Leopold s Maneuver is preferably performed after 24 weeks gestation when fetal outline can be

already palpated.
Preparation:

1. Instruct woman to empty her bladder first. 2. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. 3. Drape properly to maintain privacy. 4. Explain procedure to the patient. 5. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). 6. Use the palm for palpation not the fingers.
Purpose First Maneuver: Fundal Grip Procedure Findings Head is more firm, hard and round that moves independently of the body. Breech is less well defined that moves only in conjunction with the body. Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation

To determine Using both hands, feel fetal part lying for the fetal part lying in in the fundus. the fundus. To determine presentation. One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure.

Second To identify Maneuver: location of fetal Umbilical Grip back. To determine position.

Third Maneuver: Pawlik s Grip

To determine engagement of presenting part.

Using thumb and finger, The presenting part is engaged if it is not grasp the lower portion movable. of the abdomen above It is not yet engaged if it is still movable. symphisis pubis, press in slightly and make gentle movements from side to side. Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament. Use both hands. Good attitude if brow corresponds to the side (2nd maneuver) that contained the elbows and knees. Poor attitude if examining fingers will meet an obstruction on the same side as fetal back (hyper extended head) Also palpates infant s anteroposterior position. If brow is very easily palpated, fetus

Fourth Maneuver: Pelvic Grip

To determine the degree of flexion of fetal head. To determine attitude or habitus.

is at posterior position (occiput pointing towards woman s back)

Labor Contractions
Labor contractions are the periodic tightening and relaxing of the uterine muscle, the largest muscle in a woman's body. Something triggers the pituitary gland to release a hormone called oxytocin that stimulates the uterine tightening. It is difficult to predict when true labor contractions will begin. Contractions are often described as a cramping or tightening sensation that starts in the back and moves around to the front in a wave-like manner. Others say the contraction feels like pressure in the back. During a contraction, the abdomen becomes hard to the touch. In the childbirth process, the work of labor is done through a series of contractions. These contractions cause the upper part of the uterus (fundus) to tighten and thicken while the cervix and lower portion of the uterus stretch and relax, helping the baby pass from inside the uterus and into the birth canal for delivery. How Contractions are Timed Contractions are intermittent, with a valuable rest period for you, your baby, and your uterus following each one. When timing contractions, start counting from the beginning of one contraction to the beginning of the next.

The easiest way to time contractions is to write down on paper the time each contraction starts and its duration, or count the seconds the actual contraction lasts, as shown in the example below. Writing down the time and length of the contraction is extremely helpful for describing your contraction pattern to your physician, midwife or hospital labor and delivery personnel. TIME CONTRACTION STARTS 10:00 10:10 10:15 10:20 DURATION OF CONTRATION 45 seconds 45 seconds 60 seconds 55 seconds

What Contractions Feel Like Many mothers describe contractions that occur in early labor as similar to menstrual cramps, or as severe gas pains, which may be confused with flu symptoms or intestinal disorders. Each contraction will gradually gain in intensity until the contraction peaks, then slowly subside and go away. As the body does the work of labor, it is likely that the time in between contractions will become shorter. As the strength of each contraction increases, the peaks will come sooner and last longer. There should be some regularity or pattern when timed. Persistent contractions that have no rhythm but are five-toseven minutes apart or less should be reported to your physician or midwife. Typical Length or Duration A typical labor for a first time mother is eight-to-fourteen hours, and is usually shorter for a second or subsequent birth. For many women, rocking in a chair or swaying during a contraction assists them with this relaxation. Labor is the coordinated sequence of involuntary uterine contractions. Understanding the stages of labor would allow the mother and the health care team facilitate a less stressful and safe childbirth. The four stages of labor are based on the changes that the uterus and cervix undergo as labor progresses.

Stages of Labor
First Stage of Labor  The first stage of labor usually has 20 t0 40 contractions. Three Phases of the First Stage of Labor 1. Latent Phase. The mother is excited. This lasts from the beginning of labor until 3 cm of cervical dilatation. 2. Active Phase. The mother is anxious. The cervix dilates from 4-7 cm and dilates in a more rapid rate. 3. Transition Phase. The mother is irritable. The cervix dilates from 8-10 cm and the fetus descends further into the pelvis. Second Stage of Labor  This is where the vulva is stretching. Contractions are at 40-60. This begins with complete dilatation and full effacement of the cervix and end with the birth of the baby. Third Stage of Labor  This begins with the birth of the baby and ends with the expulsion of the placenta. The placenta is formed by the union of the chorionic villi and decidua basalis. Types of Placental Separation Schultz. The presenting part is the fetal side which is shiny. Duncan. The presenting part is the maternal side which is called dirty because it is raw and red. Nursing Care during the Third Stage of Labor Do not hurry the expulsion of the placenta. This usually takes around 20 minutes. Tract cord slowly. Inspect for missing cotyledons. There should be 30.

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Palpate the uterus. Inject oxytocin. Inspect the perineum. Put down the legs of the mother together to prevent injury. The mother should be flat on bed without pillows for 6 hours. If the client is experiencing chills, provide her with a blanket and NOT soup. Provide additional nourishment. Allow the mother to sleep to regain her strength. Fourth Stage of Labor  The fourth stage of labor is the most critical stage. This lasts from the delivery of the placenta through the first 1-4 hours after birth. The nurse should assess the fundus, blood pressure and pulse rate, the lochia which should be moderate in flow, and the perineum. If the flow of the lochia is heavy the mother should be checked for lacerations and rechecked for retained placental fragments. Nursing Care during Labor Monitoring the fetus. Monitoring the laboring woman. Helping the woman cope with labor. Condition Assessment with Fetal Compromise Fetal Heart Rate. Lower limit is 110-120 bpm and the upper limit is 150-160 bpm. No variability in the electronic monitoring. Slowing of the fetal heart rate. This persists or preceeds after contraction. Meconium stained. The amniotic fluid is green.. If the amniotic fluid is yellow, cloudy, or has a foul odor, it may indcate infection. Contractions that last for 90 secs. Incomplete uterine relaxation. Maternal hypotension. Maternal hypertension. Maternal fever.

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Evaluate Fetal Heart Rate Baseline Rate. The range of contractions and its changes and fluctuations. This should be constant. Variability. The decreases and fluctuations. Periodic changes. The changes in baseline rate. Classified as acceleration and deceleration. Types: Early decelerations. The rate of decrease during contraction but return to baseline by end of contraction. 2. Variable decelerations. 70 bpm or less for longer than 60 seconds. This may suggest fetal cord compression around the neck or inadequate amniotic fluid. 3. Late deceleration. This is similar to early deceleration except it does not return to baseline until contractions end. 1. 2. 3. 1. Inspection of Amniotic Fluid Normal color is clear with flecks of vernix caseosa. Green stained fluid indicates the amniotic fluid is meconium stained. Cloudy or yellow amniotic fluid is infected.

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