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1

What are some factors effecting labour?

• Place of birth
• Preparation for labour
• Type of provider (nurses vs. physicians)
• Procedures that may need to take place
- the 5 P's

2

What are the 5 P's?

• Passenger – the fetus & the placenta
• Passageway- the birth canal
• Powers – types of contractions
• Position- of the mother
• Psychological response to labour

3

What is the passenger and how does (P1) the passenger effect labour?

- the movement of the fetus through birth canal, placenta also must pass through birth canal but rarely impedes the process of labour in a normal vaginal birth
- size and relative rigidity makes the fetal head have a major effect on the birth process

4

How long does it take for a new borns head to go back to its normal shape?

within 3 days

5

What is the fetal presentation and how does (P2) the fetal presentation effect labour?

- part of the fetus entering the pelvis (cephalic, breech, shoulder)

6

What is presentation (P2) effected by?

FETAL LIE
• vertical or longitudinal
• fetus’s spine position compared to mom’s spine position
FETAL ATTITUDE
• flexion of the baby’s body and neck – a characteristic posture
FETAL POSITION
• The presenting part indicates the portion of the fetus that overlies the pelvic inlet
• 3 letters describe the relationship between the
presenting part and the 4 quadrants of the mother’s pelvis
• ROA = occiput is on right front of mother’s pelvis or “right occiput anterior”

7

What does station mean?

measured as above or below the ischial spines
• how far into the mother’s pelvis the fetus’s presenting part is

8

What is engagement?

• engagement
the presenting part has passed into the true pelvis
Primipara- a few weeks before Multipara before or during labour

9

What is the passageway (P3) and how does it effect labour

SIZE AND SHAPE OF BONY PELVIS
– bony pelvis = fusion of the ilium, ischium, pubis & sacral bones
– Pelvic inlet, cavity & outlet
– Affects labour as the fetus must pass beneath the pubic arch –
SOFT TISSUES – cervix (neck of the uterus), lower uterine segment, pelvic floor muscles, vagina
– Efface: Must thin
– Dilate: Must open to allow fetus through vagina
– Contractions exert pressure on fetus pushing baby against
cervix

10

What are the 2 types of powers (P4) effecting labour?

PRIMARY POWER
Involuntary uterine contractions
SECONDARY POWER
Bearing down to deliver infant – mother contracts her diaphragm and abdominal muscles and pushes

11

What is Ferguson's reflex?

Involuntary urge to bear down and push
• Causes fetus to be pushed down and out of birth canal
• Occurs when the presenting part reaches the pelvic floor
• Cervix is stretched and then oxytocin is released by the stretch receptors

12

What is mothers position (P5) and its effect on labour?

- need for frequent changes to relieve fatigue, discomfort, circulation, and effects the strength of contractions
- use gravity in labour

13

What are some psychological responses to labour?

- Conflicting emotions
• Anxiety & fear
• Desire to have it over

14

What are nursing responsibilities in regards to psychological responses to labour?

- Assess
- Monitor wellbeing
- Alleviate discomfort
- provide health teaching
- provide emotional support
- protect privacy and modesty

15

What are signs preceding labour?

- Lightening (heads descent)
- urinary frequency
- backache
- weight loss (from water)
- Stronger braxton hicks contractions
- increased vaginal discharge
- surge in energy (nesting)
- cervical ripening (softens, efface and dilate)
- ROM

16

What is labour?

• The process of moving fetus, placenta and membranes out of the uterus & through birth canal

17

What is labour marked by?

Decreased progesterone
• Increased effects of estrogen
• Increased effects of oxytocin & prostaglandin
• The uterus is stretched & distended @ term • Course of “normal” labour
• regular contractions- they are more frequent & more intense over time
• effacement and dilatation of cervix
• descent of fetus

18

What are the 4 stages of labour?

1. Dilation and effacement of cervix
2. Expulsion
3. Placenta
4. 4th stage of labour

19

How long does the 1st stage of labour take?

• Primipara: up to 18 hours (or more)
• Multipara: can be 8 -12 hours (or less)

20

How do you know its true labour?

– contractions - regular, get stronger and closer together
– become more intense with walking
– cervix changes by effacing and dilating
– presence of bloody show
– fetus usually engaged in pelvis

21

What are the 3 phases of the first stage of labour?

LATENT
• Mild to moderate contractions - 5 to 30 minutes apart • Cervix effacing; dilates from 0 – 3 cm
• Station: 0 to -2
ACTIVE
• Moderate to strong contractions- 3-5 minutes apart • Cervix continues effacing; dilates from 4 – 7 cm
• Station: +1 to +2
TRANSITION
• Strong to very strong contractions- 2 to 3 minutes apart • Cervix dilates from 8 – 10 cm
• Station: +2 to +3

22

How should you care for woman in early labour?

• Encourage to stay home
• Offer support
• Suggest: Ambulation, diversional activities, warm shower
• Recommend oral intake of appropriate fluid & food
• Health teaching- when to come to the hospital:

23

When should you come to the hospital

• ROM (rupture of membranes)
• change in fetal movement
• bleeding
• contractions increase in intensity/<5mins

24

When are woman usually admitted?

• Stage 1 – active phase
• 3-4 cm dilated, 80-90% effaced (1st baby)

25

What is assessed on admission?

Assess for prenatal care
• √ for GBS
Review birth plan
• Who will be present
• Preferred positions for labour
• What comfort measures are desired
• Any particular cultural/religious practices
Assess/reinforce
• Coping mechanisms, pain management options, assess anxiety and fear,
• Common perceptions of pain medications during labour
• Identify and address any concerns at this time

26

What does the physical assessment of the woman entail?

• VS & FHR (fetal heart rate)
• Brief systems assessment- confirm true labour
• Pain assessment
• Assess contractions (frequency, intensity, and duration) & resting tone
- Monitor intensity
• Vaginal examination (cervical changes, fetal position, FGM)
• Assessment of membranes – intact vs. ruptured
• If ROM fluid colour; is clear, pale, watery, yellow-green (meconium)
• Discourage supine position d/t decreased BP
• Last fluid intake and solid food intake for hydration assessment

27

What is assessed on the fetus?

Assess FHR and pattern
• Intermittent auscultation; count FHR - when? • Stage 1 in the active phase: q 15-30 mins. • Stage 2: q 5 mins. during active pushing
FHR (normal range)
• Range 110-160 bpm usually

28

What do you do when the FHR is abnormal?

• Focus to improve uterine blood flow - increased oxygenation
• Change position to side lying
• Make sure woman not holding breath during
contraction
• O2 as needed

29

What does the leopards manoeuvres help to identify?

• Number of fetuses
• Presenting part, fetal lie, fetal attitude
• Degree of descent of the presenting part into the pelvis
• Expected location of the PMI of the FHR on the woman’s abdomen

30

When should we use EFM?

• Any pregnancy considered high risk
• Induction or augmentation of labour
• Decreased fetal movement
• Premature labour
• Premature rupture of membranes
• Oligohydramnios, hypertension, abnormal fetal heart rate, fetal malpresentation in labour, IDDM, multiple gestation, previous C/S, trauma, meconium