Definition of Labor INTRAPARTUM Labor is the series of events by which contractions expel the fetus and placenta from the uterus It is characterized by contractions and cervical change.

INTRAPARTUM THE 5 P’S: POWERS PASSAGEWAY PASSENGER POSITION PSYCHOLOGICAL RESPONSE

INTRAPARTUM POWERS UTERINE CONTRACTIONS EVALUATION OF CONTRACTIONS WORK OF THE UTERUS CONTRACTILE POWERS OF THE UTERUS AND MATERNAL PUSHING EFFORTS IN SECOND STAGE THEORIES ONLY. (PROGESTERONE, OXYTOCIN, FETAL INITIATION, UTERTONIN) WOMAN’S BONY PELVIS AND SOFT TISSUES OF BIRTH CANAL AND OUTLET INITIATED AT A UTERINE PACEMAKER MOVES FROM FUNDUS TO CERVIX ACTIVE & PASSIVE UTERINE SEGMENTS BANDL’S RING INTENSITY, FREQUENCY, DURATION, INTERVAL METHODS PALPATION EXTERNAL/INTERNAL MONITOR Cervical Effacement Cervical Dilation Fergerson’s reflex Descent of the Fetus Birth of the Baby

INTRAPARTUM PASSAGEWAY CONSISTS OF 4 BONES - 2 innominate, sacrum, and coccyx; and 4 JOINTS - 2 sacroiliac, symphysis pubis, and sacrococcygeal FALSE PELVIS TRUE PELVIS - Inlet, Midplane, Outlet PELVIC STRUCTURES GYNECOID ANTHROPOID ANDROID PLATYPOID

INTRAPARTUM PASSENGER FETUS AFFECTS PROGRESS OF LABOUR BECAUSE OF ITS: SIZE PRESENTING PART: CEPHALIC - 96%, BREECH - 3.5%, SHOULDER - 0.4% DENOMIATOR LIE POSITION ATTITUDE and HEAD DIAMETERS Parts of fetal head SUTURES FONTANELS SYNCLITISM/ASYNCLITISM MOULDING STATION (LIGHTENING)/ENGAGEMENT

INTRAPARTUM POSITION UPRIGHT POSISITONS - walking, sitting, squatting, kneeling - enhance effects of gravity and are beneficial to maternal cardiac output SUPINE POSITIONS force uterus to work against gravity and can compress aorta and vena cava compromising cardiac output ALL FOURS relieves backache with OP position and may assist in anterior rotation SEMI RECUMBENT requires more effort and due to pressure moving coccyx forward decreases outlet size

INTRAPARTUM PYSCHOLOGIC RESPONSE MATERNAL PSYCHOLOGIC RESPONSE TO PREGNANCY AND LABOR can impede of facilitate progress. KNOWLEDGE AND RELAXATION facilitates progress and enhances oxygenation of fetus and maternal tissues FEAR, TENSION, and GRIEF have reverse effect

INTRAPARTUM – Signs of Labor TRUE LABOR FALSE LABOR IMPENDING LABOR True: REGULAR CTX DECR INTERVAL INCR DURATION INCR INTENSITY BACK TO FRONT WALKING INCR INTENSITY ASSOC PAIN/INT False IRREG CTX INTERVAL SAME DEC DURATION DEC INTENSITY FRONT ONLY WALKING NO CHANGE Impending MUCUS PLUG - BLOODY SHOW WEIGHT LOSS DIARRHEA INCREASED: BRAXTON HICKS CONTRACTIONS VAGINAL SECRETIONS BACKACHE/SLEEP DISTURBANCE

INTRAPARTUM MECHANISMS OF LABOR Also called the CARDINAL MOVEMENTS DESCENT FLEXION INTERNAL ROTATION EXTENSION RESTITUTION EXTERNAL ROTATION BIRTH OF SHOULDERS BIRTH OF BODY EXPULSION OF PLACENTA

INTRAPARTUM – Stages & Phases First Stage Latent Phase EXCITEMENT ANTICIPATION SCARED CAN TALK BETWEEN AND THROUGH CONTRACTIONS Lose MUCUS PLUG - BLOODY SHOW ONSET LABOR TO 3CM PROFOUNDLY AFFECTED BY SEDATION AND ANALGESIA DURATION 6-20 HOURS PRIMIP (AVERAGE 8.6) 2-10 HOURS MULTIP (AVERAGE 5.3)

INTRAPARTUM FIRST STAGE ACTIVE PHASE ACCELERATION PHASE 3-4 CM NOTICED RETROSPECTIVELY PHASE OF MAXIMUM SLOPE 4-8 CM MOST RAPID PRIMIP 1.2CM/HR MULTIP 1.5 CM/HR

INTRAPARTUM MATERNAL BEHAVIOR ACTIVE PHASE MAY VOMIT CONCENTRATES W/ CONTX DISCOURAGED FEARFUL RESTLESS WEEPY

INTRAPARTUM FIRST STAGE ACTIVE PHASE TRANSITION DECELERATION PHASE 8-10 CM ALSO CALLED TRANSITION MOST INTENSE PHASE PRIMIP 1CM/HR MULTIP 2.1CM/HR

INTRAPARTUM MATERNAL BEHAVIOR TRANSITION NAUSEA VOMITING INCREASED BLOODY SHOW DIARRHEA IRRITABLE/SHAKEY RECTAL PRESSURE SLEEPS BTWN CTX TURNS INWARD

INTRAPARTUM SECOND STAGE COMPLETE DILATION TO BIRTH MATERNAL PUSHING - spontaneous, directed, valsalva, and open glottis, Valsalva increases fetal hypoxia directed increases perennial tears PHASE OF MAXIMUM DESCENT PRIMIP 30 MINUTE - 1 HOUR MULTIP 5-30 MINUTES

INTRAPARTUM POSITIONS FOR SECOND STAGE SITTING AND SQUATTING makes use of gravity KNEELING OR SQUATTING facilitates descent and expulsion by moving uterus forward, straightening long axis of birth canal, and increasing pelvic outlet 28% (bispinous diameter 0,8 - 1.0 cm and AP diameter 2 cm). LATERAL - aids in rotating fetus from posterior position and good when less force is required CHOICE OF POSITION dependent on maternal preference, comfort, progress of second stage, and fetal status

INTRAPARTUM THIRD STAGE BIRTH TO DELIVERY OF PLACENTA 5-30 MINUTES UTERINE CONTRACTIONS CAUSE PLACENTAL SEPARATION

INTRAPARTUM INSPECTION OF PLACENTA SHAPE SIZE WEIGHT -1:5 PLACENTAL:FETAL CALCIFICATION INFARCT RETROPLACENTAL CLOT IS IT COMPLETE? EXTRA LOBE? CORD INSERTION LENGTH, 3 VESSELS, WHARTONS JELLY MEMBRANES - INTACT, COLOR ODOR

INTRAPARTUM Vacuum extraction Used to expedite delivery of the baby, especially if maternal exhaustion if present. Many conditions must be met before this can be accomplished. Not without risk.

INTRAPARTUM Forcep Assisted Delivery That’s about how many you will see these days as the training has dramatically decreased, so less forcep deliveries are attempted. It is a learned skill which requires careful evaluation of the fetal position and maternal pelvis. There are various types of forceps, each with a specific purpose.

INTRAPARTUM Dystocia Cephalo-Pelvic Disproportion Some difficulty in the labor; blockage. Can be caused by fat; by bones as is shoulder dystocia Literally “head-pelvic doesn’t fit”

INTRAPARTUM Caesarian Section Major surgery, with all risks of surgery. Sometime it is the best way to be born. Very high rates at the present time.

INTRAPARTUM