1. Maternal and fetal responses to labor
Physiologic and psychologic effects of labor on the mother

2. Physiologic effects: Cardiovascular system:
Sٍٍtrenuous work on the heart causing increased cardiac output, blood pressure and pulse rate.
During a contraction blood flow to the uterus decreases which leads to increase blood amount in the general circulation and thus increase in the peripheral resistance and resulting in increase in blood pressure (systole and diastole).

3. Blood loss (300 – 500 ml) aids in reducing blood volume.
Blood pressure: with the increased cardiac output during contractions, systolic blood pressure rises an average of 15mm Hg with each contraction.
When lying in supine position and pushes, her BP can drop leading to hypotension (upright or side lying position during the second stage can help avoid such a problem

4. Hemopoietic system:
Leukocytosis or sharp increase in WBCs possibly due to stress and heavy exertion (reaching 25,000/mm³ to 30,000/mm³ cells.

5. Respiratory system:
With increased cardiovascular output, the body responds with increased respiratory rate to provide oxygen leading to hyperventilation
Consumption of Oxygen is up to 100% during the second stage (similar to running)

6. Temperature regulation:
Increased muscular activity during labour leads to increased body temperature (1 degree)
Diaphoresis and evaporation helps the body to lose temperature

7. Fluid balance: Factors affecting fluid balance:
Increased rate of respiration
Diaphoresis (insensible water loss)
Withholding fluid during labor
All may necessitate IV fluid replacement

8. Urinary system:
With decreased fluid intake, kidneys begin concentration urine to preserve fluid and electrolytes
Increased specific gravity ( )
Protein in urine due to protein breakdown (muscle exertion)
Loss of sense of bladder filling (tone) which leads to overfilling. (During labor a woman must void every 2 hours)

9. Musculoskeletal system:
Relaxin (released from ovaries) during pregnancy resulted in softening cartilage between bones (symphysis pubis and sacro coccyx joints) lead to backache and pain at pubis during walking

10. Gastrointestinal system:
Fairly inactive during labor
Prolonged time of stomach emptying explain why food intake is restricted during labor
Loose bowel movements

11. Neurologic and sensory responses:
Responses related to pain (increased pulse and respiratory rate)
Pain due to contraction and perineal stretching

12. Psychological responses to labor
Fatigue:
Generally tired at the end of pregnancy
Lack of sleep

13. Fear: Cultural influences
Fear of labor (remind mother of the process taught earlier).
Cultural influences

14. Fetal responses to labor:
Neurologic system: uterine contractions exert pressure on fetal head results in increased intracranial pressure.
Decreased fetal heart rate by 5 bpm during a contraction. This decrease appears on the fetal monitor as an early deceleration pattern (normal during labor)

15. Cardiovascular system:
With contractions the uterus is arteries are sharply constricted and cotyledons filling halts leading to reduced oxygen and nutrients

16. Integumentary system:
Minimal petachiae or echymotic areas on the fetus, caput succedaneum

17. Musculoskeletal system:
Contractions encourage full flexion attitude

18. Respiratory system:
Labor assists in the maturation of surfactant production by alveoli
Pushing aids in clearing the lung fluid

19. Danger signs of labor Feat signs: High or low fetal heart rate
FHR: 120 – 160bpm
More than 16o or less than 120 means possible fetal distress
Meconium staining: a green color in the amniotic fluid: episode of loss of sphincter control allowing meconium to pass into meconium
Fetal Hypxia
Normal in breech presentation

20. Hyperactivity: normally the fetus is quiet during labor and hyperactivity indicates hypoxia is occurring (Need for oxygen)

21. Fetal acidosis: Blood pH below 7.2 is a sign of acidosis

22. Maternal Danger signs:
1. Rising or falling blood pressure
Increase of systole greater than 140 mmHg (more than 30 mmHg) or 90 of diastole (more than 15 mmHg) are indicative of pregnancy induced hypertension.
Falling Bp is indicative of intrauterine hemorrhage

23. 2. Abnormal pulse:
Normal pulse increases slightly during the second stage of labor due to exertion
Increased to more than 100 bpm is indicative of hemorrhage

24. H, 3. Inadequate or prolonged contractions:
Normally contractions increase in frequency, duration, severity. If contractions become less intense, shorter in duration or less frequent it indicates uterine exhaustion or inertia ( may need Cesarean birth)

25. 4. Pathologic retraction ring:
A sign of extreme uterine stress and impending uterine rupture
Observe the abdominal contour periodically

26. 5. Abnormal lower abdominal contour:
A full bladder during labor is manifested as a round bulge on the lower anterior abdomen. This isa danger sign for tow reasons:
1. Bladder injury by fetal head pressure
2. Pressure of full bladder inhibits fetal head descent

27. Increasing apprehension:
May be a sign of oxygen deprivation or internal hemorrhage