MATERNAL & CHILD: THE WOMAN DURING CHILDBIRTH (Part 1)

- is a coordinated sequence of involuntary, intermittent uterine contractions.

- expels the fetus and placenta out of the mother's body.

Labor

labor begins when the fetus reaches a mature age _____________ age of gestation.

38-42 Weeks

- Also known as Parturition, childbirth, birthing

- From onset of contractions, dilation of cervix up to first 4 hours after delivery

- All products of conception are expelled

Intrapartum

Care during labor and delivery

Intrapartum Care

____________- normal labor

____________- difficult labor

- Eutocia

- Dystocia

Fetal expulsion along with products of conception due to:

regular, progressive & frequent uterine contractions

________ - woman in labor

________ - woman who gave birth

- Parturient

- Puerpera

- The hollow body organ when stretched to its capacity will inevitably contract to expel its contents.

- The uterus, which is a hollow muscular organ, becomes stretched due to the growing fetal structures

Uterine Stretch theory

- Near term oxytocin production by the posterior pituitary gland increases.

- Oxytocin stimulates contractions.

- Results the uterus becomes ↑ sensitive to oxytocin

Oxytocin Stimulation Theory

- Progesterone helps maintain pregnancy by its relaxant effect on the smooth muscles of the uterus preventing uterine contractions.

- Production of progesterone by the placenta this decline in progesterone allows the uterine contractions to occur.

Progesterone Deprivation Theory

- As the placenta "ages", it becomes less efficient, producing ↓ amount of progesterone.

- This progesterone allows the concentration of prostaglandin and estrogen to rise steadily

Theory of the Aging Placenta

- Hippocrates, the father of medicine,

- was the first person to propose this theory that certain hormones produced by the fetal adrenal and pituitary gland initiates labor contractions

Fetal Adrenal response theory

- sequence of involuntary uterine contractions initiated by biochemical signals,

- Voluntary muscular efforts leading to expulsion of the products of conception (fetus, placenta, and membranes).

LABOR

play a significant role in the progression and outcome of labor.

5 P's of labor

5 P's of labor:

Passenger,

Passageway,

Powers,

Position,

Psyche

- The fetus and placenta.

Passenger

- The maternal birth canal.

Passageway

- The mother's position during labor and delivery.

Position

- Uterine contractions and maternal pushing efforts.

Powers

- The emotional and psychological state of the mother.

Psychology

- refers primarily to the fetus, and secondarily to the placenta, as both need to navigate through the maternal birth canal.

- Several features of the fetus-especially the head size, shape, position, and lie-affect labor progression.

Passenger

largest and least compressible part of the body.

Fetal Head

- These are soft spots where the cranial bones have not yet fused.

- They allow flexibility during passage through the birth canal.

Fontanels

Larger, diamond-shaped, closes around 12-18 months.

Anterior fontanel

Smaller, triangular-shaped, closes around 8-12 weeks.

Posterior fontanel

- Overlapping of cranial bones that allows the fetal skull to change shape during passage through the maternal pelvis.

- Helps the baby fit through the birth canal.

Molding

Fetal Presentation:

Cephalic presentation

Breech presentation

Shoulder presentation

- most common

- The head enters first.

Cephalic presentation

Most favorable for vaginal delivery.

Occiput (back of the head)

The buttocks, feet, or both present first.

Breech presentation

Increases risk of complications; may require cesarean delivery.

Sacrum

The shoulder enters first.

Shoulder presentation

Vaginal delivery not possible unless corrected; often requires C-section.

Scapula

relationship between the long axis (spine) of the fetus and the long axis (spine) of the mother

Fetal Lie

Fetal spine parallel to maternal spine

Longitudinal Lie

Fetal spine perpendicular to maternal spine

Transverse Lie

Fetal spine at an angle to maternal spine

Oblique Lie

Position and Presentation of the Fetus:

- vertex (head first),

- position is occiput anterior (facing toward the pregnant patient's spine)

- face and body angled to one side and the neck flexed.

If a fetus is in the occiput posterior position, ____________ is often required.

operative vaginal delivery or cesarean delivery

- For breech presentation, usually do cesarean delivery at ___________ or during labor,

- External cephalic version is sometimes successful before labor, usually at ____________

- 39 weeks

- 37 ог 38 weeks.

consists of the maternal pelvis, cervix, vagina, and soft tissues that the fetus must pass through.

Passageway

- The shape and size are critical.

- The gynecoid pelvis is considered most favorable.

Bony pelvis

Must undergo effacement (thinning) and dilation (opening) for delivery.

(Hint: it’s a part of a female rep. organ)

Cervix

Provide the final stretch for the baby's passage.

Vagina and perineum

- Any disproportion between the passenger and passageway, known as

- May result in prolonged or obstructed labor.

cephalopelvic disproportion (CPD)

Frequency: common pelvic shape, occurring in about 50% of women.

Implications for fetal rotation:

-well-suited for childbirth with a round inlet and adequate space for fetal descent and rotation.

- It usually allows for an easier and smoother labor process.

Complications of labor: Complications associated with this pelvis shape are relatively rare

Gynecoid pelvis

Frequency: is seen in around 25%-30% of women.

Implications for fetal rotation:

- shape is longer from front to back, with a narrower transverse diameter.

- It is an oval shape,

- fetal descent may be facilitated in the sagittal plane, rotation may be more challenging.

Complications of labor:

- Labor progress may be slower due to the narrower transverse diameter.

- There may be an increased risk of fetal malpositioning,

Anthropoid pelvis

Frequency: is less common, occurring in approximately 20%-25% of women.

Implications for fetal rotation: tends to have a narrower inlet and a more heart-shaped configuration, which may impede fetal descent and rotation.

Complications of labor:

- difficult due to the narrower inlet and reduced capacity for fetal accommodation.

- There is an increased risk of cephalopelvic disproportion,

- fetal head is too large to pass through the pelvis. C-section may be needed.

Android pelvis

Frequency: least common, occurring in around 3%-5% of women

Implications for fetal rotation:

- appears like an egg on its side

- flattened with a wide transverse diameter but reduced anteroposterior diameter, making it difficult for the fetus to engage and rotate.

Complications of labor:

- Difficult labor is common, as the fetus may have difficulty descending and navigating the birth canal.

- need for assisted delivery methods such as forceps or vacuum extraction.

- Most women require a C-section

Platypelloid pelvis

Position (Of the Mother):

Upright positions

Lateral position

- (standing, squatting, kneeling)

- promote gravity-assisted descent.

Upright positions

may improve blood flow and reduce perineal trauma.

Lateral position

- may compress the inferior vena cava,

- reducing blood flow and oxygenation to the fetus

Supine position

Benefits:

- Gravity assists in the descent of the fetus

- Improved pelvic opening, better fetal positioning

- Increased comfort for some

Concerns:

- May be tiring for prolonged periods

- Limited options for pain relief methods such as epidural

Upright positions

Benefits

- Reduces pressure on the perineum and provides a more comfortable position for resting between contractions

- Utilizes gravity to aid in the progression of labor Squatting helps widen the pelvis outlet, facilitating fetal descent

- Birth bar or stool combines the benefits of squatting with additional support for stability

Concerns:

- Requires sufficient strength and endurance

- May increase the risk of perineal tears if not controlled during delivery

Sitting or squatting positions

Benefits

- Increases oxygen to fetus

- Facilitates relaxation and comfort, particularly during rest periods

- Takes pressure off of the back

Concerns

- May slow down labor progression

- Limited ability to use gravity to aid in descent

- May be difficult to assess fetal heart rate

Side-lying position

Benefits

- Promotes optimal fetal positioning, particularly for fetuses in posterior position

- Relieves pressure on the back and spine

- May alleviate back pain and discomfort during contractions

Concerns

- Limited mobility for movement during labor

- Requires assistance or support for prolonged periods

Hands and knees position (all-fours)

Benefits

- Provides easy access for medical interventions such as vaginal exams and instrumental deliveries

- May be suitable for women receiving epidural anesthesia

Concerns

- Increases the risk of perineal tears and pelvic floor trauma

- May compress blood vessels, leading to decreased blood flow to the uterus and fetus

Lithotomy position (supine with legs elevated)

forces that propel the fetus through the birth canal

Powers (Contractions and Maternal Effort)

Kinds of Powers (Contractions and Maternal Effort):

Primary powers

Secondary powers

Uterine contractions, which cause cervical effacement and dilation.

Primary powers

- Maternal pushing efforts during the second stage of labor.

- Contractions are assessed by frequency, duration, intensity, and resting tone

Secondary powers

supporting the pregnant client's psychological adaptation to labor.

Psyche

childbirth classes, anticipatory guidance during labor

Education

Continuous labor support increases vaginal birth rate.

Labor support

Respect cultural differences, respect client autonomy, and communicate effectively

Client-centered support

Fear, anxiety, or lack of support can inhibit oxytocin release _____________

slowing labor progression

Factors influencing maternal psychology include:

Presence of a supportive birth partner.

Trust in healthcare providers.

Past birth experiences.

Cultural and personal beliefs

True signs of labor:

Regular uterine contractions

Cervical dilatation and effacement

- Contractions are rhythmic tightening and relaxing of the uterine muscles that help in the expulsion of the fetus.

Regular uterine contractions

Characteristics of true labor contractions include:

Regular pattern

Increasing intensity

Consistent duration

Persistence despite activity

Felt in the back and abdomen

- occur at regular intervals that gradually decrease over time

- (e.g., starting at 10 minutes apart and progressing to 5 minutes, then 3 minutes).

Regular pattern

They become progressively stronger and more painful over time.

Increasing intensity

Consistent duration: Each contraction typically lasts about

30-70 seconds.

true contractions don't disappear with rest, position change, or hydration.

Persistence despite activity

The pain often starts in the lower back and radiates to the front of the abdomen.

Felt in the back and abdomen

primigravida (first-time mothers), first stage of labor with these contractions is approximately ___________

12-14 hours

multigravida (women who have given birth before), it may last __________

6-8 hours.

- changes in the cervix

- determined through a vaginal examination by a healthcare provider.

Cervical dilatation and effacement

- opening of the cervix, measured in centimeters from 0 (closed) to 10 (fully dilated).

- allows the passage of the baby's head into the birth canal.

Cervical dilatation

- thinning and shortening of the cervix

- measured in percentages from 0% (not effaced) to 100% (completely effaced).

- When fully effaced, the cervix becomes paper-thin.

Cervical effacement

- The rupture of the amniotic sac, commonly known as "water breaking," is another definitive sign of labor. When the membranes rupture, amniotic fluid is released through the vagina. This can occur as:

Rupture of membranes (ROM)

Natural breaking of the amniotic sac.

Spontaneous rupture of membranes (SROM)

Deliberate breaking of the sac by a healthcare provider to induce or augment labor.

Artificial rupture of membranes (AROM)

- occur days or weeks before the onset of actual labor.

- referred to as "false" or "preliminary" signs of labor, but they are important indicators that the body is preparing for childbirth.

Premonitory signs of labor

- Lightening occurs when the baby's head descends into the maternal pelvis, usually 2-4 weeks before labor in primigravida and sometimes not until labor begins in multigravida.

- This process is also called "engagement" or "the baby dropping."

Lightening or engagement

Signs of lightening include:

Relief from respiratory discomfort

Increased urinary frequency

Lower abdominal pressure

Easier eating

Waddling gait

As the uterus moves away from the diaphragm, breathing becomes easier.

Relief from respiratory discomfort

Greater pressure on the bladder leads to more frequent urination.

Increased urinary frequency

Women often report feeling the baby "sitting lower."

Lower abdominal pressure

With less pressure on the stomach, heartburn and indigestion may decrease.

Easier eating

Due to the baby's head pressing on pelvic joints and ligaments.

Waddling gait

- As the cervix begins to efface and dilate, the mucus plug that sealed the cervical canal during pregnancy is expelled.

- pinkish or brownish-tinged mucous discharge

Bloody show

Characteristics of the bloody show include:

Appearance: Sticky, gelatinous discharge mixed with small amounts of blood.

Timing: May appear several days before labor or during early labor.

Amount: Usually small, distinguishing it from vaginal bleeding which requires immediate medical attention

- These are irregular, painless (or mildly uncomfortable) contractions that occur throughout pregnancy but may increase in frequency and intensity in the weeks before labor.

- called "practice contractions," they help prepare the uterine muscles for labor.

Braxton Hicks contractions

Braxton Hicks and true labor contractions:

Irregularity: Braxton Hicks contractions don't follow a consistent pattern.

Location: Usually felt in the front of the abdomen rather than the back.

Response to activity: Often subside with rest, hydration, or changing positions.

Intensity: Usually mild and don't progressively increase in strength.

Sudden burst of energy and a strong desire to clean, organize, and prepare their home for the baby's arrival in the days before labor begins.

Nesting instinct

- changes in vaginal discharge may occur due to hormonal shifts and cervical ripening.

Changes in vaginal discharge

These changes in vaginal discharge include:

Increased amount: More abundant discharge than earlier in pregnancy.

Consistency changes: Discharge may become thinner or thicker.

Color variations: Clear, white, or slightly blood-tinged discharge.

- Many women experience digestive system changes before or during early labor

Gastrointestinal changes