Week 4 part 2: labour & delivery

what are the signs of Impending Labour?

Indicators that labour may begin soon: 

• Braxton Hicks contractions (practice contractions) 

• Lightening (the fetus drops into the pelvis) 

• Backache 

• Cervical changes 

• Increased vaginal discharge (bloody show) 

• Energy surge (nesting instinct) 

• Weight loss 

• Flu-like symptoms 

• Rupture of membranes (water breaking) 

*What are the 5 “Ps”

1. Powers 

• Uterine contractions are vital in the labour process: 

• They cause the cervix to efface (thin) and dilate (open), allowing the fetus to descend through the birth canal. 

Phases of contractions: 

• Frequency (how often contractions occur) 

• Duration (how long contractions last) 

• Intensity (strength of contractions): measured as mild, moderate, or strong. 

• Pushing combines the power of uterine contractions and voluntary maternal efforts to propel the fetus downward. 

2. Passage: The birth canal

Bony pelvis: Four types of pelvic shapes: 

• Gynecoid (optimal for childbirth) 

• Android 

• Anthropoid 

• Platypelloid

Soft tissues: Will yield more easily with prior vaginal births, aiding in the comfort of contractions and pushing. 

False pelvis 

True pelvis

• Directly involved in childbirth

• Inlet, midpelvis and outlet

3. Passenger: comprises the fetus, placenta, and amniotic membranes. 

Fetal head structure plays a crucial role in labour: 

• Sutures and fontanelles (anterior and posterior) allow for changes in shape (moulding) as the head moves through the birth canal. 

Fetal lie: Orientation of the fetus in relation to the pregnant person's spine. 

• Types: Longitudinal (preferred) or transverse. 

• Fetal attitude: Relation of fetal body parts to each other, with flexion being the most favourable for vaginal birth. 

• Fetal presentation: The part of the fetus entering the pelvis first (e.g., head or breech) 

• Position: how presenting part is oriented in pelvis

• Most common fetal presentations include:

• Head - Vertex, military, brow, face,

• breech - frank, full, footling

• and transverse

4. Position 

• Upright positions (walking, squatting, sitting, kneeling) often lead to shorter labours. 

• Frequent position changes during labour are encouraged. The supine position is not beneficial

5. Psyche 

• The mental state of the labouring individual can heavily influence the progress of labour: 

• A relaxed and positive mindset may improve coping with discomfort. 

• Anxiety and fear can lead to the secretion of catecholamines, which may inhibit uterine contractions and divert blood flow. 

• Cultural and individual values will shape experiences and coping mechanisms regarding childbirth. 

contraction cycle: what is intensity

the approximate strength of the contraction which are measured by palpation or level

contraction cycle: what is interval

the amount of time the uterus relaxes between contractions

Position of the labouring patient include?

• Upright positions (walking, squatting, sitting or kneeling) facilitate shorter labours

• Change positions frequently in labour

• Supine position is not beneficial

Which sign or symptom normally occurs shortly before labor begins?

•An urge to push or bear down

•Increased clear vaginal discharge

•Moderate amount of vaginal bleeding

•Sudden weight gain of 3-5 lb