Physiological changes Secondary to pain In labor.

Discomfort during labor A = First stage B= later phase of 1st stage to 2nd stage C= 2nd stage actual birth

Exercises often taught during childbirth classes

Discomfort in labor from: Cervical dilation & effacement - first station Uterine ischemia - throughout Perineal stretching - end of 1st & 2nd stage Fear Anxiety Tension

Process of Labor & Delivery To understand the complex process of L&D it is Important to examine each of the factors involved. These are frequently called the five or even 6 P’s. Passageway = pelvis & soft tissues Passengers = fetus & placenta Powers = Contractions & voluntary effort of mom (push) Position of mother = standing, walking, side lying, squatting, on hands & knees VS lithotomy Process = all parts working together & # 6 Psychological condition of mom

Passenger

MOLDING

A = Vertex note the flexion B = Sinciput C = Face note extension D = Brow or Military

ROA & LOA WHY BEST

0 = ischeal spines

Placenta is also a passenger

PRIMARY POWER - CONTRACTION

Position of mother may also influence the secondary power of pushing. Walking, sitting, kneeling, squatting are all important aspects of position changes that are helpful. Squatting may increase size 20 - 40%. Hands & knees may help posterior fetus turn to anterior position. Remember back labor.

Psychological state of mother is another important P to remember. Education, Preparation, Support are all going to help with the labor process

Vaginal Exam – What can the examiner find out ? Effacement, Dilitation, Membranes intact, Presenting part, Presenting part, Fetal Attitude Station, if presenting part is A, P, T, fetal scalp stimulation, fetal scalp PH NOT done If vaginal Bleeding WHY ?? Placenta Previa

Mechanisms of Labor – engagement, decent, flexion, Internal rotation Descent

INTERNAL ROTATION COMPLETION OF INTERNAL ROTATION & BEGINNING OF EXTENSION

INTERNAL ROTATION COMPLETION OF INTERNAL ROTATION & BEGINNING OF EXTENSION

CROWNING - EXTENSION

EXTENSION COMPLETE EXTERNAL ROTATION

EXTERNAL ROTATION – NOTE SHOULDERS- RESTITUTION EXPULSION

EXPULSION

LOA Mech Of labor

Mechanism of labor in Breech Delivery A = breech before labor B = engagement & internal rotation C = lateral flexion D = external rota. resitution E = face rotates to sacrum when occiput is anterior F = internal rotation of shoulders & head G = head born by gradual flexion during evacuation of fetal body

CORD VESSELS

MATERNAL SIDE DIRTY DUNCAN PLACENTA FETAL SIDE SHINY SCHULTZ

CHECKING FUNDUS

STRIA GRAVIDARIUM & LINIA NIGRA

MORE MATERNAL ADAPTATION TO LABOR

M0RE MATERNAL ADAPTATIONS TO LABOR

M0RE MATERNAL ADAPTATIONS TO LABOR

Vaginal exam reveals: Cervical effacement = % Cervical dilatation = in centimeters - 4 “ Membranes intact = if not sure check with nitrizide paper Fetal presentation Fetal station Fetal attitude If presenting part A, P or T Fetal scalp stimulation Fetal scalp blood ph Attach internal monitor