LU 5 Labour

What is labor ?

• a process of expulsion of product of conception

• occurs in 3 stages and take less than 24 hours

• Primigravida will complete 12 hours

• Multipara takes 6-8 hours

What are the criterias for normal labor ?

• occurs at term

• spontaneous in onset

• spontaneous vaginal delivery

• vertex presentation

• process completed within 18 - 24 hours

• no complication arise

What are the factors affecting labor / components of labor process ?

• Power

• Passage

• Passenger

• The psyche

What are the components in power ?

• Uterine contractions (primary powers of labor during first stage)

• Mother’s pushing efforts (voluntary pushing power when the cervix is fully dilated)

What are the effect of contractions on the cervix ?

• effacement of the cervix

• cervix will feels like a thin, slick membrane over the fetus

What are the phases of uterine contraction ?

• Increment (the period of increasing strength)

• Peak / acme (the period of greatest strength)

• Decrement (the period of decreasing strength)

How to describe a contraction ?

• frequency : described in minutes and fractions such as 4/1/2 minutes (contractions occur more than every 2 minutes should be reported as it may reduce fetal oxygen supply)

• duration : duration of x to y seconds (contractions longer than 90 seconds should be reported as it may reduce fetal oxygen supply)

• intensity : mild (fundus of uterus feels similar to the tip of the nose) moderate & strong (fundus of uterus feels similar to chin)

What are the components of passage ?

• pelvic bones

• soft tissues of the cervix

• birth canal

What are the components of the passenger ?

• the fetus

• placenta

• amniotic membranes

• amniotic fluids

What factors affect the difficulty of passenger going through the passage ?

• fetal skull size

• fetal attitude

• fetal presentation

• fetal position

What are the variations of fetal attitude ?

What are the fetal presentation ?

What are the fetal position ?

What are the ways to support the psyche ?

• education : childbirth classes

• labor support : frame labor pain as meaningful and productive

• client-centered support : respect cultural differences

What are the stages of labor ?

• 1st stage (cervix dilation stage)

• 2nd stage (expulsion / delivery stage)

• 3rd stage (placental stage)

• 4th stage (recovery stage)

Briefly explain the first stage of labor

• occurs when first symptoms of true labor and ends with the complete dilatation of cervix

What are the phases in 1st stage of labor ?

• Latent phase : begins at true labor from the os closed until dilated to 4 cm

• Active phase : begins when the os is 4cm, contractions will be regular and continously

Explain the physiology of 1st stage of labor / What are the changes that take place during 1st stage of labor

• contraction and retraction of uterine muscle

• cervical effacement

• cervical dilatation

• formation of upper & lower segment

• ruptures of membranes

Briefly explain the second stage of labor

• begins when the cervix is fully dilated until the baby is completely born

• normal duration for 2nd stage : nullipara (20-60 mins), multipara (10-30 mins)

What are the factor influencing the 2nd stage ?

• strength and coordination of uterine contraction

• strength of secondary powers (ability to push)

• resistance of lower birth canal

• size, presentation, and position of the presenting part

Briefly explain the third stage of labor

• it starts from the delivery of placenta and membranes

What are the physiology / phases of 3rd stage ?

• Placental separation

• Descend of the placenta

• Expulsion of the placenta

What are the signs of placental separation ?

• lengthening of the umbilical cord

• uterus takes on a more globular shape and becomes firmer

• uterus rises in the abdomen

• a gush of blood occurs

Briefly explain the 4th stage of labor

rest, repair and relaxation an hour after the placenta is delivered

What is the mechanism and the cardinal movements of labor ?

What are the management for 1st stage of labor ?

• receives mother and gives her clean bed

• prepares the identification tags and checks with mother to ensure the information is correct

• provide psychological support by working confidently

• provide comfort by maintaining a calm atmosphere

• provide pain relief

• maintain hydration

• keep bladder empty

What are the management for 2nd stage of labor ?

• Prepare equipment for delivery

• Prepare equipment for resuscitation

• Assess maternal condition such as vital signs

• Assess fetal condition such as fetal heart rate

• Position mother for delivery

• Swab perineum

• Deliver the baby

What are the management for 3rd stage of labor ?

• begins after the delivery of the baby

• palpate abdomen to exclude undiagnosed twin

• inform mother and give IM oxytocin

• Deliver placenta and membranes by Controlled Cord Traction (CCT)

• Place placenta and membranes in a receiver

• Check placenta for it completeness

• Check maternal condition

What are the management for 4th stage of labor ?

• begins at 1st hour after delivery

• check maternal vital signs

• palpate abdomen to ensure the uterus was contracted

• ensure the entire placenta was expelled

• check to ensure tear is repaired

What are the factors affecting successful labor ?

• uterine contractions and maternal efforts

• fetal characteristics

• maternal pelvic anatomy