MECHANISM OF LABOR and DELIVERY Labor and birth is physically and emotionally straining for a woman. As the patient’s body undergoes physical changes to help the fetus pass through the cervix, she may also feel discomfort, pain, panic irritability, and loss of control. Providing measures to promote relaxation is key during labor and breath. * FETAL PRESENTATION – is the relationship of the fetus to the rvix. It can be assessed through vaginal examination (IE), abdominal inspection and palpation Leopold’s maneuver), sonography, or auscultation of the FHT.
By knowing the fetal presention, you can anticipate which part of the fetus will first pass through the cervix during delivery. a. Fetal Attitude (degree of flexion) is the relationship of the fetal body parts to one another. b. Fetal Lie (longitudinal, transverse, oblique) – is the relationship of the fetal spine to the maternal spine. c. Fetal Position – is the relationship of the fetal body parts to a specific quadrant of the mother’s pelvis. Its important to define fetal position because it influence the progression of labor and whether surgical intervention is needed.
TYPES OF FETAL PRESENTATION: * CEPHALIC: when the fetus is in cephalic presentation, the head is the first part to contact the cervix and expel from the uterus during delivery. * BREECH: labor is prolonged with breech presentation beecse of ineffective cervical dilation caused by decreased pressure on the cervix and delayed descent of thefetus. * SHOULDER: in this presentation, the shoulder, iliac crest, hand or elbow is the presenting part. The fetus is in transverse lie. * COMPOUND: the difficulty of birth because an extremity presents with the major presenting part. ENGAGEMENT: is when the presenting part of the fetus passes into the pelvis to the point where, in cephalic presentation, the biparietal diameter of the fetal head is at the level of the mid-pelvis or at the level of the ischial spine. Vaginal and cervical examinations are used to assess the degree of engagement before and during labor. * STATION: is the relationship of the presenting part of the fetus to the mother’s ischial spine. If the fetus is at station 0, the fetus is considered to be at the level of the ischial spine. The fetus is considered engaged when it reaches station 0. CROWNING: when the station is measured at +4cm, the presenting part of the fetus is the perineum. FALSE LABOR PAIN| TRUE LABOR PAIN| 1. Pain and contraction remain irregular 2. Generally confined to the abdomen 3. No increase in duration, frequency & intensity 4. Often disappears if the woman ambulates| 1. My be slightly irregular at first but becom regular and predictable in a matter of hour 2. FFist felt in the lower back and sweep around to the abdomen in a girdle-like fashion 3. Increase in duration, frequency & intensity 4. Continue no matter what the woman’s level of activity is. PRELIMINARY SIGNS and SYMPTOMS OF LABOR * LIGHTENING: is the descent of the fetal head into the pelvis. Lightening increases pressure on the bladder, which may cause urinary frequency. Leg may occur if the shifting of the fetus and uterus increases pressure on the sciatic nerve. The mother may also increase vaginal discharge because of the fetus on the cervix. Breathing however becomes easier for the woman after lightening because pressure on the diaphragm decreases. * RIPENING OF THE CERVIX: refers to the process in which the cervix softens to prepare for dilation and effacement.
As the cervix ripens, it also changes position by tipping forward in the vagina. It is determined during pelvic examination. * BRAXTON HICKS CONTRACTION: are mild contractions of the uterus that occur throughout the pregnancy. Braxton Hicks Contraction are irregular and are commonly painless. This does not progresses dilation and effacement of the cervix. SIGNS OF TRUE LABOR * UTERINE CONTRACTIONS: the involuntary contractions of true labor help effacement and dilation of the uterus and push the fetus through the birth canal. As labor progresses, they become regular with predictive pattern.
It is painful and wavelike, beginning in the lower back and moving around the abdomen. As labor progresses, a visible bulging of intact membranes can be observed. * BLOODY SHOW: occurs as the cervix thins and beginsto dilate, allowing the passage of the mucus plug that seals the cervical canal during pregnancy. * SPONTANEOUS RUPTURE OF MEMBRANES: the membranes, consisting of the amniotic fluid and chorionic membranes – cover the fetal surfaces of the placenta and form a sac that contains and support the fetus and amniotic fluid. STAGES OF LABOR I. 1st STAGE: Latent – waiting for dilation. During this phase, the cervix dilates from 0-3cm * Active – the release of show increases and the membranes may rupture spontaneously. 3-7cm * Transition – contraction reach maximum intensity, 7-10cm II. 2nd STAGE: starts of labor with full dilation and effacement of cervix and ends with the delivery of the placenta. III. 3rd STAGE: also called the placental stage, occurs after the delivery of the neonate and ends with the delivery of the placenta IV. 4th STAGE: occurs immediately after the delivery of the placenta.
Last for about 1-4 hours and it initiates the postpartum period. * Risk associated with the fourth stage of labor include: Hemorrhage, Bladder distention & Venous Thrombosis * Oxygen, blood tested for compatibility, and IV fluids must be available for 2 to 3 hours after delivery. * Inspect & Repair – cervix and vagina are inspected to check for and repair lacerations. * Monitor after delivery the woman’s Vital signs will be monitored every 15 minutes for a minimum of 1 hour, then as ordered. Prepared by: Jul, Roohani BSN III-J