominal muscles assist in the Second Stage with pushing. Increase intra-abdominal pressure to aid in expulsive forces
Length of a uterine contraction__________.
Strength of a uterine contraction is ___________.
The time from the beginning of one contraction to the beginning of the next contraction is _______.
The time that allows for placental perfusion is __.
The peak of a contraction is also known as ____.
The Birth PASSAGE
False Pelvis Supports the
weight of the uterus
Shallow basin above the inlet or brim
True Pelvis Represents the bony limits of the birth canal
Inlet Inlet - upper margin of pubic bone to
upper margin of sacrum Outlet Outlet - Lower pubic bone to tip of coccyx. This area is the
smallest portion that the
baby must travel through.
Which has the greatest
impact on labor?
Which has the greatest
impact on labor?
Because of its size and rigidity, the Fetal Head has a major impact on delivery. The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal.Head also can rotate, flex, and extend
Relationship of the long axis of the fetus to the long axis of the mother.
Longitudinal Lie Transverse Lie
AttitudeRelationshipof fetal body
parts toeach other
Optimumattitude is ovoid
The head is flexed forward, with the chin almost resting on the chest. The arms and legs are flexed.
The optimum lie of the fetus is the longitudinal lie.
A. True B. False
That portion of the fetus that enters the Pelvis first and covers the internal os.Three Types:
CephalicVertex, Face, Brow
BreechShoulder
Cephalic PresentationThe head is
entering the pelvis first.
Cephalic = Occiput, posterior fontanel
Breech = Sacrum
Face = Mentum
Reference Points
Relationship of the Fetal Presenting Part to the Maternal PelvisSteps: 1. Determine the Presenting Part 2. Divide the mothers pelvis into 4 imaginary quadrants
A
P
12
L3
6
9R
FEARFEAR
TENSIONTENSION
PAINPAIN
BREAK THE CYCLE !
The impending signs that take place the last several weeks of pregnancy or even the last several days
LIGHTENING
BRAXTON-HICKS CONTRACTIONS
CERVICAL CHANGES
SHOW
ROM
BACKACHE
SUDDEN INCREASE IN ENERGY
Weight loss
TRUE LABOR Contractions are: * Regular *Increase in intensity and duration with walking
*Felt in lower back, radiating to lower portion of abdomen
Bloody show Dilation and
effacement Fetus usually engaged
FALSE LABOR Contractions are irregular
Often stop with walking
Contractions felt in abdomen above umbilicus (abdominal pains)
No change in cervix
Fetus is ballotable
Engagement -largest diameter of
presenting part has passed through the pelvic inlet
- Assessed during vaginal exam
Ballotable
Engaged
Station- degree that the presenting part has descended
into the pelvisin
Relationship to ischial spines
Goal• Move from – to + stations
Stage 1 – From 0 cm. dilated to 10 cm.Stage 2 - From complete dilation and
effacement to delivery of the baby
Stage 3 - From delivery of baby to the delivery of the placenta
Stage 4 - the first hour after delivery
Latent Phase – is from 0 to 3 cm. dilated
Active Phase – is from 4cm. to 7 cm.
Transition Phase – is from 8 cm. to 10 cm.
Complete dilatation of cervixUrge to bear downPerineum begins to bulge, flatten and move anteriorlyIncrease in bloody show Rectal pressureLabia begins to part with each contraction
What is the reference point of a cephalic presentation when the head is fully flexed?A. occiputB. mentumC. frontald. sagittal
Overlapping of the fetal skull to facilitate its passage through the bony pelvis is ___________.Relationship of fetal body parts to each other is_____________.Head first presentation is_________________.Relationship of the fetal spine to the maternal spine is ________________.Term that refers to the part of the fetus that enters the pelvic inlet first is _____________.
Test Yourself
If the fetal head did not descend through the pelvis and stayed at the same station for a prolonged period of time, what do you think would be the treatment of choice?
When the cervical os widens or opens it is said to________.
The level of the ________ _________ is station zero.
The most common type of pelvis for a woman ___________.
When the cervix shortens and thins is _______________.
For delivery to occur, the fetus must accomodate to this rigid passageway______________.
The End