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Theories of Labor Onset

1. Uterine stretch theory any hallowed organ when stretched to its maximum capacity will contrast and empty. 2. Oxytocin theory Oxytocin, which causes contractions of the smooth muscles of the posterior pituitary gland as a result of stressful event in labor. . Progesterone Deprivation Theory !rogesterone, secreted by the corpus Luteum and then by the placenta, is essential in maintaining pregnancy. "owever, the decrease in the level of progesterone circulating in the body will initiate body pains. #. Prostaglandin Theory !rostaglandins, formed by the uterine deciduas under level of concentration in the amniotic fluid and blood of women increases during labor. $esearch has shown prostaglandin to be very effective in inducing uterine contraction at any stage of gestation. %nitiation of labor is said to be the result of the release of arachidonic acid is believed to increase prostaglandin synthesis contractions. &. Theory of Aging Placenta as the placenta matures, blood supply decreases resulting in uterine contractions. $elated Terms' Labor is the process of moving the fetus, placenta and membranes out of the uterus and through the birth canal. (ynonymous with childbirth and parturition. )elivery is the actual birth of baby *rowning encircling of the largest diameter of the baby+s head by the vulvar ring ,ffacement shortening and thinning of the cervical canal. %t is expressed in percentage -./. )ilatation is the enlargement of the cervical os from an orifice a few millimeters in si0e to an aperture large enough to permit the passage of the fetus. (how is a mucoid discharge from the cervix that is present after the mucous plug has been discharged. 1ttitude the relationship of the fetal parts to one another Lie relationship of the fetal spine to the spine of the mother. !resentation portion of the fetus that enters the pelvis first. !osition relationship of the assigned area of the presenting part of the landmar2 of the material pelvis. (tation measurement of the progress of descent of the presenting part in relation to the ischial spine.

3re4uency from the beginning of one contraction to the beginning of the next contraction )uration from the beginning of contraction to its completion %ntensity the strength of contraction to its completion ,ffacement progressive thinning and shortening of the cervix )ilatation opening of the cervix os during labor (%56( of L17O$ !reliminary8!rodromal (igns of Labor 1. Ligthening setting of fetal head into pelvic brim occurs approximately 19:1# days before labor begins gives the woman relief from diaphragmatic pressure and shortness of breath occurs early in primiparas mother may experience' shooting leg pains from the increased pressure on the sciatic nerve, increased amounts of vaginal discharge and urinary fre4uency from pressure on the bladder 2. %ncreased in Level of 1ctivity related to an increase in epinephrine release that is initiated by a decrease in progesterone produced by the placenta . 7raxton "ic2s *ontractions painless irregular contractions, sometimes strong that may cause discomfort #. $ipening of the cervix 5oodell+s sign' the cervix feels softer than normal similar to earlobe throughout pregnancy; at term cervix is described butter:soft (igns of T$<, L17O$' 1. <terine *ontractions surest sign that labor has begun 2. (how the blood mixed with mucus, ta2es on a pin2 tinge. %t is when mucus plug is expelled and capillaries are exposed. . $upture of the membranes experienced either as a sudden gush or as a scanty, slow seeping of clear fluid from the vagina. 3alse Labor' %rregular contractions !ain is confined to the abdominal 6o increase in duration, fre4uency, and intensity. !ain disappears with ambulating 6o cervical change (edation stops contractions

True Labor' $egular contractions !ain on the lower bac2 to the abdomen %ncrease in duration, fre4uency and intensity !ain not relieved upon ambulating 1ccompanied with effacement and dilatation (edation does not stop contraction *"1$1*T,$%(T%*( of *O6T$1*T%O6( 1. =ild uterine muscle are somewhat tense but can be indented by a gentle pressure 2. =oderate uterus is moderately firm and a firmer pressure is needed to indent . (trong the uterus becomes very firm that at the height of contraction cannot be indented. *O=!O6,6T( of L17O$ 1. !assage refers to the shape and measurement of maternal pelvis and distensibility of birth canal refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum. ,lastic to expand and accommodate # 7asic *lassification of !elvis' a. 5ynecoid best pelvis; half of the population b. 1ndroid common in men, 29. in women; heart shape and difficult for vaginal delivery c. 1nthropoid common in men; 29: 9., pelvic inlet oval d. !latypelloid flat pelvis; least common; &. of the population, long sacrum 2. !assenger refers to the fetus, its si0e, presentation, and position.

(agittal suture: @oins the 2 parietal bones of the s2ull *oronal suture the line of @uncture of the frontal bones and the 2 parietal bones Lambdoid suture the line of @uncture of the occipital bone and 2 parietal bones. 3ontanelles' : significant membrane:covered spaces that are found at the @unction of the main suture lines 1nterior 3ontanelle referred to as bregma; lies at the @unction of the coronal and sagittal sutures : diamond:shape : anteroposterior diameter is :#cm : transverse diameter is 2: cm !osterior 3ontanelle lies at the @unction of the lambdoidal and sagittal sutures. : triangular : smaller than the anterior 3ontanelle : only 2cm across its widest part Aertex the space between two fontanelles (inciput the area over the frontal bone Occiput the area over the occipital bone (uboccipitobregmatic narrowest diameter B.&cm; from the inferior aspect of the occiput to the center of the anterior fontanelle Occipitofrontal measured from the bridge of the nose to the occipital prominence is 12cm Occipitomental the widest which is 1 .&cm; measured from the chin to the posterior fontanelle =olding the change in shape of the fetal s2ull produced by the force of uterine contractions pressing the vertex of the head against the not:yet: dilated cervix. 3,T1L !$,(,6T1T%O6 and !O(%T%O6 1ttitude describes the degree of flexion a fetus assumes during labor or the relation of fetal parts to each other 1/ 5ood 1ttitude -complete flexion/ the spinal column is bowed forward that the chin touches the sternum, the arms are flexed and folded on chest, the thighs are flexed onto the abdomen and the calves are pressed against the posterior aspect of the thighs. 2/ =oderate flexion the chin is not touching the chest but is in an alert or military position / !oor flexion the bac2 is arched, the nec2 in extended and a fetus is in complete extension, presenting the occipitomental

. !ower forces acting together to expel fetus from the uterus 2 T>!,( of !O?,$ a. !rimary !owers involuntary contractions of the uterus b. (econdary !owers: voluntary bearing down efforts of the mother #. !syche reflects the woman+s frame of mind in dealing with the labor experience (tructure of the fetal s2ull *ranium uppermost portion of the s2ull, comprises eight bones. : the four bones' the frontal -actually 2 fused bones/, 2 parietal and occipital. : The other four' sphenoid, ethmoid, and 2 temporal bones The (uture Lines'

diameter of the head to the birth canal -face presentation/ ,ngagement refers to the settling of the presenting part of a fetus far enough into the pelvis to be at the level of the ischial spines. 3loating a presenting part that is not engaged )ipping one that is descending but has not yet reached the ischial spines (tation refers to the relationship of the presenting part of a fetus to the level of ischial spines 9 station presenting part of a fetus is at the level of the ischial spines :# station head is at outlet C# station head is floating 3,T1L L%, the relationship between the long axis of the body and the long axis of a woman+s body 2 !rimary Lie 1. Longitudinal 2. Transverse

%n some women, contractions appear to originate in the lower uterine segment rather than in the fundus. !hases !hases' increment, acme, decrement %ncrement: when the intensity of the contraction increases 1cme: when the contraction is at its strongest )ecrement: when the intensity decreases 1s labor progresses the relaxation intervals decrease from 19 minutes to 2 minutes The duration also changes from 29: 9 sec to a range of F9:B9 sec

3,T1L !$,(,6T1T%O6( denote the body part that will first contact the cervix of be born first. : this is determined by a combination of fetal lie and the degree of flexion =ain !resentations a. *ephalic the fetal head is the body part that will first contact the cervix : the four types of cephalic presentation' vertex, brow, face and mentum b. 7reech either the buttoc2s or the feet are the first body part that will contact the cervix : the type of breech presentation' complete, fran2, and footling/ c. (houlder the presenting part is usually one of the shoulders -acromion process, an iliac crest, a hand, or an elbow !O(%T%O6 the relationship of the presenting part to a specific 4uadrant of a woman+s pelvis <T,$%6, *O6T$1*T%O6(' Origins Labor contractions begin a Dpacema2erE point located in the myometrium near one of the uterotubal @unctions

*ontour *hanges <pper segment becomes thic2er and active, preparing it to be able to exert the strength necessary to expel the fetus when the expulsion phase of labor is reached The lower segment becomes thin:walled, supple, and passive so that the fetus can be pushed out of the uterus easily !hysiologic retraction ring a ridge on the inner uterine surface that mar2s the boundary between the 2 portions !athologic retraction ring -7andl+s ring/ it is a danger sign that signifies impending rupture of the lower uterine segment if the obstruction to labor is not relieved *ervical *hanges ,ffacement (hortening and thinning of the cervical canal 6ormally the canal is 1:2cm ?ith effacement the canal virtually disappears because of longitudinal traction from the contracting uterine fundus )ilation $efers to the enlargement or widening of the cervical canal from an opening of few millimeters wide to one large enough -19cm/. 3irst reason why dilation occurs is uterine contractions gradually increase the diameter of the cervical canal lumen by pulling the cervix up over the presenting part of the fetus (econd, the fluid:filled membranes press against the cervix 1s dilation begins there is large amount of vaginal secretions -show/ because the last of the operculum or mucus plug in the cervix is dislodged and capillaries in the cervix rupture

(T15,( O3 L17O$ 1. (tage 1 -stage of dilatation/ begins with the true labor pains and ends when the cervix has reached full dilatation 6ursing *are' (tay with woman; provide constant support $eminds, reassures and encourages woman to reestablish breathing patterns and concentration as needed !rompts partial respirations if woman begins to push prematurely accepts woman inability to comply with instructions Geeps woman aware of progress # !hases' Latent !hase 7egins at the regularly perceived uterine contractions and ends when rapid cervical dilatation begins *ontractions are mild and short lasting 29:#9 seconds *ervix dilates from 9: cm F hours in nullipara #.& hours in multipara 6ursing *are' : 1ssists woman to cope with contraction : "elps to concentrate in breathing techni4ues : 1ssists into comfortable position : %nforms woman of the progress of labor : ,xplains procedure and routines : Offer fluids, ice chips, food as ordered 1ctive !hase )ilatation increases from # H cm *ontraction lasts #9:F9 sec and occur every :& minutes hours in nullipara 2 hours in multipara (how and spontaneous rupture of membranes may occur 6ursing *are' :

*ontractions reached their pea2 of intensity occurring every 2: minutes with duration of F9:B9sec =aximum dilatation I:19cm *omplete cervical effacement ?oman experiences intense discomfort accompanied by nausea and vomiting ?oman may also experience a feeling of loss of control, anxiety, panic or irritability 2. (tage 2 -(tage of ,xpulsion/ the period from full dilatation to birth of the infant *ontractions change from the characteristic crescendo:decrescendo pattern to overwhelming uncontrollable urge to push or bear down with each contraction as if to move her bowels ?oman perspire and the blood vessels in her nec2 may become distended *rowning ta2es place The need to push become intense and the woman cannot stop herself F *ardinal =ovements of the =echanism of labor o )escent downward movement of the biparietal diameter of the fetal head to within the pelvic inlet : full descent occurs and the fetal head extrudes beyond the dilated cervix and touches the posterior vaginal floor o 3lexion the head bends forward onto the chest, ma2ing the smallest anteroposterior diameter o %nternal rotation the occiput rotates until it is superior, or @ust below the symphysis pubis, bringing the head into the best relationship to the outlet of the pelvis o ,xtension as the occiput is born, the bac2 of the nec2 stops beneath the pubic arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head, the face and chin are born. o ,xternal $otation almost immediately after the head of the infant is born, the head rotates -from the anteroposterior position it assumed to enter the outlet/ bac2 to the diagonal or transverse position of the early part of labor o ,xpulsion the rest of the baby is born easily and smoothly because of its smaller part si0e. The end of the pelvic division of labor. 6ursing *are'

3inds assessment techni4ues between contractions : 1ssists with fre4uent position change : 1pplies counter pressure to sacrococcygeal area : ,ncourages and praises : Geeps woman aware of progress : *hec2 bladder and encourages voiding : 5ives oral care Transition !hase

!ut both legs at the same time when positioning to the lithotomy position %nstruct mother to push as fetal head crowns. %f hyperventilation occurs, let patient breathe into a brown paper or a cupped hand.

1. ,nlarging of the vaginal opening 2. (hortening of the second stage of labor . =inimi0ing the stretching of the perineal muscle #. !reventing perineal tearing 3etal =onitoring periodic change or fluctuation in 3"$ occur in response to contractions and the fetal movements are described in terms of accelerations or decelerations : done through intermittent auscultation : electronic monitoring 1. ,xternal transabdominal, noninvasive, monitors uterine contraction and 3"$; client needs to decrease extra:abdominal movements 2. %nternal membranes must be ruptured, cervix sufficiently dilated and presenting part; invasive procedure; continuous monitoring : results of monitoring' normal 3"$ 129: 1F9; must obtain a baseline 1cceleration 1& bpm rise above baseline followed by return; usually in response to fetal movement or contractions; indicates fetal well:being )eceleration fall below baseline lasting 1& seconds or more, followed by a return' a. ,arly )eceleration are periodic decreases in the 3"$ resulting from pressure on the fetal head during contraction -head compression/ b. Late )eceleration indicative of fetal hypoxia because of deficient placental perfusion -uteroplacental insufficiency/ c. Aariable )eceleration occurs at unpredictable times during contractions and indicates cord compression 1nesthesia encompasses analgesia amnesia, relaxation and reflex activity. %t abolishes pain perception by interrupting the nerve impulses to the brain. The loss of sensation may be partial incomplete, sometimes with loss of consciousness. 1nalgesia refers to the alleviation of the sensation of pain or in the raising of the threshold for pain perception without loss of consciousness

. (tage -!lacental (tage/ begins from the delivery of the baby up to the delivery of the placenta 2 !hases' a. !lacental (eparation (igns' : Lengthening of the cord : (udden gush of blood : *hange of shape of the uterus b. !lacental ,xpulsion : 7randt 1ndrew+s =aneuver tract the cord slowly, winding it around the clamp until placenta spontaneously comes out rotating it slowly so that no membranes are left 6ursing *are' )on+t hurry the expulsion of the placenta, @ust watch for the signs of placental separation Ta2e note of the time of placental delivery %nspect for the completeness of the placenta !alpate the uterus to determine degree of contraction. %f relaxed, massage gently and apply ice cap %nspect for lacerations Types of !lacental !resentation (chult0e+s appearing shiny and glittering from the fetal membranes )uncan it loo2s raw, dirty, meaty, red and irregular

#. (tage # -!uerperium (tage/ first # hours after delivery of placenta )egrees of !erineal Lacerations' 1. 3irst )egree s2in and superficial to muscle 2. (econd )egree muscles of the perineum . Third )egree continues to anal sphincter #. 3ourth )egree involves the anterior anal wall ,pisiotomy incision made to the perineum to enlarge the vaginal opening for easy delivery Types' a. =idline8=edian b. =ediolateral c. Lateral 1dvantages'