labor

CRITICAL FACTORS IN LABOR

• Key Factors:

  • Passage

  • Psyche

  • Passenger

  • Position (Maternal)

  • Power

  • Placental

PASSAGE

• Definition: Refers to the maternal pelvis, the route the fetus must navigate during childbirth.

Pelvis Types

• Gynecoid:

  • Most common type in people assigned female at birth (AFAB).

  • Wideset, low pelvic bones, accommodating pregnancy and labor effectively.

• Anthropoid:

  • Narrower, deeper than wide.

  • Oval-shaped opening.

• Android:

  • Heart-shaped; greatest width moved toward sacrum.

  • Obstetric conjugate is greater than transverse diameter.

• Platypelloid:

  • Flat pelvis, wide but shallow; least common shape.

Other Considerations

• Cervix: Cervical scarring (Asherman's syndrome) can affect labor.

• Vagina: Obstructions can interfere with delivery; conditions such as "Tissue Dysplasia" affect tissue health and organization.

PASSENGER

• Definition: Refers to the baby and its position in the womb, influencing labor progress.

Factors Affecting Passenger

• Lie: Position relative to mother's spine:

  • Longitudinal (common): Spine parallel to mother's.

  • Transverse: Fetus at a 90-degree angle.

  • Oblique: Fetus angled.

• Fetal Attitude: Normal fetal position with head tucked, arms and legs drawn into chest, and curved spine.

• Presentation: The part that leads through the birth canal (usually the head).

• Position: Orientation of fetus; either:

  • Occiput Anterior: Facing backward, ideal for delivery.

  • Occiput Posterior: Facing forward, less ideal for delivery.

POWERS

• Definition: Refers to uterine contractions and maternal efforts in labor.

  • Assessment: Via abdominal palpation.

• Contractions:

  • Duration: Measured in seconds, from onset to end.

  • Frequency: Time from one contraction's start to the next.

  • Intensity: Measured in mm Hg, gauged by the strength of contractions.

Phases of Contraction

• Increment: Beginning of contraction spreads through the uterus.

• Acme: Peak strength of a contraction.

• Decrement: Decreasing strength of contraction.

PSYCHE

Immediate Issues

• Fatigue and anxiety.

• Trust in medical care, self, and support.

Pre-Existing Issues

• Motivation for pregnancy, self-confidence, expectations, relationships, culture, obstetric history, and childbirth education.

MATERNAL POSITION

Bedrest Positions

• Low Semi-Fowler's:

  • Position used with epidurals, side-tipped to prevent vena cava syndrome.

• Side-Lying/Runner's Position:

  • Comfort in early labor and advancing pregnancy.

Upright Positions

• Chair/Rocker, Walking, Stair Climbing, Birthing Ball, Squatting, Toilet Sitting.

• Positions for back labor: Leaning over the bed, all fours, pelvic rocking, hallway bars, slow dancing, counterpressure.

PLACENTA

• Definition: Temporary organ connecting mother and fetus via the umbilical cord.

• Low-lying placenta can lead to transverse lie and obstruct descent.

CARDINAL MOVEMENTS

• Definition: Seven sequential changes in fetal head position:

  • Engagement

  • Descent

  • Flexion

  • Internal rotation

  • Extension

  • External rotation

  • Expulsion

• Mnemonic: "Every Day Fine Infants Enter Eager and Excited."

SIGNS OF LABOR

• Lightening, frequent urination, sciatic nerve discomfort, back pain, Braxton-Hicks contractions, vaginal discharge, bloody show, nesting, rupture of membranes (PROM).

Assessing Rupture

• Time, color, clarity of fluid, fetal movement, contraction onset.

False Labor vs. True Labor

• False Labor: Mimics labor but no cervical change; contractions don't get stronger or closer.

• True Labor: Contractions lead to cervical effacement/dilation, regular and rhythmic, increase in strength/duration.

THEORIES ABOUT ONSET OF LABOR

• Uterine Stretch Theory: Pressure from the growing fetus causes contractions.

• Oxytocin Theory: Cervical pressure stimulates oxytocin release, initiating contractions.

• Progesterone Deprivation Theory: Changes in hormone levels encourage labor onset.

• Prostaglandin Theory: Increased prostaglandin leads to contractions.

• Theory of Aging Placenta: Aging placenta reduces blood supply, triggering contractions.

PHYSIOLOGICAL CHANGES IN LABOR AND DELIVERY

• Includes increased blood pressure, cardiac output, fluid loss, decreased GI activity, common anorexia, and potential nausea/vomiting.

FETAL RESPONSE TO LABOR

• Monitoring fetal heart rate for changes indicates well-being; initial assistance through maternal position changes.

STAGES OF LABOR

• Stage 1: Dilation and effacement (up to 48 hours).

• Stage 2: Delivery of the baby.

• Stage 3: Delivery of the placenta (also called afterbirth).

FIRST STAGE OF LABOR

• Early Labor (Latent Phase): Contractions irregular, mild to moderate discomfort; cervix dilates to 4 cm.

• Active Phase: Contractions become regular, stronger, and more frequent (every 3-5 minutes). Pain relief options may be available.

• Transition Stage: Final active labor, cervix dilates from 8 to 10 cm; intense contractions occur every 1-2 minutes.

SECOND STAGE OF LABOR

• Starts at 10 cm dilation; varies in duration. Techniques include different pushing positions, encouragement from healthcare providers. Emotions can range widely post-delivery.

PUSHING TECHNIQUES

• Directed Pushing: Holding breath and pushing for a count; repeats.

• Spontaneous Pushing: Wait until urge is strong, then push; recommended for shorter times and reduced stress.

EPISIOTOMY

• Definition: Surgical incision during delivery to expedite if fetal distress occurs.

• Types: Midline and mediolateral incisions, with associated risks such as incontinence, pain, or infection.

THIRD STAGE OF LABOR

• Separation of placenta should be speedy to prevent postpartum hemorrhage; signs include a firm uterus and lengthened umbilical cord.

FOURTH STAGE OF LABOR

• First hours post-delivery; assessment of the mother and bonding with the baby; monitoring vitals and uterine contractions, managing potential complications such as hypotonic bladder.