Physiological changesSecondary to pain In labor.

Discomfort during laborA = First stageB= later phase of 1st stage

to 2nd stageC= 2nd stage actual

birth

Exercises often taught during childbirth classes

Discomfort in labor from:

Cervical dilation & effacement - first stationUterine ischemia - throughoutPerineal stretching - end of 1st & 2nd stageFearAnxietyTension

Process of Labor & Delivery

To understand the complex process of L&D it isImportant to examine each of the factors involved.These are frequently called the five or even 6 P’s.

Passageway = pelvis & soft tissuesPassengers = fetus & placentaPowers = Contractions & voluntary effort of mom (push)Position of mother = standing, walking, side lying,

squatting, on hands & knees VS lithotomyProcess = all parts working together

& # 6 Psychological condition of mom

Passenger

MOLDING

A = Vertex note the flexion

B = Sinciput

C = Face note extension

D = Brow or Military

ROA & LOAWHY BEST

0 = ischeal spines

Placenta is also apassenger

PRIMARY POWER - CONTRACTION

Position of mother may also influence the secondary power of pushing. Walking, sitting, kneeling, squatting are all importantaspects of position changes that are helpful.Squatting may increase size 20 - 40%. Hands & knees may help posterior fetus turn to anterior position. Remember back labor.

Psychological state of mother is another importantP to remember.Education, Preparation, Support are all going to help with the labor process

Vaginal Exam – What can the examiner find out ?Effacement, Dilitation, Membranes intact, Presenting part, Presenting part, Fetal AttitudeStation, if presenting part is A, P, T, fetal scalp stimulation, fetal scalp PH

NOT doneIf vaginalBleedingWHY ??

Placenta Previa

Mechanisms of Labor – engagement, decent, flexion,Internal rotation

Descent

INTERNALROTATION

COMPLETIONOF INTERNALROTATION & BEGINNING OFEXTENSION

INTERNALROTATION

COMPLETIONOF INTERNALROTATION & BEGINNING OFEXTENSION

CROWNING - EXTENSION

EXTENSIONCOMPLETE

EXTERNALROTATION

EXTERNALROTATION – NOTE SHOULDERS-RESTITUTION

EXPULSION

EXPULSION

LOAMechOf labor

A = breech beforelaborB = engagement& internal rotationC = lateral flexionD = external rota. resitutionE = face rotates tosacrum when occiput is anteriorF = internal rotationof shoulders & headG = head born bygradual flexionduring evacuationof fetal body

Mechanism of labor in Breech Delivery

CORD VESSELS

PLACENTA

MATERNAL SIDEDIRTY DUNCAN

FETAL SIDESHINY SCHULTZ

CHECKING FUNDUS

STRIA GRAVIDARIUM &LINIA NIGRA

MORE MATERNAL ADAPTATION TO LABOR

M0RE MATERNAL ADAPTATIONS TO LABOR

M0RE MATERNAL ADAPTATIONS TO LABOR

Vaginal exam reveals:Cervical effacement = %Cervical dilatation = in centimeters - 4 “Membranes intact = if not sure check with nitrizide paperFetal presentationFetal stationFetal attitudeIf presenting part A, P or TFetal scalp stimulationFetal scalp blood phAttach internal monitor