1. Giving Birth
Chapter 17

2. LABOR The Process by which the Products of Conception are expelled
from the body

3. Physiologic Effects Of
the Birth Process

4. Maternal Response

5. Characteristics of Contractions
Contraction-exhibits a wavelike pattern that begins slowly climbing (increment) to a peak, and decreases (decrement)
peak
Increment
Decrement
Duration
Interval
Frequency
Duration- from beginning of one contraction to the end of the same
contraction
Frequency- from beginning of one contraction to the beginning of
another contraction
Interval - Resting time between contractions for placental perfusion

6. Opposing Features of Uterine Activity
Upper 2/3 of uterus contracts actively
Lower third and cervix are passive
These lead to downward progression of fetus
with each contraction

7. Cervical Changes Effacement- thinning of the cervix (%)
Dilation – enlargement and widening of the os (cm)

8. Cardiovascular System Changes
During each contraction, blood flow to the placenta gradually decreases, causing an increase in the woman’s blood volume causing her B/P to increase and slowing of her pulse.
Because these changes occur during a contraction, it is best to assess vital signs between contractions.

9. What are acceptable positions for the woman to assume while in labor?

10. Respiratory System Changes
During labor a woman is likely to hyperventilate causing:
Tingling in hands and feet
Numbness
Dizziness
Have the woman slow her breathing or breath into a paper bag.

11. Gastrointestinal System Changes
Most woman are limited to clear liquids or NPO during the labor process.
Gastric motility and digestion of food is reduced.
Decrease risk of aspiration
Why?

12. Urinary System Changes
Reduce sensations of needing to void
Intense contractions
Anesthesia
Unaware of having a Full bladder
Inhibit fetal descent

13. Hematopoietic System
Most woman lose ~ 500ml blood during a vaginal delivery and ~1000ml during a cesarean birth.
Clotting factors are elevated and Fibrinolyis is decreased to promote coagulation at the placental site

14. Components of the
Birth Process

15. Powers

16. Uterine Contractions Maternal Pushing Efforts
Involuntary Uterine Contractions or Primary Powers
Muscular contractions which lead to dilation and effacement in the First Stage of Labor
Voluntary Uterine Contractions or Secondary Pushing Powers
Abdominal muscles assist in the Second Stage with pushing. Increase intra-abdominal pressure to aid in expulsive forces

17. Fill in the Blank Length of a uterine contraction__________.
Strength of a uterine contraction is ___________.
The time from the beginning of one contraction to the beginning of the next contraction is _______.
The time that allows for placental perfusion is __.
The peak of a contraction is also known as ____.

18. The
Birth
PASSAGE

19. THE PELVIS False Pelvis True Pelvis Represents
Supports the weight of the uterus
Shallow basin above the inlet or brim
True Pelvis
Represents
the bony
limits of the
birth canal

20. True Pelvis vs. False Pelvis
Inlet Inlet - upper margin of pubic bone to upper margin of sacrum Outlet Outlet - Lower pubic bone to tip of coccyx. This area is the smallest portion that the baby must travel through.

21. Which has the greatest impact on labor?

22. The Passenger

23. Fetal Head
Because of its size and rigidity, the Fetal Head has a major impact on delivery.
The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal.
Head also can rotate, flex, and extend
Compare the bones, suture lines and fontanels of the fetal head. What do the bones of the fetal head do to accommodate the birth canal?

24. Fetal Lie
Relationship of the long axis of the fetus to the long axis of the mother.
Longitudinal Lie Transverse Lie
Define the term "fetal lie". Explain the difference between transverse lie and longitudinal lie. Which is the most favorable for a vaginal delivery?

25. Attitude Relationship of fetal body parts to Optimum each other
attitude is
ovoid
The head is flexed forward, with the chin almost resting on the chest. The arms and legs are flexed.

26. True or False? The optimum lie of the fetus is the longitudinal lie.
A. True
B. False

27. Fetal Presentation
That portion of the fetus that enters the Pelvis first and covers the internal os.
Three Types:
Cephalic
Vertex, Face, Brow
Breech
Shoulder
Define the term “fetal presentation” and explain difference between presentations.
Cephalic Presentation
The head is entering the pelvis first.

28. Reference Points Cephalic = Occiput, posterior fontanel
Breech = Sacrum
Face = Mentum
What reference point would the nurse use when assessing cephalic presentation? A breech presentation? A face presentation?
What reference point would the nurse use when assessing breech presentation?

29. POSITION
Relationship of the Fetal Presenting Part to the Maternal Pelvis
Steps:
1. Determine the Presenting Part
2. Divide the mothers pelvis into 4 imaginary quadrants
What is fetal position? What are the steps in assessing position? A 12 R L 9 3 6 P

30. The Psyche

31. BREAK THE CYCLE ! FEAR TENSION PAIN
18. How can stress and anxiety interfere with the process of labor?
19. What are nursing interventions to assist clients in decreasing anxiety?
PAIN

32. Normal Labor

33. Theories of Onset
Decrease in Progesterone
High levels of
Prostagladins
Stretching, pressure or irritation of the uterus and cervix
20. What are the possible causes of labor onset?

34. Premonitory Signs of Labor
The impending signs
that take place the last
several weeks of
pregnancy or even the
last several days
What are the premonitory signs of labor?

35. Premonitory Signs of Labor
LIGHTENING
Braxton-Hicks Contractions
Cervical changes
SHOW
ROM
BACKACHE
SUDDEN INCREASE IN ENERGY
Weight loss

36. True vs. False Labor FALSE LABOR TRUE LABOR Contractions are irregular
Often stop with walking
Contractions felt in abdomen above umbilicus (abdominal pains)
No change in cervix
Fetus is ballotable
TRUE LABOR
Contractions are:
* Regular
*Increase in intensity
and duration with
walking
*Felt in lower back, radiating to lower portion of abdomen
Bloody show
Dilation and effacement
Fetus usually engaged
23. What assessment findings differentiate true labor from false labor?

37. Mechanisms of Labor/ Cardinal Movements
Engagement / Descent
Flexion
Internal Rotation
Extension
External Rotation
25. Explain the positional changes /cardinal movements of stage 2 and why they occur in this order?
Expulsion

38. Engagement
Engagement
-largest diameter of presenting part has passed through the pelvic inlet
Assessed during
vaginal exam
Ballotable
8. What is engagement? How is it determined?
Engaged

39. Station
Station- degree that the presenting part has descended into the pelvis in
Relationship to ischial spines
Goal
Move from – to + stations
9. What is station? How is station determined and measured? Does the station need to be a + or – for delivery?

40. Phases and Stages of Labor
Stage 1 – From 0 cm. dilated to 10 cm.
Stage 2 - From complete dilation and
effacement to delivery of the
baby
Stage 3 - From delivery of baby to the
delivery of the placenta
Stage 4 - the first hour after delivery

41. Phases of First Stage of Labor
Latent Phase – is from 0 to 3 cm. dilated
Active Phase – is from 4cm. to 7 cm.
Transition Phase – is from 8 cm. to 10 cm.
24. What are the three phases of the first stage of labor and characteristics of each? (p )

42. Signs of Second Stage of Labor
Complete dilatation of cervix
Urge to bear down
Perineum begins to bulge, flatten and move anteriorly
Increase in bloody show
Rectal pressure
Labia begins to part with each contraction

43. Signs of Stage Three of Labor
Globular
Shape of Uterus
Fundus Rise in Abdomen
Sudden Gush of Blood
Protrusion of Umbilical cord
What are the signs in the third stage that indicate that the placenta is ready for delivery?

44. Test Yourself !
What is the reference point of a cephalic presentation when the head is fully flexed?
A. occiput
B. mentum
C. frontal
d. sagittal

45. Test Yourself
Overlapping of the fetal skull to facilitate its passage through the bony pelvis is ___________.
Relationship of fetal body parts to each other is_____________.
Head first presentation is_________________.
Relationship of the fetal spine to the maternal spine is ________________.
Term that refers to the part of the fetus that enters the pelvic inlet first is _____________.

46. Critical Thinking
If the fetal head did not descend through the pelvis and stayed at the same station for a prolonged period of time, what do you think would be the treatment of choice?

47. Try this ! When the cervical os widens or opens it is said to________.
The level of the ________ _________ is station zero.
The most common type of pelvis for a woman ___________.
When the cervix shortens and thins is _______________.
For delivery to occur, the fetus must accomodate to this rigid passageway______________.

48. The End