PHYSIOLOGICAL

CHANGES DURING
LABOUR

• Tamil Selvi C
• Msc Nursing I year
• CON
• JIPMER
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OBJECTIVES


define labour and its stages

describe nature of II stage of labour

recognize signs of II stage of labour

list out phases of II stage of labour

explain physiological changes during II stage.

identify common presentation of normal labour

demonstrate mechanism of labour

apply theory
 ●
INTRODUCTION

Physiological transition from being pregnant to
becoming a mother.


Physical and

psychological changes
 ●
DEFINITIONS

Labour

 Refers to the series of events by which the products of

conception expelled from the mother’s womb –
cunningham etal 2001.
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STAGES OF LABOUR

 I Stage

 II Stage

 III Stage

 IV Stage
●
NATURE OF SECOND STAGE OF
LABOUR

Uterine contractions
Expulsive contractions

Fetus descends

Ferguson reflex
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NATURE OF SECOND STAGE OF
LABOUR
Soft tissue Displacement

Anteriorly – Bladder

Posteriorly – Rectum

Laterally – Levator ani muscles.

The perineal body is also stretched and thinned
out
●
RECOGNITION OF THE
COMMENCEMENT OF II STAGE OF
LABOUR
Presumptive Signs

Expulsive contraction

Rupture of the forewater

Dilatation and gapping of the anus

Show

Anal cleft line

Appearance of the rhomboid of michaelas
●
RECOGNITION OF THE COMMENCEMENT
OF II STAGE OF LABOUR

Confirmatory Evidence


Vaginal Examination
●
PHASES OF II STAGE OF LABOUR


Latent Phase


Active phase
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PHYSIOLOGIC CHANGES

Maternal Response

Cardiovascular system

Cardiac output increases by 50%

Systolic pressure increases by 30 mm of Hg

Diastolic pressure increases by 25 mm of Hg
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PHYSIOLOGIC CHANGES

Respiratory System

Oxygen consumption increases

Hyperventilation

Respiratory Alkalosis

Hypocapnia
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PHYSIOLOGIC CHANGES

Renal System

Stretching and thinning of urethra

Proteinuria

Musculo Skeletal System

 Backache & Joint ache

 Fatigue and Diaphoresis

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PHYSIOLOGIC CHANGES

Gastro Intestinal System


Decreased Gastric motility and absorption
of solid foods.

Nausea and vomiting

Hematopoietic system

Elevated WBC count, levels of clotting
factor, fibrinogen

Decreased fibrinolysis.
●
PHYSIOLOGIC CHANGES

Neurologic system
 Euphoric to increased seriousness

 Short amnesia

 Elation / Fatigue
 ●
PHYSIOLOGIC CHANGES

Reproductive system

Expulsive uterine contractions

Soft tissue displacement
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PHYSIOLOGIC CHANGES

Fetal Response
Neurologic system

Uterine contractions


Increse in intracranial pressure


Decrease in FHR durinng contractions
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PHYSIOLOGIC CHANGES
Fetal Response
Cardiovascular system

Mostly unaffected by continued variations of HR.

Slight Hypoxia
Musculoskeletal System

Force of uterine contractions


Full flexion
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PHYSIOLOGIC CHANGES

Respiratory system

Maturation of surfactant production

Pressure applied to the chest


Clear lung fluid
 ●
FEMALE PELVIS

 Landmarks
 ●
FEMALE PELVIS

Diameters
●
FETAL SKULL
 ●
FETAL SKULL

Diameters
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MECHANISM OF LABOUR

Principles

Descent takes place throughout labour.

The part which leads and first meets the resistance of
pelvic floor will rotate forwards until it comes under
the symphysis pubis.

Whatever emerges from the pelvis will pivot around
the pubic bone
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COMMON PRESENTATION

Lie – Longitudinal
 ●
COMMON PRESENTATION

 Presentation – Cephalic
 ●
COMMON PRESENTATION

 Position – Right or
Left Occipito Anterior
 ●
COMMON PRESENTATION

Attitude – complete Flexion

 ●
COMMON PRESENTATION

Denominator – occiput
 ●
COMMON PRESENTATION

Presenting part – posterior part of the anterior

parietal bone
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MECHANISM OF LABOUR

Main movements
 Engagement
 Descent
 Flexion
 Internal rotation of the head
 Extension of the head
 Restitution
 Internal Rotation of the shouders
 Lateral Flexion
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MECHANISM OF LABOUR

●
 ●
MECHANISM OF LABOUR

●
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NURSES RESPONSIBILITIES


Instruct quality pushing

Provide quiet environment

Provide positive feedback

Take note time of the delivery

Assist in restrictive episiotomy
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THEORY APPLICATION
 Reva Rubin’s Framework and social support
Theory
Components of Rubin Theory
 Seeking safe passage

 Giving of oneself
 ●
THEORY APPLICATION

Social support components

 Emotional Support

 Information or Advice

 Affirmation or Appraisal

 Instrumental or Physical Aid

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JOURNAL STUDY
●
Background: Kuhn JC, Falk RS, Langesæter E conducted an
observational study, in which haemodynamic variables were
monitored continuously during the entire course of labour in healthy
parturients.
●
Methods: Continuous haemodynamic monitoring was performed in
20 healthy parturients during spontaneous labour, vaginal delivery
and for 15minutes postpartum. Cardiac output, stroke volume,
heart rate, systemic vascular resistance, and systolic arterial
pressure were measured longitudinally at baseline (periods
between/without contractions) and during contractions in early and
late stage 1, stage 2, during delivery, and postpartum, and were
analysed with marginal linear models.
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JOURNAL STUDY

●
Results: In early stage 1, baseline cardiac output was 6.3L/min (95% CI 5.7 to
6.9). Baseline values were similar across both labour stages and postpartum for
all haemodynamic variables. During stage 2 contractions, CO decreased by 32%,
SV decreased by 44%, HR increased by 52%, SVR increased by 88%, and SAP
increased by 36% compared to baseline. During stage 1 contractions,
haemodynamic changes were less profound & less uniform than during stage 2.
●
Conclusion: Progression of labour had no major effect on haemodynamic
baseline values. Haemodynamic stress during contractions was substantial in
both labour stages, yet most pronounced during the second stage of labour. The
absence of an increase in SV and CO postpartum questions the common belief in
an immediate rise in CO after delivery due to autotransfusion from the contracted
uterus.
SUMMARY
 ●
CONCLUSION


The transitional and II stage phases of labour are
emotionally intense and physically hard


Majority of labour progress physiologically.


Core midwifery skill is to support the mother in the
context of the physiology and the mechanism of
this phase of labour.


Clear comprehensive record keeping is essential.
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BIBLIOGRAPHY

Adele pillitori, Maternal Child health Nursing, 6th Edition,
Lippincott William& wilkins, Philadelphia. Pg No 346,
353,362,363.


Diane M Fraser, Margaret A Cooper, Myles Textbook for
midwives, !4th Edition Churchill Livingstone, Philadelphia Pg no
487 – 495.


Emily Stone Mc kenne, Mater Child Nursing, 3rd Ed, Saunders
publiocation Pg No 337-343


Lowdermilk, Perry Cashion & Iden, Maternity and women Health
care, 10th Ed, Elsevier Publications pg no 382 – 384
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BIBLIOGRAPHY
 Susan A Orshan, Maternity, Newborn and women’s Health Nursing,
Wolter Kluwers Publishers Pg no 596 – 598

Journal References
 Kuhn JC, Falk RS, Langesæter E. Haemodynamic changes during
labour: continuous minimally invasive monitoring in 20 healthy
parturients. Int J Obstet Anesth. 2017 May;31:74-83. doi:
10.1016/j.ijoa.2017.03.003. Epub 2017 Mar 10. PMID: 28404439.

 Sleutel MR. Intrapartum nursing: integrating Rubin's framework with

social support theory. J Obstet Gynecol Neonatal Nurs. 2003 Jan-
Feb;32(1):76-82. doi: 10.1177/0884217502239803. PMID: 12570184.

 Ouzounian JG, Elkayam U. Physiologic changes during normal

pregnancy and delivery. Cardiol Clin. 2012 Aug;30(3):317-29. doi:
10.1016/j.ccl.2012.05.004. Epub 2012 Jun 20. PMID: 22813360.
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