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LABOR

Progesterone - Estrogen Ratios

Oxytocin Stimulation
THEORIES
ON THE ONSET
OF LABOR
Prostaglandins

Fetal Cortisol level increase

Uterine Distention- cervical pressure

Four Ps

P PASSAGE

P PASSENGER

P POWER

P PSYCHE

PASSAGE (The
False Pelvis
Pelvis
)

True Pelvis
Pelvic inlet
Mid pelvis
Pelvic outlet

Dilatation and Effacement


Stations

Pelvis
Types
Gynecoid - most common for NSVD

Android - increased use of


forceps/vacuum

Anthropoid - common OP position

Platypelloid - common for C/S

Fetal Head

PASSENGER
(The
Fetal Attitude
Fetus)
Fetal Lie

Fetal Presentation

Fetal Position

Passenger
Fetal
attitude: relationship of
fetal parts to maternal uterus and
pelvis

Flexion (ideal)
Extension: labor will be more
difficult

Lie: relationship of fetal spine


to maternal spine

Longitudinal (cephalic or
breech)
Transverse (c-sec)

Passenger cont

Fetal presentation: part of fetus closest to


cervix

Crown of the head: occiput


Chin: mentum
Shoulder: scapula
Breech: sacrum

Passenger contd

Fetal position: relationship of presenting part to the


four quadrants of maternal pelvis; right/left,
anterior/posterior quadrants

First letter: mothers right or left (R, L)


Second letter: fetal presenting part (O, S, M, Sc)
Third letter: mothers anterior, posterior, or transverse
(A,P,T)

****ideal position: ROA or LOA

POWER
Primary Forces-Uterine Contractions
(TheFrequency
Forces of
Duration
Labor)
Intensity

Secondary Forces

Abdominal muscles
Perineal muscles
Pelvic floor muscles

PSYCHE
(The Patients Psychological
State)

Motivation for the pregnancy


Childbirth Education
Sense of Mastery, Self esteem
Positive Relationship with Mate
Maintaining Control
Support System during Labor
Not Being Alone during Labor
Trust in Medical Personnel

PSYCHE

SIGNS /SYMPTOMS
OF
LABOR
Cervical changes
Backache

Bloody Show

Nausea/Vomiting

Rupture of membranes

Indigestion

Sudden burst of energy

Diarrhea

Stages of Labor

First Stage - from onset of true labor to


complete dilatation of the cervix

Latent/Early Phase (0-3 cm)


Active Phase (4-7 cm)
Transition (8-10 cm)

Stages of Labor

Second Stage- from complete dilatation to


birth of the infant

Third Stage- from birth to delivery of the


placenta

Fourth Stage - From delivery of the


placenta up to four hours after birth

CARDINAL FETAL
MOVEMENTS

ENGAGEMENT

DESCENT

FLEXION

INTERNAL ROTATION

EXTENSION

RESTITUTION

EXTERNAL ROTATION

EXPULSION

Labor Analgesics

Demerol, Stadol, Nubain


Maternal Side Effects:
Respiratory Depression
Nausea/Vomiting
Drowsiness, Dizziness
Fetal Side Effects:
Respiratory Depression
Lethargy

Contraindication
sPoor fetal heart tones

Maternal respiratory depression


Known allergy

Nursing Implications
Monitor fetal and maternal response
Administer narcan/ naloxone prn - Route,
dose

Anesthesia for Labor

Regional Anesthesia
Epidural
Spinal
Pudenal
Local

Anesthesia for
Labor
General Anesthesia

Advantages

Faster access

Disadvantages

No support person
Discomfort to mother

Nursing
Responsibilities
For Epidurals

Bolus
Baseline vital signs and lab work available
Ensure client has an empty bladder
Position the patient
Ongoing monitoring of mother and baby
For General
As above
Cricoid pressure

Pitocin/Oxytocin
Uses

To induce / augment labor

To stimulate contractions after birth

Contraindications

Prone to uterine rupture


Cephalopelvic disproportion
Malpresentation
Presence of fetal distress
Preterm infant

Side Effects

Abruptio placenta
Water intoxication
Fetal hypoxia
History of rapid labor and/or birth
Uterine rupture

Fetal Monitoring

External Monitoring

Tocodynameter
Ultrasound

Internal Monitoring

IUPC
FSE

Fetal Monitoring

Baseline
Tachycardia >160 bpm
Bradycardia <120 bpm
Acceleration 15 bpm x 15 secs
Decelerations
Early - Head compression
Late - Placental insufficiency
Variables- Cord compression