4. Physiological changes
Secondary to pain
In labor.

5. Discomfort during labor
A = First stage
B= later phase of 1st stage
to 2nd stage
C= 2nd stage actual
birth

8. Exercises often taught during childbirth classes

10. Discomfort in labor from:
Cervical dilation & effacement - first station
Uterine ischemia - throughout
Perineal stretching - end of 1st & 2nd stage
Fear
Anxiety
Tension

14. Process of Labor & Delivery
To understand the complex process of L&D it is
Important to examine each of the factors involved.
These are frequently called the five or even 6 P’s.
Passageway = pelvis & soft tissues
Passengers = fetus & placenta
Powers = Contractions & voluntary effort of mom (push)
Position of mother = standing, walking, side lying,
squatting, on hands & knees VS lithotomy
Process = all parts working together
& # 6 Psychological condition of mom

16. Passenger

18. MOLDING

21. A = Vertex
note the flexion
B = Sinciput
C = Face
note extension
D = Brow or Military

27. ROA
&
LOA
WHY BEST

32. 0 = ischeal
spines

35. Placenta is also a
passenger

48. PRIMARY POWER - CONTRACTION

49. Position of mother may also influence the secondary power of
pushing. Walking, sitting, kneeling, squatting are all important
aspects of position changes that are helpful.
Squatting may increase size %. Hands & knees may help
posterior fetus turn to anterior position. Remember back labor.

51. Psychological state of mother is another important
P to remember.
Education, Preparation, Support are all going to help
with the labor process

52. Vaginal Exam – What can the examiner find out ?
Effacement, Dilitation, Membranes intact, Presenting part, Presenting part, Fetal Attitude
Station, if presenting part is A, P, T, fetal scalp stimulation, fetal scalp PH
NOT done
If vaginal
Bleeding
WHY ??
Placenta
Previa

55. Mechanisms of Labor – engagement, decent, flexion, Internal rotation
Descent

56. INTERNAL
ROTATION
COMPLETION
OF INTERNAL
ROTATION &
BEGINNING OF
EXTENSION

57. INTERNAL
ROTATION
COMPLETION
OF INTERNAL
ROTATION &
BEGINNING OF
EXTENSION

58. CROWNING - EXTENSION

59. EXTENSION
COMPLETE
EXTERNAL
ROTATION

60. EXTERNAL
ROTATION –
NOTE
SHOULDERS-
RESTITUTION
EXPULSION

61. EXPULSION

70. LOA Mech Of
labor

71. Mechanism of labor in Breech Delivery
A = breech before
labor
B = engagement
& internal rotation
C = lateral flexion
D = external rota.
resitution
E = face rotates to
sacrum when
occiput is anterior
F = internal rotation
of shoulders & head
G = head born by
gradual flexion
during evacuation
of fetal body

72. CORD VESSELS

74. MATERNAL SIDE
DIRTY DUNCAN
PLACENTA
FETAL SIDE
SHINY SCHULTZ

75. CHECKING FUNDUS

76. STRIA GRAVIDARIUM
&
LINIA NIGRA

79. MORE MATERNAL ADAPTATION TO LABOR

82. M0RE MATERNAL ADAPTATIONS TO LABOR

83. M0RE MATERNAL ADAPTATIONS TO LABOR

85. Vaginal exam reveals:
Cervical effacement = %
Cervical dilatation = in centimeters “
Membranes intact = if not sure check with nitrizide paper
Fetal presentation
Fetal station
Fetal attitude
If presenting part A, P or T
Fetal scalp stimulation
Fetal scalp blood ph
Attach internal monitor