Physiological changesSecondary to pain In labor.
Discomfort during laborA = First stageB= later phase of 1st stage
to 2nd stageC= 2nd stage actual
birth
Exercises often taught during childbirth classes
Discomfort in labor from:
Cervical dilation & effacement - first stationUterine ischemia - throughoutPerineal stretching - end of 1st & 2nd stageFearAnxietyTension
Process of Labor & Delivery
To understand the complex process of L&D it isImportant to examine each of the factors involved.These are frequently called the five or even 6 P’s.
Passageway = pelvis & soft tissuesPassengers = fetus & placentaPowers = Contractions & voluntary effort of mom (push)Position of mother = standing, walking, side lying,
squatting, on hands & knees VS lithotomyProcess = all parts working together
& # 6 Psychological condition of mom
Passenger
MOLDING
A = Vertex note the flexion
B = Sinciput
C = Face note extension
D = Brow or Military
ROA & LOAWHY BEST
0 = ischeal spines
Placenta is also apassenger
PRIMARY POWER - CONTRACTION
Position of mother may also influence the secondary power of pushing. Walking, sitting, kneeling, squatting are all importantaspects of position changes that are helpful.Squatting may increase size 20 - 40%. Hands & knees may help posterior fetus turn to anterior position. Remember back labor.
Psychological state of mother is another importantP to remember.Education, Preparation, Support are all going to help with the labor process
Vaginal Exam – What can the examiner find out ?Effacement, Dilitation, Membranes intact, Presenting part, Presenting part, Fetal AttitudeStation, if presenting part is A, P, T, fetal scalp stimulation, fetal scalp PH
NOT doneIf vaginalBleedingWHY ??
Placenta Previa
Mechanisms of Labor – engagement, decent, flexion,Internal rotation
Descent
INTERNALROTATION
COMPLETIONOF INTERNALROTATION & BEGINNING OFEXTENSION
INTERNALROTATION
COMPLETIONOF INTERNALROTATION & BEGINNING OFEXTENSION
CROWNING - EXTENSION
EXTENSIONCOMPLETE
EXTERNALROTATION
EXTERNALROTATION – NOTE SHOULDERS-RESTITUTION
EXPULSION
EXPULSION
LOAMechOf labor
A = breech beforelaborB = engagement& internal rotationC = lateral flexionD = external rota. resitutionE = face rotates tosacrum when occiput is anteriorF = internal rotationof shoulders & headG = head born bygradual flexionduring evacuationof fetal body
Mechanism of labor in Breech Delivery
CORD VESSELS
PLACENTA
MATERNAL SIDEDIRTY DUNCAN
FETAL SIDESHINY SCHULTZ
CHECKING FUNDUS
STRIA GRAVIDARIUM &LINIA NIGRA
MORE MATERNAL ADAPTATION TO LABOR
M0RE MATERNAL ADAPTATIONS TO LABOR
M0RE MATERNAL ADAPTATIONS TO LABOR
Vaginal exam reveals:Cervical effacement = %Cervical dilatation = in centimeters - 4 “Membranes intact = if not sure check with nitrizide paperFetal presentationFetal stationFetal attitudeIf presenting part A, P or TFetal scalp stimulationFetal scalp blood phAttach internal monitor