Labor

and
Delivery
Prof. Roselyn M. Butalid, RN, MAN

Every
woman
s
dream

Every Womans Dream

The Labor
Process

A series of events by which uterine

contractions & abdl pressure expel the
fetus & the placenta from a womans
body.

Theories of Labor Onset

1.

Fetal Adrenal
Response
Theory

Hormones produced by
the fetal adrenal &
pituitary glands initiate
contractions.

Theories of Labor Onset

2. Uterine Stretch
Theory
Any hollow body
organ, when
stretched to
capacity, will
necessarily
contract & empty.

Theories of Labor Onset

3. Oxytocin Stimulation Theory
The stress during labor stimulates the
posterior pituitary gland to produce
Oxytocin & intensify contractions.

Oxytocin: Neuroendocrine Reflex

Theories of Labor Onset

4. Progesterone Deprivation Theory
As pregnancy nears term, decrease
progesterone in the placenta allows
uterine contractions to occur.

Theories of Labor Onset

5. Prostaglandin
Theory
In mature fetus,
fetal membranes
produce large amt. of
arachidonic acid
converted to
prostaglandins &
stimulate
contractions.

Theories of Labor Onset

6. Theory of Aging
Placenta
As the placenta ages,
there is decreased blood
supply & will cause the
uterus to contract.

PRELIMINARY

SIGNS OF
LABOR
LIGHTENING

A ACTIVITY LEVEL

INCREASES
B BRAXTON HICKS
CONTRACTIONS,
O
increased
R RIPENING OF THE
CERVIX

PRELIMINARY
Lightening
SIGNS

settling of the fetal head

into the inlet of the true
pelvis
occurs approx. 2 weeks
before labor onset
(primipara); in multipara
unpredictable

Effects:

relief of dyspnea

ed urinary frequency

Leg pains

ed vaginal discharge

fundal height

PRELIMINARY SIGNS

Loss of Weight

Increase in Level
of Activity/ Excess
energy

Ripening of the
cervix

PRELIMINARY SIGNS

Increased Braxton hicks

contractions

TRUE SIGNS OF
LABOR
C CONTRACTIONS
S

SHOW

R
RUPTURE OF
MEMBRANES

Differences between false labor

& true labor contractions
False labor

True labor

1. No increase in intensity,
duration & frequency of uterine
contraction

Uterine contractions increase in

intensity, frequency & duration

2. Contractions disappear with

ambulation

Ambulation increases
contractions

3. Discomfort remains in the

abdomen

Discomfort radiates to the lower

back or lumbosacral area

4. Contraction stops when

woman is sedated

Contraction persists when the

woman is sedated

5. Absence of cervical dilatation

Progressive cervical dilatation

6. Absence of show

Presence of show

TRUE SIGNS OF
LABOR
C CONTRACTIONS

S SHOW
R
RUPTURE OF
MEMBRANES

- Pinkish vaginal discharge

Once membranes rupture

Labor is inevitable
Integrity of the uterus
is destroyed
High risk of umbilical
cord compression/cord
prolapse

Assessment of Amniotic Fluid

Clear or straw colored with specks of

vernix caseosa

Gray colored or
Cloudy; Foul
smelling

Green tinged
Yellow colored
Pinkish or red
stained
Brownish/Tea
colored/

Infection
Fetal distress in non breech
presentation
Hemolytic
disease;
Hyperbilirubine
Bleeding
mia

Fetal death

Essential Factors of Labor

(5 Ps)
P Passages
P Passenger
P Powers
P
Person/psyche
P Position

Essential Factors of Labor

(5
Ps)
1. Passages

Hard Passage: bony pelvis

Soft passages: lower uterine segment,

cervix, pelvic floor, vagina & perineum
2. Passenger: fetal position, presentation &
attitude
3. Power

Primary force: involuntary uterine

contractions

Secondary force: voluntary use of the

thoracic, diaphragm & abdominal
muscles when the mother bears down
4. Person/Psyche: Maternal attitude during
labor

PASSAGE

route of the fetus

PASSENGER

Refers to the
fetus

Structure of the Fetal

Skull
Important parts of
the fetal
skull/common
presenting parts

Frontal bone
Occipital bone
Parietal bone

Structure of the Fetal

Membrane
spaces/
Skull
suture lines:
Sagittal suture
line -joins the 2
parietal bones
2. Coronal suture
line - joins the
frontal & parietal
bone
3. Lambdoid
suture line
. joins the occiput &
the parietals
1.

Suture lines allow

2
3

MOLDING

Change in shape
of the fetal skull
Last only a day or
two

Structure of the Fetal

Skull
Fontanels
Anterior
fontanel
larger,
diamond
shaped
closes between
12-18 months
Posterior
fontanel
smaller,
triangular
shaped
between

Diameters of the Fetal

Skull
Fetal skull: AP > T
Anteroposterior
diameter:
A. Suboccipitobregmatic
9.5 cm (full flexion)
B. Occipitofrontal
12 cm (moderate
flexion)
C. Occipitomental
13.5 cm (poor flexion)

A
B
C

FETAL ATTITUDE

Degree of
flexion of the
fetus

FETAL ATTITUDE
Full flexion/very good
attitude

Chin is flexed on the chest

Smallest AP diameter is
presenting
Moderate flexion

Occipitofrontal
Poor flexion

Widest occipitomental
diameter is presented

FETAL ENGAGEMENT
Settling of the presenting part into
the pelvis to be at the level of the
ischial spines (midpoint of the pelvis)

FETAL STATION

Relationship of the presenting part to

the level of the ischial spines

Station 0 =

presenting part is at the

level of ischial spines

synonymous with
engagement
Station -1 =

1 cm above the ischial

spines
Station +1 =

1 cm below the level of

the ischial spines
Station +3 or +4 =

presenting part is at the

perineum

FETAL
PRESENTATIO
(Fetal
N Lie)
Relationship
between the
long axis of the
fetal body &
long axis of the
mothers body

Types
I. Vertical
A. Cephalic

B. Breech

1. Vertex

1. Complete

2. Sinciput

2. Frank

3. Brow

3. Footling

4. Face

a. Double

5. Chin

b. Single

II. Horizontal /transverse

1. Shoulder
III. Compound

FETAL PRESENTATION
Types:
I. Vertical
A. Cephalic -

FETAL PRESENTATION
I. Vertical
A. Cephalic Presentation
1.Vertex
. Head is sharply/completely
flexed
. Full flexion / very good attitude
. Most ideal
2. Sinciput
. Head is partially flexed
. Anterior fontanel /
Occipitofrontal diameter is
presenting
3. Brow presentation
. Head is extended or bent

FETAL PRESENTATION
4. Face presentation
Head is sharply extended
Occiput comes in contact
with the back

5. Chin
presentation
Head is
hyperextended
Chin is presenting

B. Breech
Feet or buttocks are the
presenting parts
1. Complete
. Feet & legs are flexed on the
thighs & the thighs are flexed
on the abdomen
2. Frank
. Hips are flexed & the legs are
extended, the anterior thighs
are in contact with the
abdomen
. Buttocks are the presenting
part
. Most common type

3. Footling
a.Double
. legs unflexed & extended
. feet are presenting
b. Single
. one leg unflexed &
extended
. one foot is presenting

FETAL PRESENTATION
II. Horizontal /
transverse lie/ shoulder
presentation
Fetus is lying perpendicular
to the long axis of the
mother
Shoulder is the presenting
part

III. Compound
presentation

E
X
T
E
R
N
A
L
V
E
R
S
I
O
N

FETAL POSITION

Relationship of
the fetal
presenting part
to a specific
quadrant in the
womans pelvis

4 quadrants:
Right anterior
Right posterior
Left anterior
Left posterior

FETAL POSITION
First letter

Defines whether the landmark

is
pointing to the mothers
Middle letter Denotes the fetal landmark
right or leftentum
Occiput
M
Sa
crum A cromion process

Last letter

Defines whether the landmark

points
Anteriorly (A) Posteriorly
(P) Posterior
Ex. LOP Left Occipito
Transversely
(T)portion of the left
Occiput is pointing
the posterior

quadrant of the mothers pelvis

Posterior positions result in more backaches

D FIRE
ERE

CARDINAL MOVEMENTS/
MECHANISM OF LABOR

Engagem
ent
Descent
Flexion
Internal
Rotation
Extensio
n

Every
darn
fool in rotterdam eats
rotten
egg rolls everyday!

Descent
Downward movement of the biparietal
diameter of the fetal head to within the
pelvic inlet.
Flexion
The head bends forward onto the
chest, making the smallest AP diameter

Internal Rotation
The head flexes as it touches the pelvic
floor, & the occiput rotates until it is
superior or just below the
symphysis pubis.

Extension
The occiput is born
External rotation
The head rotates back to transverse
position (RESTITUTION)
This brings shoulders into AP position to enter
the outlet.

Expulsion
Once the shoulders are born, the rest of
the baby is born easily & smoothly
because of its smaller size.

Mechanisms of Labor