1. Giving Birth Chapter 16, 17, 18, 19 5/20/2018
Nur 342, Second Semestre 2011
Giving Birth
Chapter 16, 17, 18, 19
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2. Physiologic Effect of the Birth Process
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chapter 17
Physiologic Effect of the Birth Process
Maternal Responses: Significant changes occurs in woman’s body system related to effect of birth process
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3. Cardiovascular system:
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Cardiovascular system:
During contraction, blood flow to the placenta gradually decreases, causing a relative increase in the woman blood volume which slightly increase the blood pressure and slow the pulse.
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Respiratory system:
Increase depth and rate of respiration especially if the mother is anxious or in pain.
The woman may experience hyperventilation (tingling in her hands and feet, numbness, dizziness)
Helping her to slow her breathing and to breath into a paper bag or her cupped hands to decrease these symptoms
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5. Gastrointestinal system:
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Gastrointestinal system:
Decrease gastric motility
Not hungry but thirsty and dry mouth
Reduce food and large amount of fluids to reduce risk of vomiting and aspiration.
Ice chips and clear liquid can be given or hard candy
Large amount of sugar is not recommended it leads to neonatal hypoglycemia after birth
chapter 17
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6. 500 ml is maximum blood loss during vaginal birth
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Hematopoitic system:
500 ml is maximum blood loss during vaginal birth
Increase in WBCs 14, ,000/mm³ in average and may reach 25,000 /mm³
Fibrinogen and clotting factors increase during labor and after birth to prevent hemorrhage. But it increase risk for venous thrombosis.
Decrease Fibrinolysis (clot breakdown) during labor to promote coagulation at the placental site and to prevent hemorrhage. But it increase risk for venous thrombosis.
Nur 342, Second Semestre 2011
Khulod Barqawi, course coordinators

7. Urinary System Decreased sensation to full bladder
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chapter 17
Urinary System
Decreased sensation to full bladder
Full bladder prevent decent and lead to discomfort
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8. Reproductive system: Contraction cycle Normal labor contractions are:
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Reproductive system:
Normal labor contractions are:
Coordinated
Involuntary
Intermittent
Contraction cycle
1. Increment: begins as the contraction starts in the uterus
2. Peak(Acme): period during which contraction is most intense
3. Decrement: the period of decreasing intensity as uterus relax
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9. Characteristics of the contraction:
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Characteristics of the contraction:
Frequency: it is the period from the beginning of one uterine contraction to the beginning of the next, expressed in minute and fractions of minute
Duration: the length of each contraction from the beginning to the end,expressed in seconds
Intensity: the strength of the contraction (mild, moderate, strong)
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10. Mild contraction like feeling the tip of the nose
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Mild contraction like feeling the tip of the nose
Moderate contractions like the chin
Strong contraction like the forhead
Interval: the period from the end of one contraction to the beginning of the next
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11. The cervix is also passive.
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Uterine body:
The upper two third 2/3 of the uterus contracts actively to push the fetus down, and it becomes thicker
The lower third remain less active (passive) allowing downward passage of the fetus, and it becomes thinner
The cervix is also passive.
The opposing characteristics of the contractions in the upper and lower uterine segment change the shape of uterine cavity to become more elongated and narrower which straighten the fetal body and directs it downward in the pelvis
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12. Uterine Contractions: Opposing Characteristics
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Uterine Contractions: Opposing Characteristics
Fig. 17-2
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Cervical changes:
Effacement: (thinning and shortening) fully thinned cervix is 100% effaced.
Dilation: opening of cervix. Full dilation is 10cm.
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14. Cervical Dilation and Effacement
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Cervical Dilation and Effacement
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16. 5/20/2018
chapter 17
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17. Fetal response Placental circulation
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Fetal response
Placental circulation
During strong contraction , the blood supply to the placenta stops intermittently ,therefore most placental blood exchange occurs during intervals between contractions
Fetus has a protective mechanism such as a high hemoglobin, hematocrite and cardiac output
chapter 17
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18. Cardiovascular system: higher heart rate 110-160
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Cardiovascular system: higher heart rate
Pulmonary: labor intensifies absorption of lung fluid and some fluid expressed from upper air way as fetus pass birth canal
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19. Components of the Birth Process(4 P,s)
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Components of the Birth Process(4 P,s)
Powers
Passage
Passenger
Psyche
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20. 1. Power Uterine contractions: Involuntary, primary power
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1. Power
chapter 17
Uterine contractions: Involuntary, primary power
Pushing efforts(Bearing down effort), Secondary Power
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21. Contraction cycle

22. Maternal pelvis and soft tissues
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2.Passage:
Maternal pelvis and soft tissues
Bony pelvis: 1. true pelvis 2. false pelvis
True pelvis has three parts
1. Inlet: upper pelvic opening
2. midpelvis: pelvic cavity
3. outlet: lower pelvic opening
chapter 17
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23. Types of pelvis
Gynecoid pelvis: wide pubic arch, angle = 90 or greater. Round, cylindrical shape. Favorable for vaginal delivery.
Android pelvis: C/S birth
Anthropoid pelvis: possible vaginal delivery.
Platypelloid pelvis: C/S

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3.Passenger
chapter 17
The passenger is the fetus plus the membranes and placenta.
Fetal head: the fetus enters the birth canal in the cephalic presentation 96% of the time.
1. Bones, sutures and fontanels
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25. Fetal Head: Bones, Sutures, Fontanels
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Fetal Head: Bones, Sutures, Fontanels
Fig. 17-5a
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27. 2. Fetal head diameters: Anteroposterior diameter
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2. Fetal head diameters:
Biparietal diameter 9.5 cm,
Anteroposterior diameter
Suboccipitobregmatic diameter 9.5 cm
Occipitofrontal diameter 11 cm
Supraoccipitomental diameter cm
Submentobregmatic diameter 9.5 cm
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28. Variations in the passenger:
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Variations in the passenger:
Fetal lie
Attitude
Presentation
position
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1. Fetal lie: it is the orientation of the long axis of the fetus to the long axis of the woman.
Longitudinal lie
Transverse lie
Oblique lie
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2. Attitude: the attitude of the fetus is the relation of fetal body parts to each others.
The normal fetal attitude is (flexion),
Head flexed toward the chest,
Arms and legs flexed over the thorax,
Back curved C shape.
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3. presentation: the fetal part that enters the pelvis first is the presenting part.
Cephalic presentation (head)
Breech presentation(buttock)
Shoulder presentation(scapula)
a. Cephalic presentation: it is the most common with the fetal head flexed.
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34. Types of Cephalic Presentation: Vertex and Military
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Types of Cephalic Presentation: Vertex and Military
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35. Types of Cephalic Presentation: Brow and Face
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Types of Cephalic Presentation: Brow and Face
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36. Variations of Cephalic presentation
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Variations of Cephalic presentation
Vertex: fetal head fully flexed most preferable for normal labor(suboccipito pregmatic diameter)
Military: head in neutral position ,neither flexed or extend(occipitofrontal diameter)
Brow: fetal head is partially extend(supraoccipito mental diameter)
Face: Face fully extended(sub mentobregmatic diameter)
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37. Face presentation if with mentum anterior prolong vaginal birth
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Nur 342, Second Semestre 2011
Brow: Fetal head is partially extend(supraoccipito mental diameter 13.5cm) prolong labor progress.
Face: Face fully extended(sub mentobregmatic diameter 9.5cm). Prolong labor.
Face presentation if with mentum anterior prolong vaginal birth
If the position mentum transverse or posterior caesarean birth.
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38. b. Breech presentation:
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Disadvantages:
The buttocks are not smooth and firm like the head and are less effective in dilating the cervix.
The fetal head is the last part to be born, so the umbilical cord is subject to compression.
Gradual molding is not permit, Because the umbilical cord can be compressed after the fetal chest is born, the head must be delivered quickly to allow infant to breath.
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39. Breech presentation variations
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Breech presentation variations
Frank breech
Full or complete breech
Footling breech
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40. Variations of a Breech Presentation
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Variations of a Breech Presentation
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43. 4. Position:
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Fetal position describes the location of a fixed reference point on the presenting part in relation to the four quadrants of the maternal pelvis.
Abbreviations indicate the relationship between the fetal presenting part and the maternal pelvis.
Example ROA( right occipito anterior)
- Right (R) or Lift (L) of the mothers pelvis,
Occiput (O), Mentum (M), or Sacrum (S) ,Scapula(Sc)
Anterior (A), Posterior (P), or Transverse (T).
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44. Example ROA( right occipito anterior)
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Example ROA( right occipito anterior)
first letter: Right (R) or Lift (L) of the mothers pelvis
Middle letter: Occiput (O), Mentum (M), or Sacrum (S) , Scapula(Sc) , Fronto(F) of presenting part
last letter: Anterior (A), Posterior (P), or Transverse (T) of the mother pelvis
Nur 342, Second Semestre 2011
Khulod Barqawi, course coordinators

46. Vertex presentations:
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Vertex presentations:
Left Occiput Anterior (LOA),
Right Occiput Anterior (ROA),
Left Occiput Posterior (LOP),
Right Occiput Posterior (ROP),
Left Occiput Transverse (LOT),
Right Occiput Transverse (ROT).
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47. 5/20/2018
Nur 342, Second Semestre 2011
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48. 5/20/2018
Nur 342, Second Semestre 2011
Station
Describes the descent of the fetal presenting part in relation to the level of the ischial spines
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49. 5.Psyche
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The psyche is a crucial part of childbirth. Marked anxiety, fear, or fatigue decreases a woman’s ability to cope with pain in labor. Maternal catecholamine secreted in response to anxiety or fear can inhibit uterine contractility and placental blood flow. Relaxation, however, augments the natural process of labor.
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50. Factors that may have a role in the onset of labor
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Factors that may have a role in the onset of labor
chapter 17
Increased fetal adrenal gland productions of glucocorticoids and androgens which reduces placental progesterone secretions and increase prostaglandin productions
A change in the ratio of maternal estrogen to progesterone so that estrogen level is higher
Stretching ,pressure and irritations of uterus and cervix
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51. Premonitory signs of labor:
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Premonitory signs of labor:
1. Braxton Hicks contractions,
2. Lightening (dropping),
3. Increased clear and nonirritating vaginal secretions occur,
4. “Bloody show” mixture of thick mucus and pink or dark brown blood (ripening),
5. An energy spurt (nesting)
6. A small weight loss of up to 3 lb (1.3 kg)
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52. True labor and false labor:
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False labor (prodromal labor): false contractions which are preparation for the true labor.
How to distinguish True labor: see page 329
contractions,
Discomfort,
Cervical changes.
The best distinction between the false and the true labor is the progressive changes in the cervix.
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53. Mechanisms of Normal Labor
Cardinal Movements of Labor:
Engagement: BPD passes through the pelvis inlet
Descent
Flexion: chin is brought into contact with fetal thorax
Internal Rotation: turning of the head such that the occiput moves towards the pubic symphysis or posteriorly
extension: of the head (or breech) so it can pass
External rotation: head undergoes restitution
expulsion: delivery of the anterior and posterior shoulders