Labor and Delivery Study Notes

Introduction to Labor Influences

The labor process is influenced by five different aspects relating to the mother (mom) and baby.

Definition: Refers to the baby and factors influencing its movement through the birth canal.
- Position: The orientation of the baby, which can affect delivery.
- Size: Larger babies may complicate the delivery process.
- Attitude: The posture of the baby in utero (flexed vs. extended).

Definition: Relates to the mother's bony pelvis and its dimensions.
- Different shapes and sizes of pelvises affect the delivery of the baby.

Definition: Refers to the contractions during labor.
- Strength: How powerful the contractions are impacts cervical dilation.
- Duration: Length of contractions affects the effectiveness of labor.
- Frequency: The intervals between contractions matter for progress.

Importance: The pregnant woman’s position can influence labor.
- Forward leaning: Encourages fetal descent and is optimal.

Impact of Maternal State: The emotional and physical well-being of the mother significantly affects labor success.
- A well-rested, calm mother will contribute to a smoother process compared to an exhausted one.

Definition: The relationship of the baby's spine to the mother's spine.
- Longitudinal: Baby's spine aligned with mom's (ideal for vaginal delivery).
- Transverse: Baby lies sideways, indicating a potential need for a C-section.
- Oblique: Baby positioned diagonally, often leads to pain due to pressure on the pelvic bone.

Definition: Describes which part of the baby presents first through the cervix during delivery.
- Cephalic (Vertex): Head down, optimal position for delivery.
- Breech: Bottom or feet first, typically requires a C-section.
- Mentum Presentation: Chin first, may lead to complications requiring a C-section.

Importance of Positioning: How the baby positions itself can affect delivery ease.
- Flexion: Optimal, with the chin tucked to minimize the head size.
- Extension: Least favorable positioning with potential complications during delivery.

Understanding Pelvic Orientation: Utilize maternal position to describe the baby's position.
- Right/Left: Based from mother's perspective, not the baby's.
- Occiput: Position of the back of the baby’s head is important for determining labor progress.

Engagement: Baby's head at the level of the ischial spines (zero station).
Flexion: Tucking the chin to offer the smallest part of the baby’s head during delivery.
Internal Rotation: Turning the baby as it descends through the pelvis.
Extension: The head moves under the pubic bone as it emerges.
External Rotation: Shoulders turn to fit through the pelvis.

Strategies for Effective Labor: Position, gravity, and movement are critical in aiding the process.
- Balance: Ensures equal stretching of muscles and ligaments.
- Gravity: Positions like squatting and forward leaning help the baby descend.
- Movement: Encourages fetal descent to prepare for pushing.

Maternal Responses: Increase in heart rate, blood pressure, and respiratory rate during contractions due to increased metabolic needs.
- Increased WBC count: Body prepares for fighting infection during labor.
- Decreased gastric motility: Allows energy focus on labor rather than digestion.

First Stage: From 0-10 cm dilation.
- Latent Phase: Typically longer with irregular contractions.
- Active Phase: More consistent and stronger contractions.
Second Stage: From 10 cm until delivery of the baby.
Third Stage: Delivery of the placenta (should not exceed 30 minutes).
Fourth Stage: Immediate recovery period post-delivery.

Baseline Heart Rate: Ideal range is between 110-160 bpm.
Variability: Indicates the baby's well-being and ability to respond to stimuli.
- Moderate Variability: Indicates healthy neurological function.
- Minimal Variability: Watchful concern, indicates need for further monitoring.
Accelerations: Temporary increases in heart rate indicating well-being.
Decelerations: Drops in heart rate categorized as:
- Variable D-cells: Related to cord compression.
- Early D-cells: Related to head compression during contractions (typically non-concerning).
- Late D-cells: Suggest potential placental insufficiency, requiring intervention.

Cervical Checks: Vital for assessing progress in labor through dilation and effacement measurements.
Positioning: Making use of gravity and facilitating fetal descent by guiding the mother into optimal positions for labor and delivery.
Fluid Management: Ensure maternal hydration and manage the bladder to promote delivery.

Understanding the intricacies of labor, including factors influencing the passenger (baby), passageway (mother's structure), the powers (contractions), and maternal positions can facilitate a smoother delivery process. Continuous monitoring of both maternal and fetal conditions throughout labor stages is crucial for successful outcomes.