INTRAPARTUM CARE

 refers to the medical and

nursing care given to a
pregnant woman and her family
during labor and delivery
 Extends from the beginning of
contractions that cause cervical
dilation to the first 1 to 4 hours
after delivery of the newborn
and placenta.
1. Factors affecting labor
and delivery
a. Passageway

 refers to the adequacy of the

pelvis and birth canal allowing
fetal descent; factors include:
i. Types of female pelvis
 Gynecoid – typical female pelvis with a
rounded inlet
 Android – normal male pelvis with a
heart shaped inlet
 Anthropoid – is an “apelike” pelvis
with an oval inlet
 Platypelloid – is a flat, female-type
pelvis with a transverse oval inlet
ii. Structure of Pelvis
a. False pelvis vs. true pelvis
FALSE PELVIS - Superior half formed by the
ilia. Offers landmark for pelvic
measurements. Supports the growing fetus
into the true pelvis near the end of gestation
 
TRUE PELVIS - Inferior half formed by the
pubes in front, the ilia and the ischia on the
sides and the sacrum and coccyx behind.
 iii. Adequate deliver y
A. Pelvic Inletdiameter
diameter
Inlet – entrance way to the true pelvis. Its Transverse
diameter is wider than its anteroposteror diameter. Also
known as pelvic brim.

B. Pelvic Outlet diameter

Outlet – inferior portion of the pelvis, bounded on the
back by the coccyx, on the sides by the ischial
tuberosities and in front by the inferior aspect of the
symphysis pubis and the pubic arch. Its anteroposterior
diameter is wider than its transverse diameter.
Engagement
refers to settling of the presenting part of the
fetus into the pelvis to be at the level of the
ischial spine, a midpoint of the pelvis.
- descent to this point means the pelvic inlet is
proven adequate for birth
- “Floating”- a presenting part that is not
engaged.
- “Dipping”- one that is descending but has
not reached the ischial spine
Station
- or degree of engagement; refers to the
relationship of the presenting part of a fetus to
the level of the ischial spines
- minus stations (-1 to -4)= presenting part above
ischial spine, measurement in cm
- plus stations (+1 to +4)= presenting part below
ischial spine, measurement in cm
- station 0= presenting part engaged
- station -4= presenting part is floating
- station +4= presenting part is at outlet or it is
crowning (the encirclement of the largest
diameter of the fetal head by the vulvar ring)
b. Passenger

 This refers to the fetus and its ability to

move through the passageway.
i. Fetal skull
Size of the fetal head and capability of the
head to mold to the passageway.

o Molding- change in shape of fetal skull produced by

force of contraction pressing the head against the not-yet
dilated cervix
Fetal lie or presentation
The part of the fetus that enters the maternal pelvis first;
the body part that will be born first or contact the
cervix first
A. Cephalic - head first; ideal presentation for
NSVD because the bones of the skull are capable
of molding so effectively to accommodate the
cervix and may actually aid in cervical dilation
a. Vertex – head is sharply flexed, making the
parietal bones the presenting parts.
b. Face
c. Brow
d. Chin or mentum
B. Breech – either buttocks or feet first; difficult
birth; can be delivered NSVD
iii. Fetal Lie- relationship between the long axis of the fetal
body and the long axis f the woman’s body (cephalocaudal)
a. Horizontal (transverse)
b. Vertical (longitudinal)- cephalic or breech
iv. Fetal Attitude
The relationship of fetal parts to one another; degree of flexion a
fetus assumes during labor.
- GOOD ATTITUDE- if in complete flexion; the spinal column is
bowed forward, the head is flexed forward so much that the
chin touches the sternum, the arms are flexed and folded on
the chest, the thighs are flexed onto the abdomen and the
calves are pressed against the posterior aspect of the thighs
- MODERATE ATTITUDE- if chin is not touching the
chest but is in alert or military position
- POOR ATTITUDE- the back is arched, the neck is
extended and a fetus is in complete extension
v. Fetal position
The relationship of presenting part and the maternal
pelvis which is divided into 4 quadrants:
1. Right anterior
2. right posterior
3. left anterior
4. left posterior
 Four parts of the fetus have been
chosen as point of direction
 
1. Occiput – = in vertex presentation
2. Chin (mentum) – in face presentations
3. Sacrum – breech presentations
4. Scapula (acromion) – in shoulder
presentations.
Possible fetal positions:
LOA (left occipitoanterior)- most common fetal position
(birthing is fast)
LOP (left occipitoposterior)- difficult delivery; more
painful
LOT (left occipitotransverse)
ROA (right occipitoanterior)- second most frequent
(birthing is fast)
ROP (right occipitoposterior)- difficult delivery, more
painful
ROT (right occipitotransverse)

*Posterior positions may be more painful for the

mother, because the rotation of the fetal head
puts pressure on the sacral nerves causing sharp
back pain.
 
c. Power refers to the frequency, duration
and strength of uterine contractions to
cause complete cervical effacement and
dilatation.
Labor monitoring/ monitoring uterine contractions:
 fingers should be spread lightly over the fundus
 three phases of uterine contractions:
i. crescendo/increment- intensity of the contraction increase. This
phase is longer than the other two phases combined.
ii. acme/apex- the height or peak of the contraction
iii. decresenco/ decrement- intensity of the contraction decreases
d. Psyche refers to the client’s
psychological state, available
support systems, preparation for
childbirth, experiences and
coping strategies.
e. Placental factors refer to the
site of placental insertion.
 2. Premonitory/preliminary/ prodromal
signs of labor
a. Lightening – is the descent of the
fetus and uterus into the pelvic
cavity 2-3 weeks before the onset of
labor.
Effects of lightening
• Shooting pains down the legs because of pressure on
the sciatic nerve
• Increased lordosis as the fetus enters the pelvis and falls
further forward
• Increased amount of vaginal discharges
• Resurgence of sign of pregnancy like urinary frequency,
as the gravid uterus impinges on the bladder
• Relief of abdominal tightness and diaphragmatic
pressure
b. Loss of weight
2- 3 lbs is loss 2 days prior to onset of labor, probably
due to loss of appetite and decrease in
progesterone level that leads to fluids excretion
thus causing loss weight.
Progesterone – is known to cause fluid retention
c. Burst of energy or Increased tension
and fatigue “Nesting behavior” – may
occur right before the onset of labor.
Sudden burst of energy is due to increase in epinephrine in
response to the stress brought about by the
approaching delivery.
Pregnant woman should be caution not to use this energy
to carry out household chores because it is meant to
prepare the body for the labor.
d. Braxton Hicks contraction
irregular intermittent contractions that
have occurred throughout the
pregnancy, become uncomfortable
and produce a drawing pain in the
abdomen and groin; painless uterine
tightening
Also known as practice contraction.

e. Cervical changes include softening “ripening”

describe as butter soft and effacement of the
cervix that will cause expulsion of the mucous
plug (bloody show).
 f. Rupture of amniotic membranes or “the bag of
water” may occur before the onset of labor.
• Its rupture may be seen as a sudden gush, or a
scanty, slow seeping of amniotic fluid from the
vagina.
It is important to remember that once
membranes (BOW) have ruptured;
• Therefore labor is inevitable. Labor pains will set in
within the next 24 hours.
• Since the integrity of the uterus has been
destroyed, infection can easily set in. Thus, ASEPTIC
TECHNIQUE should be observed in doing perineal
care. Doctors do less of the IE and enema s no
longer given.
• Check for any umbilical cord compression and or
cord prolapsed especially in breech presentation)
o Aruptured.
woman seeking admission claims that her BOW has
FIRST NURSING ACTION: Put her to bed right
away, then take the fetal heart tones. She should be allowed
to remain in the standing position or sitting position because if
its true that BOW has ruptured, the possibility of cord
compression is high.
o If a woman in labor says that she feels a loop of the cord
coming out of her vagina (cord prolapse), IMMEDIATE
ACTION: Place her in trendelenberg position – to reduce
pressure on the cord. REMEMBER: only 5 minutes of cord
compression can already lead to CNS damage or even death

Apply a warm saline saturated OS on the cord to prevent crying of

the cord.
•Normal:
Color should be noted
o clear, almost colorless and
contains white specks of vernix
caseosa.
o Abnormal:
 green staining – amniotic fluid has
been contaminated with meconium
which signifies fetal distress if the fetus
is in a non-breech presentation

 yellow staining – may mean blood

incompatibility
 Pink stain – may indicate bleeding
• Ifwoman
labor does not occur within the next 24 hours, the
will have to be induced to go into labor by
administering intravenous drip of oxytocin (Pitocin).
g. Show This is the blood-tinged mucus discharged
from the vagina because of pressure of the
descending fetal part on the cervical capillaries,
causing their rupture. Capillary blood mixes with
mucus when operculum is release that is why SHOW
than a pinkish vaginal discharge.
 
Show should be distinguished from bright red vaginal
bleeding because the later is a danger sign during
this phase of pregnancy.
 ONSET OF LABOR
 Labor normally begins when a fetus is sufficiently
mature to cope with extrauterine life, yet not to
large to cause mechanical difficulties with birth.
 h. Onset of labor theories

Maternal Factor Theories Fetal Factor Theories

Uterine Stretch Theory Theory of Aging Placenta

Uterine muscles stretch to capacity, causingPlacental aging and deterioration triggers
release of prostaglandin initiation of contraction.
Oxytocin stimulation Theory Fetal cortisol, produced by the fetal
Pressure on the cervix stimulates nerveadrenal glands, rises and acts on the
plexus, causing release of oxytocin byplacental to reduce progesterone
maternal posterior pituitary gland. This isformation and increase prostaglandin.
known as Ferguson reflex. Prostaglandin produced by fetal
Prostaglandin Theory membranes (amnion and chorion) and the
Oxytocin stimulation in circulating blooddeciduas stimulates contractions. When
increases slowly during pregnancy risesarachidonic acid stored in fetal
dramatically during labor, peaks duringmembranes is released at term, it is
second stage. Oxytocin and prostaglandinconverted to prostaglandin.
work together to inhibit calcium binding in
muscle cells, raising intracellular calcium
and thus activating contractions.
Progesterone Deprivation Theory
Estrogen/progesterone ratio shift----
estrogen excites the uterine response, and
progesterone quiets the uterine response. A
decrease of progesterone allows estrogen
to stimulate the contractile response of the
uterus
 False Labor Pains True Labor Pains

Remain irregular May be slightly irregular at first but

become regular and predictable within
Generally confined to the abdomen. a matter of hours

No increased in duration, frequencyFirst felt in the lower back and sweep

and intensity
Often disappear if the woman
ambulates
Absent cervical changes
around to the abdomen in girdle-like
fashion
Increase in duration, frequency and
intensity
Continue no matter what the woman’s
level of activity

Accompanied by cervical effacement

and dilatation
4. Stages of Labor
a. First stage ( Stage of
Dilatation) begins with the onset of
regular contractions which cause
progressive cervical dilation and
effacement. It ends when the cervix
is completely effaced and dilated.
1. Latent phase - 1-4 cm
2. Active phase - 4-7 cm
3. Transitional phase - 7-10 cm

 Power/Forces at work: involuntary uterine

contracts
PHASES
I. Latent phase – early time in
labor
•Regular contraction
•Cervical dilation – 1 to 4 cm
•Intensity: mild to moderate
•minutes
Uterine contractions occur Q15-30
and are 15-30 seconds in
duration and of mild intensity
•Mother is talkative and eager to
be in labor
II. Active Phase –
•Cervical dilation 4-7 cm
•minutes
Uterine contractions occur Q3-5
and are 30-60 seconds in
duration
• Contraction: moderate to strong,
frequent, longer more painful
• Mother may experience feeling of
helplessness and becomes restless
and anxious as contractions
intensifies
• Woman fears losing control of
herself
 III. Transitional Phase
• Cervical dilation 8-10 cm
• Uterine contractions occur every 2-3
minutes and are 45-90 seconds in duration
and of strong intensity
• Mother becomes tired, is restless and
irritable and feels out of control
• Mood change
• AMNIOTOMY (if not yet ruptured)
• Gaping (bulging) of vagina or anus or
perineum
AMNIOTOMY is not done if the station is still negative
because this can lead to cord compression
i. Contractions are severe at 2-3 minute
intervals, with a duration of 50-90 seconds
ii. Cervical dilation is complete
iii. Progress of labor is measured by descent of
fetal head thru the birth canal (change in fetal
station)
iv. Uterine contractions occur every 2-3
minutes, lasting 60-75 seconds, and the
intensity is strong.
v. Increase in bloody show
vi. Mother feels the urge to bear down
 The newborn exits the birth canal with the help
from the following cardinal movements, or
mechanisms of labor (D FIRE ERE)

DESCENT- fetus goes down the birth canal (preceded by

engagement)
FLEXION- pressure on the pelvic floor causes the fetal
chin to bind towards the chest
INTERNAL ROTATION – from antero-postero to transverse
then AP to AP
EXTENTION – as the head comes out, the back of the
neck stops beneath the pubic arch. The head extends
and the forehead, nose, mouth and chin appear
EXTERNAL ROTATION (also known as restitution) –
anterior shoulder rotates externally to the AP position
so that it is just behind the symphysis pubis
EXPULSION – the delivery of the rest of the body
 Episiotomy
Prevent prolonged & severe stretching of the muscles
woman)
Natural anesthesia (synchronized with pushing of the

perineum
Done to facilitate delivery and avoid laceration of the

Reduce duration of second stage

Enlarge outlet in breech presentations or forcep delivery
 TYPES OF EPISIOTOMY
• Median
• Mediolateral
Application of Ritgen’s Maneuver is the best method for
delivery As soon as crowning is taking phase, cover anus
with sterile towel to exert.
c. Third Stage (Placental Expulsion) - Begins
with the delivery of the baby and ends with the
delivery of the placenta.
•Placental separation and expulsion occur
•Placental birth occur 5-30 minutes after birth
of baby.
Placental Separation(Mechanisms)
SCHULTZE MECHANISM: center portion of
placenta separates first and its shiny fetal
surface emerges from the vagina. SHINY AND
GLISTENING
DUNCAN MECHANISM: margin of placenta
separates, and the dull, red, rough maternal
surface emerges from the vagina. DIRTY,
RAW, RED AND IRREGULAR WITH THE RIDGES
OR COTYLEDONS
Signs of Placental Separation
• uterus becoming globular (calkin’s sign)
• Fundus rising in abdomen
• gushing of blood
• Lengthening of the cord
 
Contractions of the uterus controls uterine
bleeding and aids with placental
separations and delivery.
 
Generally, oxytocic drugs (oxytocin 10-20
units) are administered to help the
uterus contract (after placenta out)
METHERGINE

 PROMOTES UTERINE CONTACTION AND

PREVENTS POSTPARTUM HEMORRHAGE
 PRODUCE STRONG AND EFFECTIVE
CONTRACTION
 ASSESS VITAL SIGNS (BP)
 DO NOT ADIMINISTER IF BP IS 140/90 mmHg
 LEADS TO HYPERTENSION
 DISCONTINUE: MARKED VASOCONSTRICTION
(COLDNESS, PALENESS, NUMBNESS OF THE
FEET AND HAND); NOTIFY THE PHYSICIAN
OXYTOCIN

• INCREASES UTERINE CONTRACTION

• MINIMIZED UTERINE BLEEDING
• INCREASES BLOOD PRESSURE (VASOCONSTRICTION)
d. Fourth Stage ( Recovery and Bonding)- From the
delivery of the placenta until the postpartum
condition of the woman has become stabilized
(usually after 1 hour after delivery).
- the period of time from 1-4 hours after delivery
- the mother and newborn recover from the physical process
of birht
- The maternal organs undergo initial readjustment
- to the nonpregnangt state
- The newborn baby systems begins to adjust to extrauterine
life and stabilize
Monitoring the Blood Pressure
Blood Pressure should not be taken during a
contraction as it tends to INCREASE, because
no blood supply goes to the placenta during
contraction. All the blood is in the periphery,
which explains the increased BP during
contraction
 
BP taking should be taken at least every half hour
during active labor
Whenever a woman complains of a
HEADACHE, remove the blood pressure
apparatus from the arm right away (priority
intervention)
5. Managing Discomforts
A. During Labor
1. Physical Assessment. General physical
examination, Leopold’s maneuvers and/or internal
examination are done.
2. Bath. Bath is advisable if contractions are still
tolerable or are not too close to one another. Bathing will
not only ensure cleanliness but will also provide comfort
and relaxation.
3. Perineal Preparation. Perineal flushing is done to
prevent contamination of the birth canal and reduce
possibilities of postpartum infection.
4. Ambulation. Unless contraindicated (by medications,
intravenous infusion or ruptured membranes),
ambulation is advised during the latent phase of labor in
order to help shorten the first stage of labor.
5. Diet. Solid or liquid foods are avoided for the
following reasons:
a. Digestion is delayed during labor.
b. A full stomach interferes with proper bearing
down.
c. Aspiration may occur during the reflex nausea
and vomiting of the transition phase or when
anesthesia is used.
6. Enema Administration. Enema is not a
routine procedure for all women in labor but
may be done for the following reasons:

a. A full bowel hinders labor progress;

enema increases the space available for
passage of the fetus and improves
frequency and intensity of uterine
contractions.
b. Enema decreases the possibility of fetal
contamination of the perineum during
the second stage of labor.
c. A full bowel can add to the discomfort of
the immediate postpartum period.
Contraindications of enema:
a. Vaginal bleeding
b. Premature labor
c. Abnormal fetal presentation or position
d. Ruptured membranes
e. Crowning
7. Voiding. The woman in labor should be encouraged
to empty her bladder every 2-3 hours because:
a. full bladder retards fetal descent.
b. urinary stasis can lead to urinary tract infection.
c. a full bowel may be traumatized during delivery.
8. Breathing Technique. The woman in the 1st stage of
labor should be instructed not to push or bear down
during contractions because it will not only lead to
maternal exhaustion but, more importantly, unnecessary
bearing down can lead to cervical edema bacause of the
excessive pounding of the fetal presenting part of the
pelvic floor, thus interfering with labor progress. To
minimize bearing down, the patient should be advised to
do abdominal breathing during contractions.
9. Position. Encourage the woman in labor to
assume Sim’s position because:
a. It favors anterior rotation of the head.
b. It promotes relaxation between contractions.
c. It prevents Supine Hypotensive Syndrome.

The inferior vena cava, the blood vessel which

carries unoxygenated blood back to the heart,
lies just above the spinal column. When a
pregnant woman lies flat on her back, the inferior
vena cava is caught between the gravid uterus
and the spinal column, causing a drop in arterial
blood pressure, which leads the woman to
complain of dizziness.
10. Contractions. Uterine contractions are
monitored every hour during the latent phase of
labor and every 30 minutes during the active
phase by spreading the fingers lightly over the
fundus.
 
11. Vital Signs. Blood Pressure (BP) and Fetal Heart
Rate (FHR) are taken every hour during the latent
phase and every 30 minutes during the active
phase. Definitely, BP and FHR should never be
taken during a contraction.
During uterine contractions, no blood goes to the
placenta. The blood is pooled to the peripheral
blood vessels which results in increased BP.
Therefore, the blood pressure should be taken in
between contractions and whenever the mother in
labor complains of a headache.
12. Danger Signals. The nurse must be aware
of the following danger signals during
labor and delivery.
a. Signs of fetal distress
1. Tachycardia (FHR more than
180)Bradycardia (FHR less than 100)
2. Meconium-stained amniotic fluid in non-
breech presentation
3. Fetal thrashing or hyperactivity due to
fetal struggling for more oxygen
b. Signs of maternal distress
1. BP over 140/90, or a falling BP associated with
clinical signs of shock (pallor, restlessness or
apprehension, increased respiratory and pulse
rates)
2. Bright red vaginal bleeding or
hemorrhage(blood loss of more than 500 cc)
 
3. Abnormal abdominal contour (may be due to
uterine rupture or Bandl’s pathological ring, a
condition wherein the muscles at the
physiological retraction ring become very
tense, gripping the fetus causing possible fetal
distress)
13. Administration of Analgesics. Narcotics are the
most commonly used analgesics, specifically Demerol
(meperidine hydrochloride). Demerol acts to suppress
the sensory portion of the cerebral cortex. A dose of 25-
100 mg is given and it takes effect within 20 min when
the patient experiences a sense of well being and
euphoria. Demerol, being also an antispasmodic, should
not be given very early in labor because it will retard
labor progress.
 
It should not also be given when delivery is less
than an hour away because it can cause
respiratory depression in the newborn.
It is , therefore, preferably given when cervical
dilatation is around 5-8 cm.
14. Administration of Anesthetics. Regional
anesthesia is preferred over any other form because
it does not enter the maternal circulation and
therefore does not retard labor contractions nor
cause respiratory depression in the newborn.

15. Transfer of Patients. A sure sign that the baby is

about to be born is the bulging of the perineum. In
general, multiparas are transported to the delivery
room when cervical dilatation is about 7-9 cm, while
primiparas are transferred to the delivery room at
full dilatation with perineal bulging when crowning is
taking place.
B. During Delivery
1. Positioning on the Delivery Table. When
positioning the woman on lithotomy on the
delivery table, the legs should be put up
slowly at the same time on the stirrups in
order to prevent trauma to the uterine
ligaments and backaches or leg cramps. The
same should be done when putting the legs
down from the stirrups after delivery.
 2. Bearing Down Technique. At the beginning of a
contraction, the woman is asked to take two short
breaths, then to hold her breath and bear down at
the peak of contraction. She should also be told to
use blow-blow breathing pattern to prevent
pushing between contractions.
 3. Care of the Episiotomy Wound. Episiotomy, a
perineal incision done to facilitate the birth of the
baby, is made by the doctor primarily to prevent
lacerations. No anesthesia is necessary during
episiotomy b/c the pressure of the fetal presenting
part against the perineum is so intense that the
nerve endings for pain are momentarily deadened
(natural anesthesia).
 
4. Breathing Technique. As soon as the head
crowns, the woman is instructed not to push any
longer because it can cause rapid expulsion of the
fetus. Instead, she should be advised to pant (rapid
and shallow breathing).
5. Ritgen’s Maneuver.
a. Support the perineum during crowning by
applying pressure with the palm against the
rectum. This will not only prevent lacerations of
the fourchette but will also bring the fetal chin
down the chest so that the smallest diameter of
the fetal head is the one presented at the birth
canal.
b. In order to prevent rapid expulsion of the fetus
which could result not only in lacerations,
abruptio placenta, and uterine inversion but
also to shock because of sudden decrease in
intraabdominal pressure, the head should be
pressed gently while it slowly eases out.
6.Time of Delivery. Take note of the time the baby is
delivered.
7. Handling of the Newborn. Immediately after delivery,
the newborn should be held below the level of the
mother’s vulva so that blood from the placenta can
enter the infant’s body on the basis of gravity flow.
• The newborn should be held with his head in a dependent position
to allow drainage of secretions.
• Aofnewborn is never stimulated to cry unless he has been drained
his secretions because he can aspirate these secretions into his
lungs.
• The newborn should be immediately wrapped in a clean diaper to
keep him warm because chilling increases the body’s need for
oxygen.
• He should then be placed on his mother’s abdomen so that the
weight of the baby can help contract the uterus; a noncontracted
uterus can lead to death due to hemorrhage
 
 8. Cutting of the cord. Cutting of the cord
is postponed until pulsations have
stopped because it is believed that 50-100
ml of blood is flowing from the placenta to
the newborn at this time. It is then
clamped twice, an inch apart, and cut in
between.
 
9. Initial Contact. Maternal-infant bonding
is initiated as soon as the mother has eye-
to-eye contact with her baby. The mother
is informed of her baby’s sex and helped
to hold and inspect her baby if she wishes.
Nursing Diagnosis
 
• Fear r/t uncertainty about the outcome of the
birth process
• Acute Pain r/t uterine contraction, cervical
dilatation and fetal descent
• Health seeking behaviors: Information about
the fetal monitor r/t an expressed desire to
understand equipment used
• Readiness for enhanced family processes r/t
opportunity to incorporate newborn into the
family
 Fetal Heart Monitoring
Goal: to detect signs that identifies fetal distress in its early stages

PARAMETERS INTERPRETATION
Baseline heart rate 120-160 bpm Normal

Tachycardia 161-180 bpm Nonreassuring

Moderate >180 bpm Abnormal
Marked 100-119 bpm Non reassuring
Bradycardia <100 bpm Abnormal
Moderate
Marked

Acceleration >15 bpm for >15 sec Stimulation

Maternal fever

Deceleration 10-40 bpm Head compression

Early 50-60 bpm Hypoxia/acidosis
Late 10-60 bpm Cord compression
Variable Non reassuring
Severe bradycardia- FHR less than 80 bpm
 
Persistent severe bradycardia- severe
bradycardia that persists for longer than 5
minutes
 
Accelerations
• FHR increases than 15 bpm for more than 15
seconds
• Appear as smooth patterns on electronic fetal
monitoring
• Good indicators of fetal well-being
• Triggered in the normal mature fetus by fetal
body motions, sounds stimulations of the fetal
scalp and other stimuli
Early decelerations

• Normal and common

• Deceleration pattern matches the contraction
with the most deceleration occurring at the
peak of the contraction
• FHR rarely goes below 100 bpm
• Cause: head compression during uterine
contraction
Late decelerations
• Decrease in FHR from the baseline rate with a lag
time of greater than 20 seconds from the peak of
contraction
• First appear at or after the peak of the uterine
contractions. The FHR improves only after the
contraction has stopped.
• May be mild or severe based on how low the FHR
goes and how long it takes for the FHR to recover
• Caused by reduced blood flow to the uterus and
placenta during contraction
• Associated with uteroplacental insufficiency and is
a consequence of hypoxia and metabolic
abnormalities
Variable deceleration

• Common type of FHR deceleration in labor

• Cause by umbilical cord compression
• Significance depends on how low the heart
rate drops and how long the episode lasts
• Classified severe if they last more than 60
seconds or to a FHR of less than 90 bpm.
Interventions for late or variable
decelerations lasting more than 60
seconds:

1. Reposition the patient

2. Administer oxygen by face mask
3. Discontinue oxytocin’
4. IV fluids to increase maternal volume
5. Notify physician
6. Vaginal exam to check for prolapsed of
cord
7. Prepare for emergency caesarean
section
 TYPES OF CHILDBIRTH:

1. Vaginal delivery

• Asignificant
natural process that usually does not require
medical intervention
• NSVD- normal spontaneous vaginal delivery
• Forceps delivery- vaginal delivery with the use
of obstetric forcep (an instrument designed to
extract the baby’s head)
o Indications:

•and
Uterine inertia or poor uterine contraction
the second stage has gone pass two
hours
• Face presentation; OA in flat pelvis, OP
position
• Relative CPD
• Cardiac and pulmonary disorders of the
mother, maternal exhaustion
• Late deceleration pattern, excessive fetal
movement, meconium stained in cephalic
presentation
2. Leboyer method
• Postulated that moving from a warm, fluid-filled
intrauterine environment to noisy air filled, brightly
lit birth room creates a major shock for newborn
• He proposed that birthing room should be
darkened, kept pleasantly warm, soft music is
played, infant is gently handled, cord is cut late
and placed immediately into a warm water bath
• Advantage: ideal for most birthing institution
• Disadvantage:
o warm bath could reduce spontaneous
respiration and high level of acidosis;
o late cutting of the cord causes excess blood
viscosity in newborn
3. Hydrotherapy and Water Birth

• Baby is born underwater and immediately brought

to the surface for a first breath
• Advantage: reduce discomfort in labor
• Disadvantage:
o Contamination of bath water with feces
expelled
o Aspiration of bath water by fetus: pneumonia
o Maternal chilling
o Uterine infections- pushing efforts in 2nd stage
of labor
4. Caesarean birth
• Latin word “caedore” means to cut
• Birth accomplished through abdominal incision
into the uterus, after 28 weeks AOG
• Emergency procedure (under general
anesthesia) or elective procedure (under spinal)
• Indications :
oCPD
oPlacenta previa
oAbruption placenta
oMalpresentation or malposition
oPreeclampsia/eclapmsia
 oFetal distress
oCord prolapsed
oPrevious CS
oCervical dystocia
oCancer of the cervix
ovesico-vaginal
Other factors: poor obstetrical history, vaginoplasty,
fistula

• Complications
oUterine rupture in subsequent pregnancy
oPostop infection
oInjury to urinary system
oInjury to uterine vessels
oEmbolism
•Types:
o Classic caesarean section
 Incision made vertically through the
abdominal skin and uterus
 Advantage: incision is made high on the
uterus to avoid cutting the placenta and be
used with placenta previa
 Disadvantage:
• Leaves a wide skin scar
• Scar could rupture during labor and not
be able to have a subsequent vaginal
birth
o Low segment incision

 Lower
(LSTCS)
segment transverse caesarean section

 Made horizontally across the abdomen over

the cervix
 Referred
incision
to as pfannesteil incision or bikini

 Advantage:
•Less likely to rupture in subsequent labours
•Less blood loss- easier to suture
•Decrease postpartal infections
•Less possibility of GI complications
 Disadvantage:
•Longer procedure
•No assurance for small skin incision and
small uterine incision