5 PS OF LABOR

1. POWERS

Uterine Contractions: During the first stage of labor uterine contractions are the primary force that moves the fetus through the maternal pelvis.
Maternal Pushing efforts: During the second stage of labor uterine contractions continue to propel the fetus through the pelvis. In addition, the woman feels an urge to push and bear down as the fetus distends her vagina and puts pressure on her rectum.

In Labor:

Uterine contractions are rhythmic but intermittent. Between contractions, a period of relaxation occurs. This allows uterine muscles to rest and provides relief for the labouring woman. It also restores uteroplacental circulation, which is important to fetal oxygenation and adequate circulation in the uterine blood vessels.

Each contraction has three phases:

(1) Increment: building up of the contraction (longest phase) (2) Acme: peak of the contraction (3) Decrement: letting up of the contraction

The terms frequency, duration, and intensity are used to describe uterine contractions during labor. Frequency: refers to the time between the beginning of one contraction and the beginning of the next contraction. Duration: is measured from the beginning of one contraction to the completion of that same contraction. Intensity: refers to the strength of the contraction during acme.

2. PASSAGE

The birth passage consists of the maternal pelvis and soft tissues. The true pelvis, which forms the bony canal through which the fetus must pass, is divided into three sections: the inlet, the pelvic cavity (midpelvis), and the outlet.
The Caldwell-Moloy classification is widely used to differentiate bony pelvis types. The four classic types are: gynecoid, android, anthropoid, and platypelloid.

CLASSIFICATION OF PELVIS

Implications of Pelvic Type for Labor and Birth:

Pelvic Type 1. Gynecoid Pertinent Characteristics Inlet rounded with all inlet diameters adequate Midpelvis diameters adequate with parallel side walls Outlet adequate Inlet heart-shaped, with short posterior sagittal diameter Midpelvis diamaters reduced Outlet capacity reduced Inlet oval in shape, with long anteroposterior diameter Midpelvis diameters adequate Outlet adequate Inlet oval in shape, with long transverse diameters Midpelvis diameters reduced Outlet capacity inadequate Implications for Birth Favorable for vaginal birth.

2. Android

Not favorable for vaginal birth Descent into pelvis is low Favorable for vaginal birth

3. Anthropoid

4. Platypelloid

Not favorable for vaginal birth.

3. PASSENGER

THE FETUS
Fetal Head The fetal skull has three major parts: the face, base of the skull, and the vault of the cranium (roof). The cranial bones overlap under pressure of the powers of labor and the demands of the unyielding pelvis. This overlapping is called molding. Sutures of the fetal skull: are membranous spaces between the cranial bones. Fontanelles: Intersections of the cranial sutures.

Fetal Attitude Refers to the relation of the fetal parts to one another The normal attitude of the fetus is one of moderate flexion of the head, flexion of the arms onto the chest, and flexion of the legs onto the abdomen.

Fetal Lie

Relationship of the cephalocaudal axis of the fetus to the cephalocaudal axis of the mother.

Fetal Presentation Determined by fetal lie Body part of the fetus that enters the pelvic passage first This portion of the fetus is referred to as the presenting part.

4. Relationship between the maternal

pelvis and presenting part

Engagment
occurs when the largest

diameter of the presenting part reaches or passes through the

pelvic inlet.
-

In primigravidas: 2 weeks before term. In multiparas: several weeks before the onset of labor.

-confirms the adequacy of the pelvic inlet

4. Relationship between the maternal

pelvis and presenting part
-

Station refers to the relationship of the presenting part to an imaginary line drawn between the ischial spine of the maternal pelvis. Ischial spines= Zero station Positive numbers indicate that the presenting part has passed the ischial spines.

4. Relationship between the maternal pelvis and presenting part

Relationship between designated landmark on the presenting fetal part and the front sides, or back of the maternal pelvis. Most common fetal position: occiput anterior

5. PSYCHE

The psyche is a crucial part of childbirth. Marked anxiety and fear decrease a womans ability to cope with pain in labor. Preparation for childbirth can enhance a womans ability to work with her bodys efforts rather than resist the natural forces. Much of the nurses care during labor involves promoting relaxation and reducing anxiety and fear. Information and a positive sense of control and mastery over the birth increase the womans sense of satisfaction with her birth experience.