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1.) uterine stretch theory ( any hallow organ stretched, will always contract & expel its content) –
contraction action
2.) oxytocin theory – post pit gland releases oxytocin that initiates labor. Hypothalamus produces
oxytocin
3.) prostaglandin theory – stimulation of arachidonic acid – prostaglandin- contraction (from early
pregnancy, a precursor from the fetal adrenal glands is conjugated in the placenta into estrogen. As estrogen reaches a high level,
glycerophospholipid (A1 prostaglandin )precursors are laid down. At the point when estrogen becomes dominant, phospholipase A2
converts prostaglandin precursors into prostaglandin.Prostaglandin stimulate the myometrium)
4.) progesterone theory – before labor, decrease progesterone will stimulate contractions & labor
(when the level of progesterone (which has a relaxing effect on the uterus) decreases, the myometrium becomes sensitive to
oxytocin, possibly by blocking calcium sequestration in the muscle fiber)
5.) theory of aging placenta – (By 260 days, the placenta began to age.)life span of placenta 42 wks. At 36 wks
degenerates (leading to contraction – onset labor).
T – temporal P – parietal 2 x
Fontanels:
Anteroposterior diameter -
Fetal LIE
This is the relationship of the long axis (spine) of the fetus to the long axis (spine) of the
mother.
If the two are parallel, then the fetus is said to be in a longitudinal lie.
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If the two are at 90-degree angles to each other, the fetus is said to be in a transverse
lie.
Fetal presentation
Two types:
Face
Chin
Kneeling
Is the portion of the fetus that enters the pelvis first and covers the internal os of the cervix, such as:
Cephalic (head)
Vertex
Brow
Face
Breech
If your baby is breech, his bottom is the part of his body closest to the birth canal. No one is sure what causes a breech presentation,
but it happens in 3% to 5% of single-baby deliveries.
Fetal Attitude
o The back is markedly flexed, head is flexed on the chin, thighs are
Fetal Position
symphysis pubis and bisecting it transversely by a line from one side to the other, forming the
right anterior and posterior quadrants and the left anterior and posterior quadrants.
Six positions are usually defined for each presentation except the shoulder presentation.
Station
Refers to the relationship of the presenting part to the level of the ischial spines.
When the presenting part is at the level of the ischial spines, it is at station 0 (synonymous with engagement).
If the presenting part is above the spines, the distance measured and described as station -1 or so if it is 1 cm or so
above the ischial spines;
Passageway
Cervix
Vaginal canal
Pelvis
Pelvis
1. Gynecoid – round, wide, deeper most suitable (normal female pelvis) for pregnancy
2. Android – heart shape “male pelvis”- anterior part pointed, posterior part shallow
3. Anthropoid – oval, ape like pelvis, oval shape, AP diameter wider transverse narrow
b. Pelvis
Important Measurements
Power – the force acting to expel the fetus and placenta – myometrium – powers of labor
a. Involuntary Contractions (Primary forces: is the uterine contraction → complete effacement and dilation of the cervix.
)
b. Voluntary bearing down efforts (Secondary forces: use of abdominal muscles to push during the 2nd stage of labor.
Pushing force adds to the primary force after the cervix is fully dilated.)
c. Characteristics: wave like
of true labor.
• UTERINE CONTRACTION
• SHOW
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- the mucus plug that filled the cervical canal during pregnancy is expelled. The exposed
cervical capillaries seep blood as s result of pressure exerted by the fetus. The blood,
mixed with mucus
• RUPTURE OF MEMBRANE
- actually there is no dry labor because even the amniotic membrane has ruptured.
Duration of Labor
Placenta - The placenta may impede labor when implantation took place in the lower uterine segment.
The placenta may cover part or all of the internal cervical os. This is known as placenta previa
Signs of placental separation
1.Fundus rises – becomes firm & globular “ Calkins sign”
2.Lengthening of the cord
3.Sudden gush of blood
Psyche - Women who are relaxed, knowledgeable, and capable of actively participating in the control of the
birth process usually experience shorter, less intense labors.
Cultural Assessment
o Address and honor values and beliefs of laboring woman
o Nurses more effective when aware of
Cultural beliefs of specific group
Recognition that individual difference may have impact on laboring mother
o Challenging for nurses to achieve balance between cultural awareness and risk of stereotyping
Psychosocial Assessment
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Laboring client has previous ideas, knowledge, and fears about childbearing - using assessment
techniques, nurse can meet laboring client's needs for information and support
Support system
o Father or support person - what are their caretaking activities, such as soothing conversation
and touching?
o Does relationship involve interactions? Is support person in close proximity?
Need to consider possibility that woman has experienced domestic violence - use ACOG(1998)
guidelines when interviewing and interview alone
o Has anyone close to you ever threatened to harm you?
o Have you ever been hit, kicked, slapped, or choked. If yes, by whom? What is the total
number of times?
o Has anyone, including your partner, ever forced you to have sex?
o Are you afraid of your partner or anyone else?
Anxiety
o Observe for rapid breathing, nervous tremors, frowning, grimacing, clenching of teeth,
thrashing, crying, and increase pulse and respiration
o Provide support, information, and encourage client
o Teach relaxation and breathing techniques
o May need to provide a paper bag if client's lips are tingling (hyperventilating)
I. First Stage of Labor (onset of true contractions to full dilation and effacement of cervix)
- Begins from the onset of regular contractions to full dilatation of the cervix. The first stage is much longer
than the 2nd & 3rd stages combined, averaging about 12 hours for primis and about 6 hours for multis.
Phases of Labor:
Latent Phase:
Assessment:
Dilations: 0 – 3 cm
Mom – excited, apprehensive, can communicate
Frequency: every 5 – 10 min
Intensity mild
Nursing Care:
Encourage walking - shorten 1st stage of labor
Encourage to void q 2 – 3 hrs – full bladder inhibit contractions
Breathing – chest breathing
Active Phase:
Assessment:
Dilations 4 -8 cm
Mom- fears losing control of self
Frequency: q 3-5 min lasting for 30 – 60 seconds
Intensity: moderate
Nursing Care:
M – edications – have meds read
A – ssessment include: vital signs, cervical dilation and effacement, fetal monitor, etc
D – dry lips – oral care (ointment)
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o dry linens
B – abdominal breathing
Transitional Phase:
Assessment:
Dilations: 8 – 10 cm
Frequency: q 2-3 min contractions
Durations: 45 – 90 seconds
Intensity: strong
Mom – mood changes with hyperesthesia
II. Second Stage of Labor (fetal stage, complete dilation and effacement to birth) – from full dilatation and
effacement to delivery. The average duration for primi is 1 hour and for multis, about 20 minutes.
Mediolateral – more bleeding & pain, hard to repair, slow to heal -use local or pudendal
anesthesia.
2.) Will facilitate complete flexion & extension. (Support head & remove secretion, check cord if coiled.
Pull shoulder down & up. Check time, identification of baby.
Mechanisms of Labor:
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II. Third Stage of Labor or Placental stage (Birth to expulsion of placenta) - Lasts from the delivery of the
fetus to the delivery of the placenta.
Placenta has 15 – 28 cotyledons
Placenta delivered from 3-10 minutes
a. Placental Seperation- because the uterus contracts and the placenta cannot so it buckles &
seperates
Signs of Placental Seperation
Globular and firmer uterus
Lengthening of umbilical cord by about 3 inches out of the vagina
Sudden gush of blood
* Normal blood loss because of placental seperation is 300-500 ml
b. Placental Expulsion Actual expulsion of the placenta happens either because of the mother’s
bearing-down efforts or through gentle pressure on the fundus of a contracted uterus (Crede’s
maneuver). Slowly pull cord and wind to clamp – BRANDT ANDREWS MANEUVER
Hurrying of placental delivery will lead to inversion of uterus.
CREDE’S MANEUVER – putting pressure to the uterus to fasten the expulsion of placenta.
AMNIOTOMY
o Artificial rupturing of the membranes. It allows the fetal head to contact the cervix ---»more efficient
contractions.
o This may be done with a hemostat. Take FHR after (danger: escape of loop cord with fluid).
o Psychosocial support
o Preparation of the DR and instruments (forceps, scissors, needle, needle holder, bowl/kidney
basins, sutures, sponges)