c. mechanisms of labor

8/18/2019 c. Mechanisms of Labor

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STAGES OF LABORSTAGES OF LABOR

FIRST STAGE- Dilatation stageFIRST STAGE- Dilatation stage

– Begins with true labor contractions andBegins with true labor contractions andends with complete dilatation of theends with complete dilatation of theceri!"ceri!"


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PHASESPHASES

1. LATENT -1. LATENT - Earl# time of labor"Earl# time of labor"– Ta$es up % of the &'(hour )rst stage Ta$es up % of the &'(hour )rst stage

– *erical dilatation is minimal up + cms*erical dilatation is minimal up + cmsonl# because e,acement is occurring"onl# because e,acement is occurring"

– *ontractions are mild and short- lasting*ontractions are mild and short- lasting'.(/. second"'.(/. second"

– 0oman in labor is e!cited with some0oman in labor is e!cited with somedegree of apprehension but still withdegree of apprehension but still withabilit# to communicate"abilit# to communicate"


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2. ACTIVE -2. ACTIVE - *eri! /(1cm- complete e,acement*eri! /(1cm- complete e,acement

– *ontractions are stronger"*ontractions are stronger"

– 2uration – /.(%.3secs2uration – /.(%.3secs– Fre4uenc# – +(5 minsFre4uenc# – +(5 mins

– Lasts appro!imatel# + hours in nullipara and 'Lasts appro!imatel# + hours in nullipara and 'hours in multipara"hours in multipara"

– S6O0 and perhaps spontaneous rupture ofS6O0 and perhaps spontaneous rupture ofthe membranes ma# occur"the membranes ma# occur"

– *ontractions cause true discomfort"*ontractions cause true discomfort"

– E!citing time because the mother reali7es thatE!citing time because the mother reali7es thatsomething dramatic is happening" "something dramatic is happening" "

– Frightening time because she reali7es thatFrightening time because she reali7es thatlabor is trul# progressing and her life is aboutlabor is trul# progressing and her life is about

to change"to change"


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3. TRANSITION3. TRANSITION – 9er# important period– 9er# important periodbetween the )rst and second stages ofbetween the )rst and second stages of

labor"labor" ( ma!imum dilatation of :(&. cms( ma!imum dilatation of :(&. cms

occursoccurs

– ceri! :(&. cmceri! :(&. cm– fre4uenc# '(+ minsfre4uenc# '(+ mins

– duration %.(;. secondsduration %.(;. seconds

– The mood of the woman suddenl# The mood of the woman suddenl#changes and the nature of thechanges and the nature of thecontractions intensif#"contractions intensif#"


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– S6O0 becomes prominent"S6O0 becomes prominent"

– There is uncontrollable urge to push There is uncontrollable urge to push

with contractions >a sign that secondwith contractions >a sign that secondstage of labor is er# near? so thatstage of labor is er# near? so thatprofuse perspiration and distention ofprofuse perspiration and distention of

nec$ eins are seen"nec$ eins are seen"

– ausea and omiting is a re=e!ausea and omiting is a re=e!reaction due decreased gastricreaction due decreased gastricmotilit# and absorption"motilit# and absorption"

– /. mins? in multis- aftercontractions >/. mins? in multis- afterabout &. contractions >'. mins?"about &. contractions >'. mins?"


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N!sing "a!e is #o"se$N!sing "a!e is #o"se$

%!i&a!il' on gi(ing "oo!t%!i&a!il' on gi(ing "oo!t

&eas!es&eas!esCC Sacral pressure >appl#ing pressure withSacral pressure >appl#ing pressure withthe heel of the hand on the sacrum?the heel of the hand on the sacrum?reliees discomfort from contractions"reliees discomfort from contractions"

Droper bearing down techni4ueC pushDroper bearing down techni4ueC pushwith contractions"with contractions"

*ontrolled chest >costal? breathing*ontrolled chest >costal? breathing

during contractions"during contractions" Emotional support"Emotional support"


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SE*O2 STAGE ofSE*O2 STAGE of

LABORLABORBegins with the completeBegins with the complete

dilatation of the ceri! anddilatation of the ceri! andends with the delier# of theends with the delier# of thebab#"bab#"


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PO)ERS*Fo!"es at +o!, PO)ERS*Fo!"es at +o!, ––


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E*6A


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Te "anges o# %osition a!e te!&e$ asTe "anges o# %osition a!e te!&e$ asCARDINAL /OVE/ENTS OF LA0ORCARDINAL /OVE/ENTS OF LA0OR

1.1. DESCENT DESCENT Refers to the progress of theRefers to the progress of thepresenting part through the pelis"presenting part through the pelis"

( 2ownward moement of the( 2ownward moement of thebiparietal diameter of the fetal headbiparietal diameter of the fetal head

within the pelic inlet"within the pelic inlet"( 2escend depends on four forces( 2escend depends on four forces

a"a" amniotic =uid pressureamniotic =uid pressure

b"b" direct fundal pressuredirect fundal pressurec"c" abdominal muscle contractionabdominal muscle contraction

fetal bod# e!tension and straighteningfetal bod# e!tension and straightening


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2.2. FLEION FLEION As descent occurs- pressureAs descent occurs- pressurefrom the pelic =oor causes the Fetal headfrom the pelic =oor causes the Fetal headbend forward onto the chest"bend forward onto the chest"

3.3. INTERNAL ROTATION INTERNAL ROTATION The descent and The descent and=e!ion bring the shoulders- coming ne!t=e!ion bring the shoulders- coming ne!tinto the optimal position to enter the inletinto the optimal position to enter the inlet

or put the widest diameter of the shouldersor put the widest diameter of the shouldersin line with the wide transerse diameter ofin line with the wide transerse diameter ofthe inlet"the inlet"

.. ETENSION ETENSION As the occiput is born- theAs the occiput is born- the

bac$ of the nec$ stops beneath the pubicbac$ of the nec$ stops beneath the pubicarch and acts as a piot for the rest of thearch and acts as a piot for the rest of thehead" The head thus e!tends and thehead" The head thus e!tends and theforemost parts of the head- the face and theforemost parts of the head- the face and the

chin are born"chin are born"


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4.4.

ETERNAL ROTATION -ETERNAL ROTATION - AlmostAlmostimmediatel# after the head is born-immediatel# after the head is born-the head rotates bac$ to thethe head rotates bac$ to thediagonal or transerse position ofdiagonal or transerse position of

the earl# part of the labor" Thethe earl# part of the labor" Theanterior shoulder is born )rst-anterior shoulder is born )rst-assisted b downward =e!ion of theassisted b downward =e!ion of theinfants head"infants head"

5.5. EP6LSION EP6LSION Once the shouldersOnce the shouldersare born- the rest of the bab# is bornare born- the rest of the bab# is borneasil# and smoothl# because of itseasil# and smoothl# because of itssmaller si7e"smaller si7e"


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N6RSING CAREN6RSING CARE

N6RSING CARE7N6RSING CARE7A" 0hen positioning legs onto the stirrups- putA" 0hen positioning legs onto the stirrups- put

them up at the same time in order to preentthem up at the same time in order to preentinur# to the uterine ligaments"inur# to the uterine ligaments"

B" As soon as the head crowns- instruct motherB" As soon as the head crowns- instruct mothernot to push- but to pant >rapid and shallownot to push- but to pant >rapid and shallowbreathing?- so as to preent rapid e!pulsion ofbreathing?- so as to preent rapid e!pulsion ofthe bab#"the bab#"


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6#perentilation is due to the direct6#perentilation is due to the direct

e,ect of progesterone in thee,ect of progesterone in therespirator center in the brain"respirator center in the brain"

sg"


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*" Assist episiotom# incision made in the*" Assist episiotom# incision made in theperineum primaril# to preent laceration"perineum primaril# to preent laceration"

Other reasons for doing episiotom#COther reasons for doing episiotom#C

&"To preent prolonged and seere&"To preent prolonged and seerestretching of muscles supporting thestretching of muscles supporting the

bladder and rectum"bladder and rectum"'" To reduce the second stage of labor'" To reduce the second stage of labor

when there is h#pertension- fetal distresswhen there is h#pertension- fetal distressorr other problems which necessitateorr other problems which necessitate

immediate delier# of the bab#"immediate delier# of the bab#"+" To enlarge outlet in breech+" To enlarge outlet in breech

presentation of forceps delier#"presentation of forceps delier#"


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T9PES OF EPISIOTO/97T9PES OF EPISIOTO/97

1. /EDIAN 1. /EDIAN From middleFrom middleportion of the lower aginal borderportion of the lower aginal border

directed towards the anus"directed towards the anus" 2. /EDIOLATERAL 2. /EDIOLATERAL Begun inBegun in

the midline but directed laterall#the midline but directed laterall#

from the anusfrom the anus


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D. A%%l' teD. A%%l' te /ODIFIED/ODIFIEDRITGEN:S /ANE6VERRITGEN:S /ANE6VER

As soon as crowning is ta$ing place-As soon as crowning is ta$ing place-coer the anus with sterile towel and e!ertcoer the anus with sterile towel and e!ertupward and forward pressure on the fetalupward and forward pressure on the fetal

chin- at the time e!erting gentle pressure onchin- at the time e!erting gentle pressure onthe head to preent rapid e!pulsion" Thisthe head to preent rapid e!pulsion" Thiswill not onl# support the perineum- thuswill not onl# support the perineum- thuspreenting lacerations- but will also faorpreenting lacerations- but will also faor

=e!ion so the smallest suboccipitobregmatic=e!ion so the smallest suboccipitobregmaticdiameter of the fetal head is the onediameter of the fetal head is the onepresented at the birth canal"presented at the birth canal"


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Ease the head out andEase the head out andimmediatel# wipe the mouth andimmediatel# wipe the mouth andnose of secretions to establish patentnose of secretions to establish patentairwa#"airwa#"

After head delier#- insert twoAfter head delier#- insert two

)ngers into the agina to feel for the)ngers into the agina to feel for thepresence of a cord around the nec$presence of a cord around the nec$>nuchal cord?" nuchal cord?"


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As the head rotates- delierAs the head rotates- delier

the anterior shoulder b# giing it athe anterior shoulder b# giing it agentle- downward push and thengentle- downward push and thendelier the posterior shoulder b#delier the posterior shoulder b#

giing it a gentle- upward lift"giing it a gentle- upward lift" 0hile supporting the head0hile supporting the head

and the nec$- delier the rest ofand the nec$- delier the rest of

the bod#" Ta$e note of the time ofthe bod#" Ta$e note of the time ofdelier# as soon as the entire bod#delier# as soon as the entire bod#has been e!pelled"has been e!pelled"


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E.E. head lowerthan the rest of the bod#? to allowthan the rest of the bod#? to allow

drainage of secretions"drainage of secretions" F.F. The newborn should be held The newborn should be held

below the leel of the mothers ulabelow the leel of the mothers ulafor a few seconds so that the bloodfor a few seconds so that the blood

from the placenta can enter thefrom the placenta can enter theinfants bod# on the basis of grait#infants bod# on the basis of grait#=ow"=ow"


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G.G. 0rap the bab# in a sterile0rap the bab# in a sterile

diaper to $eep him warmH chillingdiaper to $eep him warmH chilling

increases the bod#s need forincreases the bod#s need foro!#gen"o!#gen"

H.H. Dut the bab# on the mothersDut the bab# on the mothersabdomen- the weight of the bab#abdomen- the weight of the bab#will help contract the uterus"will help contract the uterus"


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I.I. *utting of the cord is postponed*utting of the cord is postponeduntil the pulsations hae stoppeduntil the pulsations hae stoppedbecause it is belieed that 5.(&.. mlbecause it is belieed that 5.(&.. mlof blood is still =owing from theof blood is still =owing from the

placenta to the bab# at this time"placenta to the bab# at this time" Then- clamp twice- an inch apart and Then- clamp twice- an inch apart andcut between"cut between"

;. ;. Show the bab# to the mother-Show the bab# to the mother-

inform her of the se! and time ofinform her of the se! and time ofdelier# and hand bab# to thedelier# and hand bab# to thecirculating nurse"circulating nurse"


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THIRD STAGE7 PLACENTALTHIRD STAGE7 PLACENTAL

STAGESTAGEFrom the delier# of the bab# to theFrom the delier# of the bab# to thedelier# of the placentadelier# of the placenta

SIGNS OF PLACENTAL SEPARATIONSIGNS OF PLACENTAL SEPARATION1.1.CAL


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TJDES OF DLA*ETAL TJDES OF DLA*ETAL

2EL


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2.2.D6NCAN:S /ECHANIS/D6NCAN:S /ECHANIS/ –


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IRS


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C.C. Ta$e note of the time of placental Ta$e note of the time of placentaldelier#"


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E.E. The most important aspect of care The most important aspect of careafter the delier# of the bab# and placentaafter the delier# of the bab# and placenta

is maintenance of uterine contractions" Theis maintenance of uterine contractions" Thefundus should be palpatedH an#time at allfundus should be palpatedH an#time at allthat is rela!ed- non(contracted or bogg#Hthat is rela!ed- non(contracted or bogg#H

&" assage carefull# – initial nursing&" assage carefull# – initial nursing

reaction"reaction"'"'" Appl# an ice oer the abdomen to helpAppl# an ice oer the abdomen to helpcontract the uteruscontract the uterus &"&"

'" +"'" +"

it shouldnot be gien before placental delier#not be gien before placental delier#because placental entrapment can occur"?because placental entrapment can occur"?


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F"F"


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CATEGORIESCATEGORIES

Fi!st $eg!eeFi!st $eg!ee –inoles the aginal mucous–inoles the aginal mucousmembrane and perineal s$in"membrane and perineal s$in"

Se"on$ $eg!eeSe"on$ $eg!ee –


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EPISIORRHAPH9 EPISIORRHAPH9 – Repair of the– Repair of theepisiotom#- in aginalepisiotom#- in aginalepisiorrhaph#- a aginal pac$ isepisiorrhaph#- a aginal pac$ isinserted to maintain pressure oninserted to maintain pressure onthe suture line- thus preentingthe suture line- thus preentingfurther bleeding" 9aginal pac$ isfurther bleeding" 9aginal pac$ isusuall# remoed '/(/: hoursusuall# remoed '/(/: hours

postpartum"postpartum"


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GG" a$e mother comfortable b#" a$e mother comfortable b#perineal care and appl#ing cleanperineal care and appl#ing cleansanitar# snugl# to preent itssanitar# snugl# to preent itsmoing forward from the anus tomoing forward from the anus to

the aginal opening" Soiled nap$insthe aginal opening" Soiled nap$insshould be remoed from the frontshould be remoed from the frontto bac$"to bac$"

HH"" Dosition the newl# delieredDosition the newl# deliered

mother =at on her bac$ withoutmother =at on her bac$ withoutpillows to preent di77iness due topillows to preent di77iness due todecrease in abdominal pressuredecrease in abdominal pressure


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FO6RTH STAGE FO6RTH STAGE First &('First &('hours after the delier# whichhours after the delier# whichis said to be dangerous stageis said to be dangerous stage

of the mother because herof the mother because herital signs are still unstable"ital signs are still unstable"


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ASSESSETASSESSET

&"&" F6ND6SF6ND6S – Should be chec$ed eer# &5– Should be chec$ed eer# &5minutes for one hour then eer# +. minutesminutes for one hour then eer# +. minutesfor the ne!t / hours" Fundus should be )rm infor the ne!t / hours" Fundus should be )rm inthe midline and during the )rst &' hoursthe midline and during the )rst &' hours

postpartum is slightl# aboe the umbilicus"postpartum is slightl# aboe the umbilicus"'"'" LOCHIALOCHIA – Should be moderate in amount"


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3. 0LADDER3. 0LADDER – A full bladder is– A full bladder is

eidenced b# a fundus which is to theeidenced b# a fundus which is to theright of the midline" 2ar$ red bleedingright of the midline" 2ar$ red bleedingand some clots are e!pressed"and some clots are e!pressed"

. PERINE6/. PERINE6/ –Should be tender-–Should be tender-discolored and edematous"


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P!o&ote "oo!tP!o&ote "oo!tCC

( $eep warm- chills are common( $eep warm- chills are commonbecause of e!citement- sudden drop inbecause of e!citement- sudden drop inmaternal hormones- release of intra(maternal hormones- release of intra(abdominal pressure- fetal blood inabdominal pressure- fetal blood in

circulation"circulation" ( Gie partial bath- peri(care-( Gie partial bath- peri(care-

change wet linenschange wet linens

( Assess for after painsH reassure( Assess for after painsH reassure

that it is secondar# to uterinethat it is secondar# to uterinecontractions"


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HH" The newl# deliered mother" The newl# deliered motherma# suddenl# complain of chills-ma# suddenl# complain of chills-

this is normal immediate after thethis is normal immediate after thedelier# and ma# onl# be due todelier# and ma# onl# be due tothe decrease in intraabdominalthe decrease in intraabdominalpressure- fatigue- cold delier#pressure- fatigue- cold delier#room temperature" Droideroom temperature" Droideadditional blan$ets"additional blan$ets"

I.I. Gie initial nourishment e"g"Gie initial nourishment e"g"

mil$- co,ee- soup- or tea"mil$- co,ee- soup- or tea" ;. ;. Allow patient to sleep in order toAllow patient to sleep in order to

regain lost energ#"regain lost energ#"


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FO6RTH STAGE FO6RTH STAGE First &('First &('hours after the delier#hours after the delier#

which is said to bewhich is said to bedangerous stage of thedangerous stage of the

mother because her italmother because her ital

signs are still unstable"signs are still unstable"


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ASSESSETASSESSET

FI2IS – Should be chec$ed eer#FI2IS – Should be chec$ed eer#&5 minutes for one hour then eer#&5 minutes for one hour then eer#+. minutes for the ne!t / hours"+. minutes for the ne!t / hours"

Fundus should be )rm in the midlineFundus should be )rm in the midlineand during the )rst &' hoursand during the )rst &' hourspostpartum is slightl# aboe thepostpartum is slightl# aboe the

umbilicus"umbilicus"


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LO*6


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BLA22ER – A full bladder is eidencedBLA22ER – A full bladder is eidencedb# a fundus which is to the right of theb# a fundus which is to the right of themidline" 2ar$ red bleeding and somemidline" 2ar$ red bleeding and someclots are e!pressed"clots are e!pressed"

DER


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P!o&ote "oo!tP!o&ote "oo!t

– Neep warm- chills are common becauseNeep warm- chills are common becauseof e!citement- sudden drop in maternalof e!citement- sudden drop in maternalhormones- release of intra(abdominalhormones- release of intra(abdominal

pressure- fetal blood in circulation"pressure- fetal blood in circulation"– Gie partial bath- peri(care- change wetGie partial bath- peri(care- change wet

linenslinens

– Assess for after painsH reassure that it isAssess for after painsH reassure that it issecondar# to uterine contractions"

c. mechanisms of labor

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