Normal Labor & Delivery Part 1 PDF

Maternity and Women Health Nursing Care (NUR 335) NORMAL LABOR AND DELIVERY Dr. Anwar Alkhunaizi  At the end of the lecture, students will be able to: Define normal labor Explain the stages of normal labor Objectiv...

Maternity and Women Health Nursing Care (NUR 335) NORMAL LABOR AND DELIVERY Dr. Anwar Alkhunaizi  At the end of the lecture, students will be able to: Define normal labor Explain the stages of normal labor Objectives Discuss the mechanisms of normal labor Explain the nursing management of normal labor  THE PROCESS OF NORMAL LABOR ❑ Labor is defined as the onset ❑ Labor is the process by ❑ The exact mechanism of regular painful contractions which the end production of that triggers the onset with progressive cervical conception(fetus ,placenta of labor is unknown effacement and dilatation of ,cord, amniotic fluids and 3 cervix accompanied by the amniotic sac)are expel from descend of the presenting the uterus part. Criteria for a normal labor!  Criteria for a normal labor The following criteria should be present to call it normal labor Spontaneous expulsion, of a single Through the birth canal Without mature fetus (37 (i.e. vaginal delivery), complications to completed weeks 42 within a reasonable time (not less than 3 hours or the mother, or the weeks), more than 18 hours) fetus. presented by vertex.  MAJOR VARIABLES Psyche IN preparation, THE BIRTH PROCESS Previous birth Passage(Pelvis) experiences size and shape “Four Ps”. -- 4 components must work together for labor to progress normally Passenger fetus Powers size and position effectiveness of contractions  Passage ▪ The route that the fetus must travel when leaving the uterus. ▪ Type of pelvis: Gynecoid (is considered the true female pelvis, this shape offers the optimal diameters in all three planes). ▪ Pelvis must be of adequate size for the fetus to pass through.  Passage ▪ Soft Tissues: consist of the cervix, the pelvic floor muscles and the vagina. Through effacement the cervix thins to allow presenting fetal part to descend in to vagina. The pelvic floor muscles help the fetus to rotate anteriorly. The vagina expand to accommodate the fetus. Passenger Includes Fetus Placenta Membranes Amniotic fluid FETOPELVIC RELATIONSHIP  Fetal Engagement: The entrance of the largest diameter of Fetal Skull: (Size Fetal Attitude: the presenting part into the smallest and molding) (degree of body flexion) diameter of the maternal pelvis Fetal Lie: relationship of FETOPELVIC body parts Fetal Presentation: RELATIONSHIP (first body part) Fetal Station: relationship Fetal Position: of presenting part to the relationship to maternal pelvis level of the maternal pelvis  Fetal skull FETOPELVIC RELATIONSHIP  Fetal skull FETOPELVIC RELATIONSHIP  BONY SKULL OF FETAL HEAD Fetal skull Separated by strong Composed of connective tissue several bones(5) Sutures (allow flexibility and 2 frontal, 2 parietal bones, and overlapping of bones, so the occiput are important during smallest skull diameter will pass) childbirth  FETAL ATTITUDE Relation of fetal extremities to the fetal body (Flexion or extension) ❑ The most common fetal attitude when labor begins is with all joints flexed- the fetal back is rounded, the chain is on the chest, the thighs are flexed on the abdomen, and the legs are flexed at the knees. ❑ The normal fetal position is most favorable for vaginal birth, presenting the smallest fetal skull diameters to the pelvis. FETAL ATTITUDE FETAL LIE Fetal Lie Refers to the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother. There are three possible lies: longitudinal (which is the most common), transverse and oblique. Longitudinal Lie When the long axis of the fetus is parallel to that of the mother (fetal spine to maternal spine side by side) Transverse Lie When the long axis of the fetus is perpendicular to the long axis of the mother Oblique Lie When the long axis of the fetus is at an angle to the bony inlet, and no palpable fetal part is presenting. Fetal Presentation  Fetal ▪ Refers to the body part of the fetus that presentation enters the pelvic inlet first (the presenting part) ▪ The three main fetal presentations are cephalic (head first) 97%, breech (pelvis first), and shoulder (scapula first) Fetal presentation  Fetal Position Relation of the presenting part of the fetus to a designated point of the maternal pelvis. The landmark fetal presenting parts include: Occipital bone (O) Chin (mentum)(M) Buttocks (sacrum) (S) Scapula (Acromion process (A) Vertex presentation Face presentation Breech presentation Shoulder presentation  Fetal Position LO A (left occipito anterior) R O A (right occipito anterior) are the most common Thank you! Write a closing statement or call-to-action here. Fetal Position Thank you! Write a closing statement or call-to-action here. Fetal Station ▪ Refers to the relationship of the presenting part to the level of the maternal pelvis ischial spines Fetal Station Zero (0) -1 +1 Zero (0) station is If the presenting part is If the presenting part is designated when the above the ischial spines by below the ischial spines presenting part is at 1 cm, it is documented as by 1 cm, it is the level of the being a -1 station documented as being +1 maternal ischial spines  Fetal The entrance of the largest diameter of the Engagement presenting part into the smallest diameter of the maternal pelvis Engagement occurs in primigravidas 2 weeks before term, whereas multiparas may experience engagement several weeks before the onset of labor The term floating is used when engagement has not occurred, because the presenting part is freely movable above the pelvis inlet.  POWER (CONTRACTIONS + MATENAL PUSH) CONTRACTIONS AND THE CERVIX DILATATION ▪ Begins in top of ▪ Spreads throughout ▪ Cause cervix to efface ▪ Contractions push fetus uterus down ward and pull uterus (fundus) (thin) and dilate (open) cervix upward ▪ Cervix becomes thinner and shorter PSYCHE ▪ Psyche means the feelings that the woman brings to labor ▪ It is part of labor process ▪ Anxiety or fear decreases woman’s ability to cope ▪ Maternal catecholamines(stress hormones)known to inhibit contractility and placental blood flow ▪ Relaxation augments natural process of labor