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MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH

MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH

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MODULE 2 INTRAPARTUM PROCESSES OF LABOR AND BIRTH

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  1. MODULE 2 INTRAPARTUMPROCESSES OF LABOR AND BIRTH

  2. KEY FACTORS RELATED TO PROGRESS OF LABOR • FORCES OF LABOR • INTRAPARTAL ASSESSMENT AND CARE OF MOTHER AND FETUS • CARE OF MOTHER AND INFANT IN LABOR, DELIVERY, AND IMMEDIATE POST PARTUM • BIRTH RELATED PROCEDURES

  3. MODULE 2 PART 1KEY FACTORS RELATED TO PROGRESS OF LABOR

  4. KEY FACTORS RELATED TO PROGRESS OF LABOR • PASSAGEWAY (BIRTH CANAL) • PASSENGER (FETUS) • POSITION OF THE MOTHER AND FETUS • PHYSIOLOGICAL FORCES OF LABOR • PSYCHOSOCIAL CONSIDERATIONS

  5. BIRTH PASSAGE • SIZE OF PELVIS • TYPE OF PELVIS • CERVICAL DILATATION, EFFACEMENT • ABILITY OF VAGINA AND INTROITUS TO EXPAND

  6. BIRTH PASSAGE • FOUR CLASSIC PELVIC TYPES • GYNECOID • ANDROID • ANTHROPOID • PLATYPELLOID

  7. BIRTH PASSAGE CERVICAL DILATATION AND EFFACEMENT • DILATATION—MEASURED IN CENTIMETERS FROM 0 TO 10 • 0 CM—CERIVX CLOSED • 10 CM—FULL DILATATION • EFFACEMENT—MEASURED IN PERCENTAGE 0 TO 100%

  8. Figure 15–11a Effacement of the cervix in the primigravida. Beginning of labor. There is no cervical effacement or dilatation. The fetal head is cushioned by amniotic fluid.

  9. Figure 15–11b Beginning cervical effacement. As the cervix begins to efface, more amniotic fluid collects below the fetal head.

  10. Figure 15–11c Cervix about one-half effaced and slightly dilated. The increasing amount of amniotic fluid exerts hydrostatic pressure.

  11. Figure 15–11d Complete effacement and dilatation.

  12. UTERINE AND CERVICAL CHANGES • UPPER UTERINE SEGMENT THICKENS AND PULLS UP • LOWER SEGMENT EXPANDS AND THINS OUT • EFFACEMENT • CAUSES OF UTERINE CHANGES • ESTROGEN STIMULATES MUSCLE CONTRACTIONS • COLLAGEN IN CERVIX BROKEN DOWN • INCREASED WATER CONTENT OF THE CERVIX

  13. MODULE 2 PART 2THE PASSENGER (FETUS)

  14. FETUS (PASSENGER) • SIZE OF FETAL HEAD • FETAL ATTITUDE • FETAL LIE • FETAL PRESENTATION • IMPLANTATION SITE OF PLACENTA

  15. PASSENGER • FETAL HEAD • SUTURES • FRONTAL • SAGITTAL • CORONAL • LAMBOIDAL • MOLDING • FONTANELLES

  16. Figure 15–2 Superior view of the fetal skull.

  17. PASSENGER LANDMARKS OF FETAL SKULL • MENTUM • SINCIPUT • ANTERIOR FONTANELLE (BREGMA) • VERTEX • POSTERIOR FONTANELLE • OCCIPUT

  18. Figure 15–4a Typical anteroposterior diameters of the fetal skull. When the vertex of the fetus presents and the fetal head is flexed with the chin on the chest, the smallest anteroposterior diameter (suboccipitobregmatic) enters the birth canal.

  19. Figure 15–6a Cephalic presentation. Vertex presentation. Complete flexion of the head allows the suboccipitobregmatic diameter to present to the pelvis.

  20. Figure 15–6c Brow presentation. The fetal head is in partial (halfway) extension. The occipitomental diameter, which is the largest diameter of the fetal head, presents to the pelvis.

  21. PASSENGER FETAL LIE AND PRESENTATION • FETAL LIE-- Relation of long axis of fetus to long axis of the mother • Longitudinal • Transverse • FETAL PRESENTATION—the body part of the fetus that first enters the pelvis

  22. PASSENGER (PRESENTATION) CEPHALIC PRESENTATION (95%) • VERTEX—SUBOCCIPTOBREGMATIC • MILITARY--OCCIPITOFRONTAL • BROW--OCCIPITOMENTAL • FACE--SUBMENTOBREGMATIC

  23. PASSENGER (PRESENTATION) BREECH PRESENTATION (3%) • COMPLETE—HIPS FLEXED, KNEES FLEXED • FRANK—HIPS FLEXED, KNEES EXTENDED • FOOTLING—HIPS & FEET EXTENDED, FEET,FOOT PRESENT TO MATERNAL PELVIS • KNEELING—HIPS EXTENDED, KNEES FLEXED

  24. PASSENGER (PRESENTATION) SHOULDER (TRANSVERSE) PRESENTATION (2%) • TRANSVERSE LIE—SHOULDER IS USUAL PRESENTING PART • COMPOUND—USUALLY ARM OR HAND PRESENTING ALONG PRESENTING PART

  25. MODULE 2 PART 3POSITION OF MOTHER AND FETUS

  26. POSITION OF FETUS IN RELATION TO MOTHER’S PELVIS ENGAGEMENT • WHEN THE WIDEST DIAMETER OF THE PRESENTING PART HAS REACHED OR PASSED THE PELVIC INLET • ENGAGEMENT USUALLY CORRESPONDS TO O STATION • FLOATING—WHEN PRESENTING PART IS ENTIRELY OUT OF THE PELVIS AND FREELY MOVABLE IN THE INLET

  27. Figure 15–8 Measuring the station of the fetal head while it is descending. In this view the station is 22/23.

  28. POSITION STATION • RELATIONSHIP OF FETAL PRESENTING PART TO THE LEVEL OF THE ISCHIAL SPINES • THE ISCHIAL SPINES ARE O STATION • ABOVE THE SPINES IS A NEGATIVE VALUE • BELOW THE SPINES IS A POSITIVE VALUE

  29. MODULE 2 PART 4A PHYSIOLOGICAL FORCES OF LABOR

  30. PHYSIOLOGIC FORCES OF LABOR • CONTRACTION PHASES---INCREMENT, ACME, DECREMENT • DESCRIBED WITH FREQUENCY, DURATION, AND INTENSITY PRIMARY AND SECONDARY FORCES OF LABOR EFFECTIVENESS OF PUSHING DURATION OF LABOR

  31. Figure 15–10 Characteristics of uterine contractions.

  32. SIGNS OF LABOR • LIGHTENING • “BRAXTON HICKS” CONTRACTIONS • CERVIAL CHANGES • BLOODY SHOW • RUPTURE OF MEMBRANES • SUDDEN BURST OF ENERGY • WEIGHT LOSS • N&V, DIARRHEA, BACKACHE

  33. TRUE LABOR/FALSE LABOR • TRUE • CONTRACTIONS REGULAR, INCREASE IN DURATION & STRENGTH • INTERVAL SHORTENS • DILATATION & EFFACEMENT PROGRESS • INTENSITY INCREASES WITH WALKING • FALSE • CONTRACTIONS IRREGULAR, NO CHANGE IN DURATION, STRENGTH • INTERVAL IRREGULAR OR NO CHANGE • NO DILATATION OR EFFACEMENT • WALKING LESSENS OR HAS NO EFFECT ON CONTRACTIONS

  34. MODULE 2 PART 4BSTAGES OF LABOR

  35. FIRST STAGE OF LABOR • STARTS WITH BEGINNING OF REGULAR CONTRACTIONS TO FULL DILATATION • FIRST STAGE IS DIVIDED INTO THREE PHASES: LATENT, ACTIVE, AND TRANSITION

  36. PHASES OF LABOR—FIRST STAGE • LATENT---0--3 CENTIMETERS, CONTINUING EFFACEMENT • ACTIVE---4--7 CENTIMETERS, COMPLETE EFFACEMENT • TRANSITION 8--10 CENTIMTERS ENGAGEMENT

  37. CONTRACTION CHARACTERISTICS • LATENT PHASE • MILD—10-30MIN. LASTING 20-40 SECONDS • MODERATE—5-7MIN. LASTING 30-40 SECONDS • ACTIVE PHASE • MODERATE TO STRONG—2-3 MIN. LASTING 40-60 SECONDS • TRANSITION • STRONG—1-1/2-2 MIN. LASTING 60-90 SECONDS

  38. PSYCHOLOGIC ADAPTIONSTO LABOR: LATENT PHASE • FEELS ABLE TO COPE WITH DISCOMFORT • MAY BE RELIEVED THAT LABOR HAS FINALLY STARTED • USUALLY ABLE TO TALK THROUGH CONTRACTION • IS ABLE TO RECOGNIZE AND EXPRESS FEELING OF ANXIETY

  39. PSYCHOLOGIC ADAPTIONSTO LABOR: ACTIVE PHASE • ANXIETY INCREASES • FEARS LOSS OF CONTROL • MAY HAVE DECREASED ABILITY TO COPE • LESS TALKATIVE

  40. PSYCHOLOGIC ADAPTIONS TO LABOR: TRANSITION PHASE • WITHDRAWS INTO HERSELF • DOUBTS ABILITY TO COPE • APPREHENSIVE AND IRRITABLE • TERRIFIED OF BEING ALONE • DOES NOT WANT ANYONE TO TALK TO HER OR TOUCH HER • DIFFICULT TO CONCENTRATE ON TASK

  41. SECOND STAGE OF LABOR • BEGINS WITH COMPLETE CERVICAL DILATATION AND ENDS WITH THE BIRTH OF THE INFANT

  42. THIRD STAGE OF LABOR BEGINS WITH BIRTH OF INFANT AND ENDS WITH THE DELIVERY OF THE PLACENTA

  43. FOURTH STAGE OF LABOR BEGINS WITH DELIVERY OF PLACENTA TO 4 HOURS AFTER

  44. LABOR REVIEW • DESCRIBE THE FIVE CRITICAL FACTORS THAT INFLUENCE LABOR IN THE ASSESSMENT OF A MOTHER’S AND FETUS’ PROGRESS IN LABOR AND BIRTH, GIVING TWO EXAMPLES OF EACH