labour and delivery

what is the process of labour?

• is a process of moving fetus, placenta and membranes out of uterus and membranes out of uterus and through birth canal

• changes occur in woman’s reproductive system in days and weeks before labour begins 

when does labour begin

• 37th and 42nd week of gestation

what happens before labour begins

• increase braxon hicks contraction

• cervical ripening (flexible and ready for dilation)

hormones; oestrogen, relaxin and prostaglandin loosen and break down connective tissue in cervix

• relaxin makes pelvic joints and liagments more flexible

• prostaglandin helps ripen the cervix

• uterine muscles becomes more excitability

what are signs that labour coming

• lightening or dropping

  • baby moves lower in pelvis

• increase vaginal discharge ; bloody show

  • as cervix softens, small blood vessels break

• backache

  • trouble breathing

• stronger braxon hicks contractions

• weight loss of 0.5 to 1.5kg

• surge of energy aka nesting

  • sudden burst of energy

• flu like symptoms

• cervical ripening

• possible rupture of membrane

  • water membrane; either voluntary or spontaneous

what do you see in true labour?

• contractions 

  • increase in intensity

  • increase in duration

  • discomfort begins in back, radiates around abdomen

  • become progressively closer together

  • do not disappear with walking

• cervix

  • begins to efface and dilate

• show

  • may/not be present

what do you see in false labour?

• contractions

  • do not increase in intensity

  • do not increase in duration

  • discomfort usually in abdomen

  • do not become progressively closer

  • may disappear while walking

• cervix

  • no cervical change 

• show

  • not present 

what are the 5 p’s of labour

• power (contractions)

• passageway (birth canal)

• passenger (fetus and placenta)

• position of the mother

• psychological response 

powers?

• primary powers 

  • uterine contractions

    • frequency, durations, intensity

  • effacement

    • thinning of cervix

  • dilation

  • ferguson reflex

    • more oxytocin to release for stronger contractions

• secondary powers

  • bearing-down efforts

    • how mother pushes

how should you teach a mother how to push

• when they have a contraction, breathe in like your smelling flour and hold and then push like your going to poop 

• make sure to relax during relaxation(no contractions) to reduce exhuastion

passanger?

• fetal presentation 

  • cephalic/vertex

    • head as presenting part, down, ideal 

  • breech 

    • buttocks as presenting part 

  • shoulder/transverse

    • shoulder as presenting part 

• size of fetal head 

• fetal lie 

  • how is it alighned with mother spine?

  • transverse, oblique, longitude?

• fetal attitude 

• fetal postion 

  • station

  • engagement

what fetal presentation is at high risk

• breech

• shoulder/transverse

vertex presentation

• occiput typically is anterior and is optimal position to negotitate the pelvic curve by extending the head

  • ROA; right occiput anterior- back of head or 

  • LOA; left occiput anterior 

frank breech

• lie; longitudal or vertical

• presentation; breech (incomplete)

• presenting  part; sacrum 

• attitude; flexion, except from legs at knees

single footling breech

• lie; longitudal or vertical

• presentation; breech (incomplete)

• presenting part; sacrum 

• attitude; flexion, except for one leg extended at hip and knee

complete breech

• lie; longitudinal or vertical

• presentation; breech (sacrum and feet presenting)

• presenting part; sacrum (with feet)

• attitude; general flexion 

shoulder presentation

• lie; transverse or horizontal

• presentation; shoulder

• presenting part; scapula 

• attitude; flexion

fetal lie

• relationship of long axis of fetal to long axis of mother 

• longitudinal

  • long-axis of fetus is parallel to long axis of mother

• transverse

  • long axis of fetus is perpendicular to long axis of mother

• oblique

  • fetal lie is at an angle between transverse and longitudinal lie

fetal attitude 

• relationship of fetal head to its spine 

• complete flexion

  • when the chin of fetus is flexed and touches sterum

  • chin tucked

• moderate flexion

  • military position, chin not touching chest but is in an alert postiton

  • chin not fully tucked

• deflection or extension

  • back is arched and head is extended

  • head tilted back 

fetal station

• relationship of presenting part to an imaginary line drawn between matenal ischial spines

• measurement of fetal head in relation to the level of maternal ischial spines 

  • measured in cm

  • ranges from