1. Chapter 16 Labor and Birth Processes
Maternity & Women’s Health Care, 11th Edition
by Lowdermilk, Perry, Cashion, and Alden
Instructor: LaTricia Perry, MSN, RN, COI

2. Factors Affecting Labor
Passenger
Passageway
Powers
Position
Psychological Response

3. Factors Affecting Labor
5 factors affecting process of labor and birth
Passenger: fetus
Size of fetal head
Fontanels
Molding
Fetal presentation
Cephalic
Breech
Shoulder
Fetal lie

4. Factors Affecting Labor (cont.)
5 factors affecting process of labor and birth
Passenger: fetus
Fetal attitude
General flexion
Biparietal diameter
Suboccipitobregmatic diameter
Fetal position
Station
Engagement

6. Factors Affecting Labor (cont.)
5 factors affecting process of labor and birth
Passageway: birth canal
Bony pelvis
Gynecoid
Android
Anthropoid
Platypelloid
Soft tissues
Retraction ring

7. Factors Affecting Labor (cont.)
5 factors affecting process of labor and birth
Powers
Primary powers: contractions
Frequency, duration, intensity
Effacement
Dilation
Ferguson reflex
Secondary powers: bearing-down efforts
Valsalva maneuver

8. Contractions:

9. Cervical effacement

10. Cervical dilation

11. Factors Affecting Labor (cont.)
5 factors affecting process of labor and birth
Position of laboring woman
Upright position
“All fours” position
Lithotomy position
Semirecumbent position
Lateral position

12. Factors Affecting Labor (cont.)
Psychologic Response
Unique to each woman
Cultural beliefs
Previous experience
Anxiety level
Environment

13. Onset of Labor Cannot be ascribed to a single cause
Onset preceded by a number of signs
Braxton Hicks contractions
Lightening
Bloody Show
Nesting
Cannot be ascribed to a single cause
Change in uterus and hormones (progesterone)
Hormones produced by fetus’ hypothalamus
Uterine distention and prostaglandins
Increased uterine pressure

14. Process of Labor First stage Second stage Third stage Fourth stage
Dilation
First stage
Delivery of fetus
Second stage
Expulsion of placenta
Third stage
Recovery x 2 hours
Fourth stage

15. First Stage of Labor – Effacement and Dilation
Begins with onset of regular uterine contractions
Ends with full cervical effacement and dilation
Three phases -
Latent phase (up to 3 cm of dilation)
Active phase (4 to 7 cm of dilation)
Transition phase (8 to 10 cm of dilation)

16. First Stage of Labor: Latent (Early)
Early: - lasts 5 to 12 hours
Physical changes:
Bloody show, loss of mucus plug, diarrhea
Dilation – 0 to 3 cm
Effacement – 50% to 80%
Contractions - duration – 30 sec to 45 sec
frequency – 5 to 30 min apart
intensity – usually mild building to moderate

17. First State of Labor: Latent (Early)
Emotional changes: excited, nervous, not sure this labor, restless, wants to talk, best to be at home
Psychological: Interested in everything go on, need for reassurance, positive verbal and emotional support

18. First State of Labor: Active
Active: last 3 to 7 hours
Physical changes:
Decreased appetite, using more energy, smell of food may make her nauseous, difficult to walk or talk through contractions, need to change positions
Dilation – 4 to 7 cm
Effacement – 80% to 100%
Contractions - duration – 40 sec to 70 sec
frequency – 3 to 5 min apart
intensity – moderate to strong

19. First Stage of Labor: Active
Emotional changes: Focused on labor, decreased talking, wants focused emotional and physical support, irritated by noises
Psychological: Only involved in what is going on in room is in, decreased modesty, more dependent on partner,

20. First Stage of Labor: Transition
Transition: last ½ hr to 1 ½ hr
Physical changes:
Nausea, vomiting, difficulty focusing, double peaked contractions, hot and cold flashes, shaking, hiccups, burping, common time for rupture of amniotic sac, need to bear down
Dilation – 10 cm
Effacement – 100%
Contractions - duration – 45 sec to 90 sec
frequency – 2 to 3 min apart
intensity – extremely strong

21. First State of Labor: Transition
Emotional changes: Losing control, desire to quit, bargaining, may ask for medication, inward centered, irritable, natural amnesia, needs undivided attention
Psychological: Only focus about 10 inches from her face, easily overwhelmed , needs unwavering encouragement and praise

22. Second Stage of Labor Infant is born
Begins with complete effacement (100%) and full cervical dilation (10 cm)
Ends with baby’s birth

23. Seven Cardinal Movements of the Mechanism of Labor
Engagement
Descent
Flexion
Internal Rotation
Extension
Restitution and External Rotation
Expulsion

25. Posterior position

27. Second Stage of Labor -Birthing the baby
Two phases – ½ to 2 hours
Latent (“Laboring Down”): relatively calm with passive descent of baby through birth canal
Active Pushing (Descent): active pushing and urges to bear down
Ferguson reflex

28. Third Stage of Labor – 15 to 60 min
Placental separation and expulsion
Firmly contracting fundus
Change in uterus
Sudden gush of dark blood from the introitus
Apparent lengthening of the umbilical cord
Vaginal fullness

29. Fourth Stage of Labor – 1 to 2 hours post-delivery
Begins after delivery of placenta
Body is attempting to regain homeostasis
Watch for abnormal bleeding

30. Fetal Adaptation to Labor
Fetal Heart Rate (FHR)
Fetal Circulation
Fetal Respiration

31. Maternal Physiologic Adaptation to Labor (cont.)
Cardiovascular changes
Respiratory changes
Renal changes
Integumentary changes
Musculoskeletal changes
Neurologic changes
Gastrointestinal changes
Endocrine changes
Women exhibit both objective and subjective symptoms:

32. Questions, Comments, or Concerns???