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MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH

MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH. KEY FACTORS RELATED TO PROGRESS OF LABOR FORCES OF LABOR INTRAPARTAL ASSESSMENT AND CARE OF MOTHER AND FETUS CARE OF MOTHER AND INFANT IN LABOR, DELIVERY, AND IMMEDIATE POST PARTUM BIRTH RELATED PROCEDURES.

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MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH

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  1. MODULE 2 INTRAPARTUMPROCESSES OF LABOR AND BIRTH

  2. KEY FACTORS RELATED TO PROGRESS OF LABOR • FORCES OF LABOR • INTRAPARTAL ASSESSMENT AND CARE OF MOTHER AND FETUS • CARE OF MOTHER AND INFANT IN LABOR, DELIVERY, AND IMMEDIATE POST PARTUM • BIRTH RELATED PROCEDURES

  3. MODULE 2 PART 1KEY FACTORS RELATED TO PROGRESS OF LABORTHE PASSAGE

  4. KEY FACTORS RELATED TO PROGRESS OF LABOR • PASSAGEWAY (BIRTH CANAL) • PASSENGER (FETUS) • POSITION OF THE MOTHER AND FETUS • PHYSIOLOGICAL FORCES OF LABOR • PSYCHOSOCIAL CONSIDERATIONS

  5. BIRTH PASSAGE • SIZE OF PELVIS • TYPE OF PELVIS • CERVICAL DILATATION, EFFACEMENT • ABILITY OF VAGINA AND INTROITUS TO EXPAND

  6. BIRTH PASSAGE • FOUR CLASSIC PELVIC TYPES • GYNECOID • ANDROID • ANTHROPOID • PLATYPELLOID

  7. Figure 15–1 Comparison of Caldwell-Moloy pelvic types.

  8. BIRTH PASSAGE CERVICAL DILATATION AND EFFACEMENT • DILATATION—MEASURED IN CENTIMETERS FROM 0 TO 10 • 0 CM—CERIVX CLOSED • 10 CM—FULL DILATATION • EFFACEMENT—MEASURED IN PERCENTAGE 0 TO 100%

  9. Figure 15–11a Effacement of the cervix in the primigravida. Beginning of labor. There is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid.

  10. Figure 15–11b Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head.

  11. Figure 15–11c Cervix about one-half effaced and slightly dilated. The increasing amount of amniotic fluid exerts hydrostatic pressure.

  12. Figure 15–11d Complete effacement and dilatation.

  13. UTERINE AND CERVICAL CHANGES • UPPER UTERINE SEGMENT THICKENS AND PULLS UP • LOWER SEGMENT EXPANDS AND THINS OUT • EFFACEMENT • CAUSES OF UTERINE CHANGES • ESTROGEN STIMULATES MUSCLE CONTRACTIONS • COLLAGEN IN CERVIX BROKEN DOWN • INCREASED WATER CONTENT OF THE CERVIX

  14. MODULE 2 PART 2THE PASSENGER (FETUS)

  15. FETUS • SIZE OF FETAL HEAD • FETAL ATTITUDE • FETAL LIE • FETAL PRESENTATION • IMPLANTATION SITE OF PLACENTA

  16. PASSENGER • FETAL HEAD • SUTURES • FRONTAL • SAGITTAL • CORONAL • LAMBOIDAL • MOLDING • FONTANELLES

  17. Figure 15–2 Superior view of the fetal skull.

  18. PASSENGER LANDMARKS OF FETAL SKULL • MENTUM • SINCIPUT • ANTERIOR FONTANELLE (BREGMA) • VERTEX • POSTERIOR FONTANELLE • OCCIPUT

  19. Figure 15–4a Typical anteroposterior diameters of the fetal skull. When the vertex of the fetus presents and the fetal head is flexed with the chin on the chest, the smallest anteroposterior diameter (suboccipitobregmatic) enters the birth canal.

  20. Figure 15–6a Cephalic presentation. Vertex presentation. Complete flexion of the head allows the suboccipitobregmatic diameter to present to the pelvis.

  21. Figure 15–6c Brow presentation. The fetal head is in partial (halfway) extension. The occipitomental diameter, which is the largest diameter of the fetal head, presents to the pelvis.

  22. PASSENGER FETAL LIE AND PRESENTATION • FETAL LIE-- Relation of long axis of fetus to long axis of the mother • Longitudinal • Transverse • FETAL PRESENTATION—the body part of the fetus that first enters the pelvis

  23. PASSENGER (PRESENTATION) CEPHALIC PRESENTATION (95%) • VERTEX—SUBOCCIPTOBREGMATIC • MILITARY--OCCIPITOFRONTAL • BROW--OCCIPITOMENTAL • FACE--SUBMENTOBREGMATIC

  24. PASSENGER (PRESENTATION) BREECH PRESENTATION (3%) • COMPLETE—HIPS FLEXED, KNEES FLEXED • FRANK—HIPS FLEXED, KNEES EXTENDED • FOOTLING—HIPS & FEET EXTENDED, FEET,FOOT PRESENT TO MATERNAL PELVIS • KNEELING—HIPS EXTENDED, KNEES FLEXED

  25. PASSENGER (PRESENTATION) SHOULDER (TRANSVERSE) PRESENTATION (2%) • TRANSVERSE LIE—SHOULDER IS USUAL PRESENTING PART • COMPOUND—USUALLY ARM OR HAND PRESENTING ALONG PRESENTING PART

  26. MODULE 2 PART 3POSITION OF MOTHER AND FETUS

  27. POSITION OF FETUS IN RELATION TO MOTHER’S PELVIS ENGAGEMENT • WHEN THE WIDEST DIAMETER OF THE PRESENTING PART HAS REACHED OR PASSED THE PELVIC INLET • ENGAGMENT USUALLY CORRESPONDS TO O STATION • FLOATING—WHEN PRESENTING PART IS ENTIRELY OUT OF THE PELVIS AND FREELY MOVABLE IN THE INLET

  28. Figure 15–8 Measuring the station of the fetal head while it is descending. In this view the station is 22/23.

  29. POSITION STATION • RELATIONSHIP OF FETAL PRESENTING PART TO THE LEVEL OF THE ISCHIAL SPINES • THE ISCHIAL SPINES ARE O STATION • ABOVE THE SPINES IS A NEGATIVE VALUE • BELOW THE SPINES IS A POSITIVE VALUE

  30. FETAL POSITION IN RELATION TO MOTHER’S PELVIS • RIGHT OR LEFT SIDE OF MATERNAL PELVIS • ANTERIOR (A), POSTERIOR (P), OR TRANSVERSE (T) DETERMINES

  31. WHETHER LANDMARK IS IN FRONT, BACK OR SIDE OF PELVIS • LANDMARK OF FETAL PRESENTING PART: • (O) OCCIPUT, (M) MENTUM, (S) SACRUM, (A) ACROMION PROCESS

  32. Figure 15–9 Categories of presentation. Source: Courtesy Ross Laboratories, Columbus, OH.

  33. MODULE 2 PART 4A PHYSIOLOGICAL FORCES OF LABOR

  34. PHYSIOLOGIC FORCES OF LABOR • PRIMARY FORCES—UTERINE MUSCLE CONTRACTIONS • CONTRACTION PHASES---INCREMENT, ACME, DECREMENT • DESCRIBED WITH FREQUENCY, DURATION, AND INTENSITY SECONDARY FORCES—ABDOMINAL MUSCLES USED IN PUSHING

  35. PHYSIOLOGIC FORCES OF LABOR • FREQUENCY, DURATION, INTENSITY OF CONTRACTION • EFFECTIVENESS OF MATERNAL PUSHING • DURATION OF LABOR

  36. CAUSES OF LABOR UNCLEAR • POSSIBLE CHANGES IN PROGESTERONE AND ESTROGEN LEVELS • RESEARCH ON POSSIBLE CAUSES • FETAL MEMBRANES, DECIDUAS • PROGESTERONE WITHDRAWAL, PROSTAGLANDIN • CORTICOTROPHIN-RELEASING HORMONE

  37. LABOR • FORCES OF LABOR • FREQUENCY, DURATION, INTENSITY (STRENGTH) • THREE PHASES OF CONTRACTIONS • INCREMENT • ACME • DECREMENT

  38. Figure 15–10 Characteristics of uterine contractions.

  39. SIGNS OF LABOR • LIGHTENING • BRAXTON HICKS CONTRACTIONS • CERVIAL CHANGES • BLOODY SHOW • RUPTURE OF MEMBRANES • SUDDEN BURST OF ENERGY • WEIGHT LOSS • N&V, DIARRHEA, BACKACHE

  40. TRUE LABOR/FALSE LABOR • TRUE • CONTRACTIONS REGULAR, INCREASE IN DURATION & STRENGTH • INTERVAL SHORTENS • DILATATION & EFFACEMENT PROGRESS • INTENSITY INCREASES WITH WALKING • FALSE • CONTRACTIONS IRREGULAR, NO CHANGE IN DURATION, STRENGTH • INTERVAL IRREGULAR OR NO CHANGE • NO DILATATION OR EFFACEMENT • WALKING LESSENS OR HAS NO EFFECT ON CONTRACTIONS

  41. MODULE 2 PART 4BSTAGES OF LABOR

  42. FIRST STAGE OF LABOR • STARTS WITH BEGINNING OF REGULAR CONTRACTIONS TO FULL DILATATION • FIRST STAGE IS DIVIDED INTO THREE PHASES: LATENT, ACTIVE, AND TRANSITION

  43. PHASES OF LABOR—FIRST STAGE • LATENT---0--3 CENTIMETERS, CONTINUING EFFACEMENT • ACTIVE---4--7 CENTIMETERS, COMPLETE EFFACEMENT • TRANSITION 8--10 CENTIMTERS ENGAGEMENT

  44. CONTRACTION CHARACTERISTICS • LATENT PHASE • MILD—10-30MIN. LASTING 20-40 SECONDS • MODERATE—5-7MIN. LASTING 30-40 SECONDS • ACTIVE PHASE • MODERATE TO STRONG—2-3 MIN. LASTING 40-60 SECONDS • TRANSITION • STRONG—1-1/2-2 MIN. LASTING 60-90 SECONDS

  45. PSYCHOLOGIC ADAPTIONSTO LABOR: LATENT PHASE • FEELS ABLE TO COPE WITH DISCOMFORT • MAY BE RELIEVED THAT LABOR HAS FINALLY STARTED • USUALLY ABLE TO TALK THROUGH CONTRACTION • IS ABLE TO RECOGNIZE AND EXPRESS FEELING OF ANXIETY

  46. PSYCHOLOGIC ADAPTIONSTO LABOR: ACTIVE PHASE • ANXIETY INCREASES • FEARS LOSS OF CONTROL • MAY HAVE DECREASED ABILITY TO COPE • LESS TALKATIVE

  47. PSYCHOLOGIC ADAPTIONS TO LABOR: TRANSITION PHASE • WITHDRAWS INTO HERSELF • DOUBTS ABILITY TO COPE • APPREHENSIVE AND IRRITABLE • TERRIFIED OF BEING ALONE • DOES NOT WANT ANYONE TO TALK TO HER OR TOUCH HER • DIFFICULT TO CONCENTRATE ON TASK

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