Normal Labor and Delivery Physiological Adaptations Chapter 17 Presented by Ann Hearn LABOR The process by which the products of conception are expelled from the body.
Download ReportTranscript Normal Labor and Delivery Physiological Adaptations Chapter 17 Presented by Ann Hearn LABOR The process by which the products of conception are expelled from the body.
Normal Labor and Delivery Physiological Adaptations Chapter 17 Presented by Ann Hearn LABOR The process by which the products of conception are expelled from the body UTERINE CONTRACTIONS Contraction - exhibits a wavelike pattern that begins slowly climbing (increment) to a peak (acme), and decreases (decrement) acme Intensity - strength of uterine contraction UTERINE CONTRACTIONS acm e Duration Interval Frequency Duration- from beginning of one contraction to the end of the same contraction Frequency- from beginning of one contraction to the beginning of another contraction Interval - resting time between contractions allows for placental perfusion Uterine Contraction - review Assessment of Contraction 1. Subjective symptoms by woman 2. Palpation and timing by the nurse 3. Use of Electronic Fetal Monitor (EFM) Fill in the blank ! Length of a uterine contraction__________. Strength of a uterine contraction is ___________. The time from the beginning of one contraction to the beginning of the next contraction is _______. The time that allows for placental perfusion is __. The peak of a contraction is also known as ____. When the biparietal diameter of the head passes through the pelvic inlet it is said to be ________. CERVICAL ASSESSMENT Dilation – is expressed in centimeters of the size of the cervical opening. Effacement – is estimated as a percentage of the amount the cervix has thinned. Full dilation = 10cm Complete effacement = 100% Myometrial Activity Effacement- thinning of the cervix (%) Dilation – enlargement and widening of the os (cm) Passenger Passageway Essential Factors in Labor Psychological Powers THE POWERS Major Powers Involved Primary Force: Involuntary Uterine Contractions or Muscular contractions which lead to dilation and effacement in the First Stage of Labor Secondary Force: Voluntary Uterine Contractions or Abdominal muscles assist in the Second Stage of Labor with pushing. Increase intraabdominal pressure to aid in expulsive forces THE PASSAGEWAY THE PELVIS Determine if the pelvic cavity is of adequate size to allow for the passage of the full term infant Optimum shaped pelvis is Gynecoid THE PELVIS False Pelvis Supports the weight of the uterus Shallow basin above the inlet or brim True Pelvis Represents the bony limits of the birth canal True Pelvis vs False Pelvis True Pelvis Inlet - upper margin of symphysis pubis to the upper margin of sacrum Midpelvis - level of the ischial spines Outlet - Lower pubic bone to tip of coccyx. This area is the smallest portion that the baby must travel through. THE PASSENGER And PPRESENTATION Fetal Head Because of its size and rigidity, the fetal head has a major impact on delivery. The bones are not firmly united. There are sutures between the bones that allow them to overlap or MOLD to the birth canal. Head also can rotate, flex, and extend Fetal Lie Relationship of the long axis of the fetus to the long axis of the mother. Longitudinal Lie Transverse Lie True or False? The optimum lie of the fetus is the longitudinal lie. A. True B. False Attitude Relationship of fetal body parts to each other Optimum attitude is flexion or ovoid Fetal Presentation The portion of the fetus that enters the pelvis first Three Types: Cephalic Breech Shoulder Reference Points of Presentation Cephalic = Head Vertex, Breech = Buttock or Foot Frank, Military, Brow, Face Full, Footling Shoulder = Transverse lie Cephalic Presentations Breech Presentations Position Position Relationship of the Fetal Presenting Part to the Maternal Pelvis Steps: 1. Determine the Presenting Part 2. Divide the mothers pelvis into 4 imaginary quadrants A 12 R 9 3 6 P L Test Yourself ! What is the reference point of a cephalic presentation when the head is fully flexed? A. B. C. d. occiput mentum frontal sagittal Test Yourself Overlapping of the fetal skull to facilitate its passage through the bony pelvis is ___________. Relationship of fetal body parts to each other is_____________. Head first presentation is_________________. Relationship of the fetal spine to the maternal spine is ________________. Term that refers to the part of the fetus that enters the pelvic inlet first is _____________. THE PSYCHOLOGICAL BREAK THE CYCLE ! FEAR TENSION PAIN CAUSES OF LABOR Decrease in Progesterone Increase in Estrogen High levels of Prostaglandins Over-distention of Uterus Degeneration of Placenta Premonitory Signs of Labor The impending signs that take place the last several weeks of pregnancy or even the last several days Premonitory Signs of Labor LIGHTENING FALSE LABOR PAIN (Braxton Hicks) SHOW Rupture of Membranes (ROM) BACKACHE DIARRHEA SUDDEN INCREASE IN ENERGY True vs False Labor TRUE LABOR FALSE LABOR Contractions are: Contractions are: * Irregular * Regular * Increase in intensity and duration with walking * Felt in lower back, radiating to lower portion of abdomen Bloody show Dilation and effacement Fetus usually engaged * No change or decrease with walking * Contractions felt in abdomen above umbilicus: Braxton Hicks No change in cervix Fetus is ballotable Mechanisms of Labor/ Cardinal Movements Descent Flexion Internal Rotation Extension External Rotation Expulsion Station Station- degree that the presenting part has descended into the pelvis in relationship to ischial spines. Goal: Move from – to + stations Engagement Descent of the fetal presenting part in relation to the ischial spines of the maternal pelvis = 0 station. Engagement Engagement Ballotable -largest diameter of presenting part has passed through the pelvic inlet - Assessed during vaginal exam Engaged Phases and Stages of Labor Stage 1: 0 - 10 cm. Phase 1 - Latent - dilate 0 - 3 cm. Phase 2 - Active - dilate 4 - 7 cm. Phase 3 - Transition - dilate 8 - 10 cm Stage 2: From complete dilation and effacement to delivery of the baby Stage 3: From delivery of baby to the delivery of the placenta Stage 4: the first hour after delivery Signs of Second Stage of Labor Complete dilatation of cervix Urge to bear down Perineum begins to bulge, flatten and move anteriorly Increase in bloody show Rectal pressure Labia begins to part with each contraction Signs of Stage Three of Labor Globular Shape of Uterus Protrusion of Umbilical cord Fundus Rise in Abdomen Sudden Gush of Blood Forth Stage of Labor Recovery period after delivery and bonding with the newborn. Last from 1- 4 hours. Nursing Care Nursing Assessment and Interventions during Labor and Birth. Technique for Assessing Fetal Presentation and Position Abdominal Palpation/Leopold’s Maneuver Standing on the right side, face the woman and palpate with the palms of the hands. Step 1 - Start at upper fundus and palpate for the head or buttocks Step 2 - Go down each side and locate back Step 3 - Gently grasp lower portion of uterus and feel for the head or buttock Step 4 - Turn and face the woman feet, using both hands palpate lower abd. for cephalic prominence or brow. Ausculation Assess for the area of greatest intensity of the FHR. Usually best heard at the fetal back True or False ? If the fetal heart tones (FHT’s) are heard loudest (PMI) in the patient’s upper right quadrant of her abdomen, the fetus would be assessed for a breech presentation. A. True B. False Amniotic Membranes Intact Ruptured Color SROM AROM Clear Yellow Meconium Amount Vaginal Examination Presentation (head/buttock) – presenting part – fetal head (OA, OP etc.) Condition of Membranes – ruptured or Position intact Dilation - enlargement & widening of os (cm) Effacement – thinning of the cervix (%) Vaginal Examination – cont’d Station- degree that the presenting part has descended into the pelvis. Relationship to ischial spines (-, 0, +) Engagement -largest diameter of presenting part has passed through the pelvic inlet Try this ! When the cervical os widens or opens it is said to________. The level of the ________ _________ (bony structure) is station zero. The most common type of pelvis for a woman ____________. When the cervix shortens and thins is _______________. For delivery to occur, the fetus must accommodate to this rigid passageway______________. Duration of Labor Resistance of the Cervix Presentation and position of the fetus, The woman’s pelvis Preparation and relaxation of the mother Primigravida - up to 22 hrs; average 12 1/2 hrs Multigravida - 8 - 17 hrs; average 10 hrs. The End Return to Module