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NURS 1400 Unit 2

NURS 1400 Unit 2. Theories for the Onset of Labor. Maternal factors Estrogen and progesterone Prostaglandins Oxytocin Fetal factors Fetal adrenocorticotropic hormone. Fetal Factors Affecting the Process of Labor. Head size Molding Presentation Cephalic, breech, shoulder Lie

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NURS 1400 Unit 2

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  1. NURS 1400 Unit 2

  2. Theories for the Onset of Labor • Maternal factors • Estrogen and progesterone • Prostaglandins • Oxytocin • Fetal factors • Fetal adrenocorticotropic hormone

  3. Fetal Factors Affecting the Process of Labor • Head size • Molding • Presentation • Cephalic, breech, shoulder • Lie • Longitudinal, oblique, transverse • Attitude • Flexion • Position Fetal attitude flexion, fetal lie longitudinal Fetal attitude flexion, fetal lie transverse

  4. Factors Affecting Labor Progress • The birth passageway (birth canal) • The passenger (fetus) • The physiologic forces of labor • The position of the mother • The woman’s psychosocial considerations

  5. Passenger • Fetal head • Fetal attitude • Fetal lie • Fetal presentation • Fetal position

  6. Fetal Attitude • The relation of the fetal body parts to one another (Figure 22-4) • Normal attitude is flexion

  7. Figure 22–4 Fetal attitude. A, The attitude (or relationship of body parts) of this fetus is normal. The head is flexed forward with the chin almost resting on the chest. The arms and legs are flexed. B, In this view, the head is tilted to the right. Although the arms are flexed, the legs are extended.

  8. Figure 22–4 (continued) Fetal attitude. A, The attitude (or relationship of body parts) of this fetus is normal. The head is flexed forward with the chin almost resting on the chest. The arms and legs are flexed. B, In this view, the head is tilted to the right. Although the arms are flexed, the legs are extended.

  9. Fetal Lie • The relationship spinal column of the fetus that of the mother • Longitudinal or transverse

  10. Fetal Presentation • Engagement • Station (Figure 22-7) • Ischial spines are zero station • Presenting part moves from – to +

  11. Figure 22–7 Measuring the station of the fetal head while it is descending. In this view the station is 22/23.

  12. Fetal Position • Right (R) or left (L) side of the maternal pelvis • Landmark: occiput (O), mentum (M), sacrum (S), or acromion (scapula[Sc]) process (A) • Anterior (A), posterior (P), or transverse (T)

  13. Physiology of Labor • Primary force is uterine muscular contractions • Secondary force is pushing during the second stage of labor

  14. Uterine Contractions • Frequency • Duration • Intensity

  15. Figure 22–9 Characteristics of uterine contractions.

  16. Causes ofCervical Effacement • Estrogen - Stimulates uterine muscle contractions • Collagen fibers in the cervix are broken down • Increase in the water content of the cervix

  17. Cervical Effacement • Physiologic retraction ring • Upper uterine segment thickens and pulls up • Lower segment expands and thins out • Effacement

  18. Figure 22–10 Effacement of the cervix in the primigravida. A, At the beginning of labor, there is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid. B, Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head. C, Cervix is about one-half (50%) effaced and slightly dilated. The increasing amount of amniotic fluid below the fetal head exerts hydrostatic pressure on the cervix. D, Complete effacement and dilatation.

  19. Figure 22–10 (continued) Effacement of the cervix in the primigravida. A, At the beginning of labor, there is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid. B, Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head. C, Cervix is about one-half (50%) effaced and slightly dilated. The increasing amount of amniotic fluid below the fetal head exerts hydrostatic pressure on the cervix. D, Complete effacement and dilatation.

  20. Figure 22–10 (continued) Effacement of the cervix in the primigravida. A, At the beginning of labor, there is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid. B, Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head. C, Cervix is about one-half (50%) effaced and slightly dilated. The increasing amount of amniotic fluid below the fetal head exerts hydrostatic pressure on the cervix. D, Complete effacement and dilatation.

  21. Figure 22–10 (continued) Effacement of the cervix in the primigravida. A, At the beginning of labor, there is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid. B, Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head. C, Cervix is about one-half (50%) effaced and slightly dilated. The increasing amount of amniotic fluid below the fetal head exerts hydrostatic pressure on the cervix. D, Complete effacement and dilatation.

  22. The Five Ps of Labor • Passageway • Passenger • Powers • Position • Psychological response Station or relationship of the fetal presenting part to the ischial spines.

  23. Positions of a Vertex Presentation

  24. Leopold’s Maneuvers • Is the fetal lie longitudinal or transverse? • What is in the fundus? Am I feeling buttocks or head? • Where is the fetal back? • Where are the small parts or extremities? • What is in the inlet? Does it confirm what I found in the fundus? • Is the presenting part engaged, floating, or dipping into the inlet?

  25. Figure 23–7 Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

  26. Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

  27. Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

  28. Figure 23–7 (continued) Leopold’s maneuvers for determining fetal head position, presentation, and lie. NOTE: Many nurses do the fourth maneuver first to identify the part of the fetus in the pelvic inlet.

  29. Powers of Labor • Primary powers • Involuntary uterine contractions • Effacement • Dilation • Secondary powers • Voluntary pushing in second stage

  30. Maternal Position • Ambulation • Lateral recumbent in bed • Fowler’s position in bed or chair • Birthing ball • Avoid supine position

  31. Culture Expectations and goals for the labor process Feedback from people participating in the birth process Psychological Response of the Mother

  32. Signs and Symptoms of Impending Labor • Lightening • Cervical change • Braxton Hicks contractions • Bloody show • Energy spurt • Gastrointestinal disturbances

  33. Stages of Labor • First stage–onset of labor to complete dilation of the cervix • Latent phase (ends with cervix 3–4 cm dilated) • Active phase (3–4 cm to 8 cm dilated) • Transition (8–10 cm dilated) • Second stage–complete dilation to birth • Third stage–birth to placental expulsion • Fourth stage–four hours following delivery of the placenta

  34. True Labor • Progressive dilatation and effacement • Regular contractions increasing in frequency, duration, and intensity • Pain usually starts in the back and radiates to the abdomen • Pain is not relieved by ambulation or by resting

  35. True Labor

  36. True Labor

  37. True Labor

  38. True Labor

  39. True Labor

  40. True Labor

  41. False Labor • Lack of cervical effacement and dilatation • Irregular contractions do not increase in frequency, duration, and intensity • Contractions occur mainly in the lower abdomen and groin • Pain may be relieved by ambulation, changes of position, resting, or a hot bath or shower

  42. First Stage of Labor: Latent Phase • Beginning cervical dilatation and effacement • No evident fetal descent • Uterine contractions increase in frequency, duration, and intensity • Contractions are usually mild

  43. First Stage of Labor: Active Phase • Cervical dilatation from 4 to 7 cm • Progressive fetal descent • Contractions more frequent and intense

  44. First Stage of Labor: Transition • Cervical dilatation from 7 to 10 cm • Progressive fetal descent • Contractions more frequent and intense

  45. Second Stage of Labor • Begins with complete dilatation (10 cm) • Ends with birth of the baby

  46. Figure 22–12 Mechanisms of labor. A, B, Descent. C, Internal rotation. D, Extension. E, External rotation.

  47. Third Stage of Labor • From birth of infant to delivery of placenta

  48. Fourth Stage of Labor • 4 hours after birth • Physiologic readjustment • Thirsty and hungry • Shaking • Bladder is often hypotonic • Uterus remains contracted

  49. Cardinal Movements of Labor

  50. Palpation: Advantages • Noninvasive • Readily accessible, requiring no equipment • Increases the “hands on” care of the patient • Allows the mother freedom

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