Fetal Position - is the positioning of the body of a prenatal fetus as it develops. In this position, the back is curved, the head is bowed, and the limbs are bent and drawn up to the torso.

Fetal attitude - This describes the relationship of fetus' body parts to one another. Normal fetal attitude is when the head is tucked down to the chest with its arms and legs drawn in towards center of chest.

Fetal Lie - Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

LOCATING FETAL HEART TONE •transmitted best through the convex portion of a fetus, because that is the part that lies in closest contact with the uterine wall fetal back

• Vertex or breech presentation - best heard through the

• Face presentation - best heard through the thorax

• Breech presentations - heard most clearly high in the uterus, at the woman’s umbilicus or above

Cephalic presentations - heard loudest low in the abdomen •ROA position - right lower quadrant

•LOA position - left lower quadrant

•LOP or ROP - on a woman’s side

FHT rate should be 120-160 bpm through out the pregnancy

FHT sounds can be heard and counted as early as the 10th -11th week of pregnacy by the use of the ultrasonic doppler technique

A nonstress test (NST) measures fetal heart rate and response to movement in the third trimester to ensure your baby's doing well and getting enough oxygen.

The term "nonstress" refers to the fact that nothing is done to place stress on the baby during the test. done in the third trimester of pregnancy, from week 28 on typically last 20 to 40 minutes Non-invasive

CTG (CARDIOTOPOGRAPHIC MACHINE) - Use to monitor progress of labor and fetal status.

MONITORING PROGRESS OF LABOR

INCREASED BRAXTON-HICKS CONTRACTION - The irregular painless contraction of pregnancy becomes stronger, longer, more frequent, enough to cause discomfort and alarm the mother.

LIGHTENING “the baby dropped”-Setting of the presenting part to the pelvic brim or inlet.-Occurs 2 weeks before labor onset in primipara and just before or during labor in multis.

ENGAGEMENT is the descent of the biparietal of the fetal head the pelvic inlet

•FIXATION is the descent of the fetal head to

•FLOATING is when the head is still movable

RIPENING OF THE CERVIX- Cervix become butter soft when labor is near at hand.

INCREASE LEVEL OF ACTIVITY-this high level of adrenalin makes the woman highly energetic and active.

SHOW-Surest signs of labor is active

ROM (Rupture of Membrane) - bag water is signified by a gash or sticky trickle of fluid.

PHASES OF CONTRACTION

INCREMENT - when the intensity of the contraction increases

ACME - when the contraction is at its strongest

DECREMENT - when the intensity decreases

FREQUENCY OF CONTRACTIONS - time from the beginning of one contraction to the beginning of the next contraction

(A) DURATION – time from beginning of one contraction to the end of the same contraction (B) INTERVAL – period of relaxation; time from end of one contraction to the beginning of the next Relaxation time is usually of longer duration than the actual contraction

False Labor Contractions

✓ Begin and remain irregular.

✓ Felt first abdominally and remain confined to the abdomen and groin.

✓ Often disappear with ambulation or sleep.

✓ Do not increase in duration, frequency, or intensity.

✓ Do not achieve cervical dilatation.

True Labor Contractions

✓ Begin irregularly but become regular and predictable.

✓ Felt first in lower back and sweep around to the abdomen in a wave.

✓ Continue no matter what the woman’s level of activity.

✓ Increase in duration, frequency, and intensity.

✓ Achieve cervical dilatation.

STAGES OF LABOR

1. FIRST STAGE

❑DILATATION STAGE ❑Onset of true labor pains to full dilatation of the cervix

Three Phases

❖Latent Phase ❖Active Phase ❖Transition Phase

SECOND STAGE PUSHING STAGE

Full dilatation of the cervix to the delivery of the baby

❑5 P’s of Labor

❖Passage ❖Passenger ❖Position ❖Psyche ❖Power

7 Mechanisms of labor (EDFIERE)

1. Engagement- occurs when the widest part of the fetal head (usually the biparietal diameter) enters and descends into the maternal pelvic inlet. This indicates that the baby is starting to move into position for delivery.

2. Descent- refers to the downward movement of the fetal head through the pelvis. This process is gradual and continuous throughout labor, particularly in the active phase.

3. Flexion-is the bending of the fetal head so that the chin moves closer to the chest. This action reduces the diameter of the head that needs to pass through the pelvis.

4. Internal Rotation is the turning of the fetal head to align with the pelvic outlet. In most cases, the fetal head rotates so that the occiput (back of the head) moves from a transverse position (sideways) to an anterior position (facing the mother's front).

5. Extension- occurs as the fetal head reaches the perineum and the pubic symphysis acts as a pivot point. The head extends as it passes under the pubic bone, allowing the forehead, nose, mouth, and chin to be born.

6. Restitution (External Rotation)- After the head is delivered, it naturally rotates back to the original position it was in while in the pelvis. This movement is called restitution.

7. Expulsion-is the delivery of the rest of the fetal body following the head. First, the anterior shoulder is delivered under the pubic symphysis, followed by the posterior shoulder and the rest of the baby.

THIRD STAGE

❑PLACENTAL STAGE Begins with birth and ends with the delivery of the placenta

❑Two phases:

Placental separation ❖Placental expulsion

❑Methods of Placental Separation

❖Schultze ❖Duncan

FOURTH STAGE

❑PUERPERIAL STAGE ❑4 hours after birth

❑Close observation: Post-partum hemorrhage

ASSESSING FETAL WELL BEING

• NORMAL: 2 times every 10 mins or 10-12 times/hr

• Less than 5 times: fetus experiencing distress, poor placental perfusion

PERINEAL CARE Purpose: to clean the vaginal or rectal secretions and prepare the cleanest environment for the birth of the baby.

o Proper positioning for birth

a.Lithotomy

b.Lateral or Sims’ position

c.Dorsal recumbent position