Theories of Labor Onset

1. Uterine stretch theory any hallowed organ when stretched to its maximum capacity will contrast and empty. 2. Oxytocin theory Oxytocin, which causes contractions of the smooth muscles of the posterior pituitary gland as a result of stressful event in labor. 3.Progesterone Deprivation Theory Progesterone, secreted by the corpus Luteum and then by the placenta, is essential in maintaining pregnancy. However, the decrease in the level of progesterone circulating in the body will initiate body pains. 4. Prostaglandin Theory Prostaglandins, formed by the uterine deciduas under level of concentration in the amniotic fluid and blood of women increases during labor. Research has shown prostaglandin to be very effective in inducing uterine contraction at any stage of gestation. Initiation of labor is said to be the result of the release of arachidonic acid is believed to increase prostaglandin synthesis contractions. 5. Theory of Aging Placenta as the placenta matures, blood supply decreases resulting in uterine contractions.

Related Terms:
Labor is the process of moving the fetus, placenta and membranes out of the uterus and through the birth canal. Synonymous with childbirth and parturition. Delivery is the actual birth of baby. Crowning encircling of the largest diameter of the babys head by the vulvar ring. Effacement shortening and thinning of the cervical canal. It is expressed in percentage (%). Dilatation is the enlargement of the cervica l os from an orifice a few millimeters in size to an aperture large enough to permit the passage of the fetus. Show is a mucoid discharge from the cervix that is present after the mucous plug has been discharged. Attitude the relationship of the fetal parts to one another. Lie relationship of the fetal spine to the spine of the mother. Presentation portion of the fetus that enters the pelvis first. Position relationship of the assigned area of the presenting part of the landmark of the material pelvis. Station measurement of the progress of descent of the presenting part in relation to the ischial spine. Frequency from the beginning of one contraction to the beginning of the next contraction. Duration from the beginning of contraction to its completion. Intensity the strength of contraction to its completion.

Effacement progressive thinning and shortening of the cervix. Dilatation opening of the cervix os during labor.

SIGNS of LABOR
1. Lightening setting of fetal head into pelvic brim. occurs approximately 10-14 days before labor begins. gives the woman relief from diaphragmatic pressure and shortness of breath. occurs early in primiparas. mother may experience: shooting leg pains from the increased pressure on the sciatic nerve, increased amounts of vaginal discharge and urinary frequency from pressure on the bladder. 2. Increased in Level of Activity related to an increase in epinephrine release that is initiated by a decrease in progesterone produced by the placenta. 3. Braxton Hicks Contractions painless irregular contractions, sometimes strong that may cause discomfort. 4. Ripening of the cervix Goodells sign: the cervix feels softer than normal similar to earlobe throughout pregnancy; at term cervix is described butter-soft.

Signs of TRUE LABOR:

1. Uterine Contractions surest sign that labor has begun. 2. Show the blood mixed with mucus, takes on a pink tinge. It is when mucus plug is expelled and capillaries are exposed. 3. Rupture of the membranes experienced either as a sudden gush or as a scanty, slow seeping of clear fluid from the vagina.

False Labor:
Irregular contractions Pain is confined to the abdominal No increase in duration, frequency, and intensity. Pain disappears with ambulating No cervical change Sedation stops contractions

True Labor:
Regular contractions Pain on the lower back to the abdomen Increase in duration, frequency and intensity Pain not relieved upon ambulating Accompanied with effacement and dilatation Sedation does not stop contraction

CHARACTERISTICS of CONTRACTIONS
1. Mild uterine muscle are somewhat tense but can be indented by a gentle pressure. 2. Moderate uterus is moderately firm and a firmer pressure is needed to indent. 3. Strong the uterus becomes very firm that at the height of contraction cannot be indented.

COMPONENTS of LABOR
1. Passage refers to the shape and measurement of maternal pelvis and distensibility of birth canal ; refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum.; Elastic to expand and accommodate.

4 Basic Classification of Pelvis:

a. Gynecoid best pelvis; half of thepopulation b. Android common in men, 20% in women; heart shape and difficult for vaginal delivery. c. Anthropoid common in men; 20-30%,pelvic inlet oval.

d. Platypelloid flat pelvis; least common; 5% of the population, long sacrum. 2. Passenger refers to the fetus, its size, presentation, and position. 3. Power forces acting together to expel fetus from the uterus

2 TYPES of POWER
a. Primary Powers involuntary contractions of the uterus, b. Secondary Powers- voluntary bearing down efforts of the mother. 4. Psyche reflects the womans frame of mind in dealing with the labor experience.

Structure of the fetal skull

Cranium uppermost portion of the skull, comprises eight bones. - the four bones: the frontal (actually 2 fused bones), 2 parietal and occipital. - The other four: sphenoid, ethmoid, and 2 temporal bones

The Suture Lines:

Sagittal suture- joins the 2 parietal bones of the skull. Coronal suture the line of juncture of the frontal bones and the 2 parietal bones. Lambdoid suture the line of juncture of the occipital bone and 2 parietal bones.

Fontanelles:
- significant membrane-covered spaces that are found at the junction of the main suture lines. Anterior Fontanelle referred to as bregma; lies at the junction of the coronal and sagittal sutures; - diamond-shape - anteroposterior diameter is 3-4cm - transverse diameter is 2-3cm Posterior Fontanelle lies at the junction of the lambdoidal and sagittal sutures. - triangular - smaller than the anterior Fontanelle - only 2cm across its widest part Vertex the space between two fontanelles. Sinciput the area over the frontal bone. Occiput the area over the occipital bone.

Suboccipitobregmatic narrowest diameter, 9.5cm; from the inferior aspect of the occiput to the center of the anterior fontanelle. Occipitofrontal measured from the bridge of the nose to the occipital prominence is 12cm. Occipitomental the widest which is 13.5cm; measured from the chin to the posterior fontanelle. Molding the change in shape of the fetal skull produced by the force of uterine contractions pressing the vertex of the head against the notyetdilated cervix.

FETAL PRESENTATION and POSITION

Attitude describes the degree of flexion a fetus assumes during labor or the relation of fetal parts to each other. 1) Good Attitude (complete flexion) the spinal column is bowed forward that the chin touches the sternum, the arms are flexed and folded on chest, the thighs are flexed onto the abdomen and the calves are pressed against the posterior aspect of the thighs. 2) Moderate flexion the chin is not touching the chest but is in an alert or military position.

3) Poor flexion the back is arched, the neck in extended and a fetus is in complete extension, presenting the occipitomental diameter of the head to the birth canal (face presentation). Engagement refers to the settling of the presenting part of a fetus far enough into the pelvis to be at the level of the ischial spines. Floating a presenting part that is not engaged. Dipping one that is descending but has not yet reached the ischial spines Station refers to the relationship of the presenting part of a fetus to the level of ischial spines 0 station presenting part of a fetus is at the level of the ischial spines +4 station head is at outlet. -4 station head is floating.

FETAL LIE
the relationship between the longaxis of the body and the long axis of a womans body. 2 Primary Lie: 1. Longitudinal 2. Transverse

FETAL PRESENTATIONS
denote the body part that will first contact the cervix of be born first. - this is determined by a combination of fetal lie and the degree of flexion.

3 Main Presentations:
a. Cephalic the fetal head is the body part that will first contact the cervix - the four types of cephalic presentation: vertex, brow, face and mentum. b. Breech either the buttocks or the feet are the first body part that will contact the cervix. - the 3 type of breech presentation: complete,frank, and footling) c. Shoulder the presenting part is usually one of the shoulders (acromion process, an iliac crest, a hand, or an elbow. POSITION the relationship of the presenting part to a specific quadrant of a womans pelvis.

POWERS
UTERINE CONTRACTIONS: Origins Labor contractions begin a pacemaker point located in the myometrium near one of the uterotubal junctions. In some women, contractions appear to originate in the lower uterine segment rather than in the fundus. Phases 3 Phases: increment, acme, decrement Increment- when the intensity of the contraction increases. Acme- when the contraction is at its strongest. Decrement- when the intensity decreases. As labor progresses the relaxation intervals decrease from 10 minutes to 2 3 minutes. The duration also changes from 20-30 sec to a range of 60-90 sec. Contour Changes Upper segment becomes thicker and active, preparing it to be able to exert the strength necessary to expel the fetus when the expulsion phase of labor is reached. The lower segment becomes thin-walled, supple, and passive so that the fetus can be pushed out of the uterus easily

Physiologic retraction ring a ridge on the inner uterine surface that marks the boundary between the 2 portions. Pathologic retraction ring (Bandls ring) it is a danger sign that signifies impending rupture of the lower uterine segment if the obstruction to labor is not relieved . Cervical Changes Effacement Shortening and thinning of the cervical canal. Normally the canal is 1-2cm. With effacement the canal virtually disappears because of longitudinal traction from the contracting uterine fundus. Dilation Refers to the enlargement or widening of the cervical canal from an opening of few millimeters wide to one large enough (10cm). First reason why dilation occurs is uterine contractions gradually increase the diameter of the cervical canal lumen by pulling the cervix up over the presenting part of the fetus. Second, the fluid-filled membranes press against the cervix. As dilation begins there is large amount of vaginal secretions (show) because the last of the operculum or mucus plug in the cervix is dislodged and capillaries in the cervix rupture.

STAGES OF LABOR
1. Stage 1 (stage of dilatation) begins with the true labor pains and ends when the cervix has reached full dilatation. Nursing Care: Stay with woman; provide constant support . Reminds, reassures and encourages woman to reestablish breathing patterns and concentration as needed. Prompts partial respirations if woman begins to push prematurely accepts woman inability to comply with instructions. Keeps woman aware of progress.

3 Phases:
1. Latent Phase Begins at the regularly perceived uterine contractions and ends when rapid cervical dilatation begins Contractions are mild and short lasting 20-40 seconds .Cervix dilates from 0-3cm. 6 hours in nullipara and 4.5 hours in multipara. Nursing Care: - Assists woman to cope with contraction.

- Helps to concentrate in breathing techniques. - Assists into comfortable position . - Informs woman of the progress of labor. - Explains procedure and routines. - Offer fluids, ice chips, food as ordered.

2. Active Phase Dilatation increases from 4 7 cm Contraction lasts 40-60 sec and occur every 3-5 minutes 3 hours in nullipara 2 hours in multipara Show and spontaneous rupture of membranes may occur. Nursing Care: - Finds assessment techniques between contractions - Assists with frequent position change - Applies counter pressure to sacrococcygeal area - Encourages and praises - Keeps woman aware of progress - Check bladder and encourages voiding - Gives oral care 3. Transition Phase Contractions reached their peak of intensity occurring every 2-3 minutes with duration of 6090sec Maximum dilatation 8-10cm Complete cervical effacement

Woman experiences intense discomfort accompanied by nausea and vomiting Woman may also experience a feeling of loss of control, anxiety, panic or irritability 2. Stage 2 (Stage of Expulsion) the period from full dilatation to birth of the infant. Contractions change from the characteristic crescendo-decrescendo pattern to overwhelming uncontrollable urge to push or bear down with each contraction as if to move her bowels. Woman perspire and the blood vessels in her neck may become distended. Crowning takes place. The need to push become intense and the woman cannot stop herself.

6 Cardinal Movements of the Mechanism of labor o Descent downward movement of the biparietal diameter of the fetal head to within the pelvic inlet - full descent occurs and the fetal head extrudes beyond the dilated cervix and touches the posterior vaginal floor o Flexion the head bends forward onto the chest, making the smallest anteroposterior diameter o Internal rotation the occiput rotates until it is superior, or just below the symphysis pubis, bringing the head into the best relationship to the outlet of the pelvis o Extension as the occiput is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the

rest of the head. The head extends, and the foremost parts of the head, the face and chin are born. o External Rotation almost immediately after the head of the infant is born, the head rotates (from the anteroposterior position it assumed to enter the outlet) back to the diagonal or transverse position of the early part of labor o Expulsion the rest of the baby is born easily and smoothly because of its smaller part size. The end of the pelvic division of labor. Nursing Care: Put both legs at the same time when positioning to the lithotomy position. Instruct mother to push as fetal head crowns. If hyperventilation occurs, let patient breathe into a brown paper or a cupped hand. 3. Stage 3 (Placental Stage) begins from the delivery of the baby up to the delivery of the placenta 2 Phases: a. Placental Separation Signs: - Lengthening of the cord - Sudden gush of blood - Change of shape of the uterus b. Placental Expulsion

- Brandt Andrews Maneuver tract the cord slowly, winding it around the clamp until placenta spontaneously comes out rotating it slowly so that no membranes are left. Nursing Care: Dont hurry the expulsion of the placenta, just watch for the signs of placental separation. Take note of the time of placental delivery Inspect for the completeness of the placenta Palpate the uterus to determine degree of contraction. If relaxed, massage gently and apply ice cap. Inspect for lacerations Types of Placental Presentation Schultzes appearing shiny and glittering from the fetal membranes Duncan it looks raw, dirty, meaty, red and irregular

4. Stage 4 (Puerperium Stage) first 4 hours after delivery of placenta Degrees of Perineal Lacerations: 1. First Degree skin and superficial to muscle 2. Second Degree muscles of the perineum 3. Third Degree continues to anal sphincter 4. Fourth Degree involves the anterior anal wall

Episiotomy incision made to the perineum to enlarge the vaginal opening for easy delivery Types: a. Midline/Median b. Mediolateral c. Lateral Advantages: 1. Enlarging of the vaginal opening 2. Shortening of the second stage of labor 3. Minimizing the stretching of the perineal muscle 4. Preventing perineal tearing.

NCM 102 Lec

HIGH RISK PREGNANCY: COMPONENTS OF LABOR

Written Report

GROUP 1, BSN II SECTION 1 ACOSTA, JEFFERSON R. AGBUYA, RODERICK G. ALARMADO, MARY EDEN JEAN F. ALLELIGAY, LEONEE AZARCON, GERALD MIKE G. BAYANIN, HERON JAYSON E. BAUTISTA, KIRK RAYMUND E. BEREDO, HANNA FAYE BUNDALIAN, ALLOREN GRACE