Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
St. Ignatius Lying-in CenterRLE 7
MTW 3-11PM
Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated.
Preparation:1. Instruct woman to empty her bladder first.2. Place woman in dorsal recumbent position, supine with
knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort.
3. Drape properly to maintain privacy.4. Explain procedure to the patient.5. Warms hands by rubbing together. (Cold hands can
stimulate uterine contractions).6. Use the palm for palpation not the fingers.
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Fundal Grip Purpose:• To determine fetal part lying in the fundus.• To determine presentation.
Procedure:• Using both hands, feel for the fetal part lying in the fundus.
Findings:• Head is more firm, hard and round that moves independently of the body.
• Breech is less well defined that moves only in conjunction with the body.
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Umbilical Grip Purpose:• To identify location of fetal back.• To determine positionProcedure:• One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts.• Use gentle but deep pressure.
Findings: Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular
nodulation
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Pawlik’s Grip Purpose:• To determine engagement of presenting part.
Procedure:• Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side.
Findings:• The presenting part is engaged if it is notmovable.
• It is not yet engaged if it is still movable.
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Pelvic Grip Purpose:• To determine the degree of flexion of fetal head.• To determine attitude or habitusProcedure:• Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament.• Use both hands.Findings:Good attitude – if brow correspond to the side (2nd maneuver) that containedthe elbows and knees.Poor attitude – if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head) Also palpates infant’s anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards woman’s back)
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
LAMAZE METHOD• The Lamaze method of childbirth was developed in France by
Dr. Fernand Lamaze in 1951.
• The method is based on the theory that through stimulus-
response conditioning, women can learn to use controlled
breathing to reduce pain during labor
• “Psychoprophylactic Method”: focuses on preventing pain in
labor (prophylaxis) by use of mind (psyche)
• Developed in Russia Major Concepts
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Six Major Concepts Let labor begin on its own. Letting the body go into labor on its own is
almost always the best way to know that the baby is ready to be born and
the body is ready for labor.
Walk, move around and change positions throughout labor. Moving
in labor (not confined to a bed) helps women cope with strong and painful
contractions, while gently moving the baby into the pelvis and through the
birth canal.
Bring a loved one, friend or doula for continuous support. In
childbirth, a woman feels better when supported by people she trusts and
those who use encouragement.
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Continuation… Avoid interventions that are not medically necessary. When
interventions (e.g., induction, epidural, continuous monitoring) are used in a
routine manner, women and babies are exposed to unnecessary risks.
Avoid giving birth on back and follow the body’s urges to
push. Upright positions are safe during pushing and can make it easier to
push the baby out. This could mean squatting, sitting or lying on the side
Keep mother and baby together – it’s best for mother, baby and
breastfeeding. Mother and baby share a natural instinct to be close after
birth, and experts recommend that a healthy newborn be placed and cared
for skin-to-skin on the mother’s abdomen or chest. Premises
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
THREE MAIN PREMISES OFGATE CONTROL METHOD OF PAIN RELIEF
1. Pain occurs to a lesser extent if a woman is relaxed
2. Sensations such as uterine contractions can be blocked from
reaching the brain cortex & registering as pain through active
interventions
3. Conditioned reflexes can also be used to displace pain
during labor
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Conscious Relaxation
• Learning to relax body portions deliberately so that
a woman does not remain tense and cause
unnecessary muscle strain and fatigue during
labor
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
The Cleansing Breath
• To begin all exercises, a woman breathes in
deeply and then exhales deeply. Stop to be
repeated to the end of each exercise.
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Consciously Controlled Breathing
• Setting breathing patterns at specific rates provides distraction as well as prevents the diaphragm from descending fully & putting pressure on the expanding uterus
• Inhale fully but comfortably, exhalation stronger that inhalation at a controlled pace depending on intensity of contraction.
BreathingLevels
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Level 1• Early contractions
• Slow chest breathing
• Comfortable but full respirations; 6-12 breaths/min
Level 2• Lighter breathing than Level 1
• Expansion of ribcage; diaphragm barely moves
• RR=40breaths per minute
• For cervical dilation between 4&6
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Level 3• Shallow breathing; at the sternum• RR= 50-70 breaths per minute• Respiration becomes faster, exhalation must be little
stronger than the inhalation• For transition contractions
Level 4• “pant blow” pattern; 3-4 quick breaths (in&out), then
forceful exhalation• Breath-breath-breath-hutt• “Choo-choo breathing”/ “hee-hee-hee-hoo” breathing
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
Level 5• Chest panting: continuous, very shallow• RR= 60 breaths per minute• Second stage of labor
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
EFFLEURAGE
• A distraction technique and decrease sensory stimuli
transmission from the abdominal wall• Light abdominal massage• A woman traces a pattern on her abdomen with her
fingertips• Rate should remain constant even when breathing
changes
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
FOCUSING OR IMAGERY
• “SENSATE FOCUS”• A method of keeping sensory output from reaching
the cortex of the brain through focusing intently on
an object
SECOND STAGE BREATHING• 2nd stage of labor• “physiologic” pushing: breathing out while pushing
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
LEOPOLD’S MANEUVER & THE LAMAZE METHOD
The End.
Leopold’sManeuver
CleansingBreath
ConsciouslyControlledBreathing
EffleurageFocusing
OrImagery
LamazeMethod
ConsciousRelaxation
