COMPONENTS COMPONENTS OF OF

LABOR LABOR
Ps of Labor Ps of Labor
Passage Passage
Passenger Passenger
Power Power
Psyche Psyche
Person Person
A. PASSAGEWAY A. PASSAGEWAY- - refers to the refers to the
adequacy of the pelvis and birth adequacy of the pelvis and birth
canal in allowing fetal descent canal in allowing fetal descent
PELVIC GIRDLE: PELVIC GIRDLE:
W/ APPROPRIATE PELVIC W/ APPROPRIATE PELVIC
SHAPE SHAPE
W/ O STRUCTURAL W/ O STRUCTURAL
ABNORMALITIES ABNORMALITIES
%oo prominent ischial spines and short bi %oo prominent ischial spines and short bi- -
ischial diameter ischial diameter
Sacrum too acutely curved anteriorly Sacrum too acutely curved anteriorly
Narrow pubic arch angle Narrow pubic arch angle
W/ APPROPRIATE PELVIC W/ APPROPRIATE PELVIC
SIZE/DIAMETERS SIZE/DIAMETERS
- -Measure the actual diameters oI the pelvic inlet Measure the actual diameters oI the pelvic inlet
and outlet through which the Ietus must pass and outlet through which the Ietus must pass
1. 1. Diagonal coniugate Diagonal coniugate
- - Irom the anterior surIace oI sacral Irom the anterior surIace oI sacral
promontory to the anterior surIace oI the promontory to the anterior surIace oI the
inIerior margin oI the symphysis pubis inIerior margin oI the symphysis pubis
- - more than 12.5 cm more than 12.5 cm
2. %rue coniugate or Coniugate vera 2. %rue coniugate or Coniugate vera
- - Irom anterior surIace oI the sacral Irom anterior surIace oI the sacral
promontory to the posterior surIace oI the promontory to the posterior surIace oI the
inIerior margin oI the symphysis pubis inIerior margin oI the symphysis pubis
- - Diagonal coniugate minus 1.5 Diagonal coniugate minus 1.5- -2 cm 2 cm
- -10.5 to 11 cm at inlet 10.5 to 11 cm at inlet
. Ischial tuberosity diameter . Ischial tuberosity diameter
- - done at level oI anus done at level oI anus
- - Irom 1 ischial tuberosity to another Irom 1 ischial tuberosity to another
- - measures the transverse diameter oI the outlet measures the transverse diameter oI the outlet
- - 11 cm 11 cm
B. PASSENGER B. PASSENGER -- refers to the fetus refers to the fetus
and its ability to move through the and its ability to move through the
passageway passageway
E%L SKULL E%L SKULL
8 CRNIL BONES 8 CRNIL BONES
1 RON%L 1 RON%L
2 PRIE%L 2 PRIE%L
1 OCCIPI%L 1 OCCIPI%L
2 %EMPORL 2 %EMPORL
1 SPHENOID 1 SPHENOID
1 E%HMOID 1 E%HMOID
14 CIL BONES 14 CIL BONES
Shiny schultze Shiny schultze Ietal surIace Ietal surIace
Dirty duncan Dirty duncan maternal surIace maternal surIace
No clinical signiIicance No clinical signiIicance
SU%URES SU%URES
CORONL CORONL
SGI%%L SGI%%L
LMBDOID LMBDOID
ON%NELLES ON%NELLES
N%ERIOR/BREGM%IC N%ERIOR/BREGM%IC
POS%ERIOR/OCCIPI%L POS%ERIOR/OCCIPI%L
SPHENOID/N%ERO SPHENOID/N%ERO- -L%ERL L%ERL
MS%OID/POS%ERO MS%OID/POS%ERO- -L%ERL L%ERL
ON%NELLES ON%NELLES
N%ERIOR/BREGM%IC N%ERIOR/BREGM%IC
POS%ERIOR/OCCIPI%L POS%ERIOR/OCCIPI%L
SPHENOID/N%ERO SPHENOID/N%ERO- -L%ERL L%ERL
MS%OID/POS%ERO MS%OID/POS%ERO- -L%ERL L%ERL
PASSENGER PASSENGER
W/ APPROPRIATE PRESENTATION W/ APPROPRIATE PRESENTATION
W/ APPROPRIATE LIE W/ APPROPRIATE LIE
W/ APPROPRIATE POSITION W/ APPROPRIATE POSITION
eg L.O.A. L.S.P. L.A.A.. R.M.T eg L.O.A. L.S.P. L.A.A.. R.M.T
irst letter determined by: irst letter determined by:
the right or leIt side oI the mother`s pelvis the right or leIt side oI the mother`s pelvis
as you Iace the perineum during internal as you Iace the perineum during internal
examination examination
Second letter determined by: Second letter determined by:
using a reIerence point or landmark aIter using a reIerence point or landmark aIter
knowing the presentation knowing the presentation
- -occiput occiput - -brow brow - -mentum mentum
- -sacrum sacrum - -acromion acromion
%hird letter determined by: %hird letter determined by:
the direction oI the reIerence point or landmark the direction oI the reIerence point or landmark
- -anterior anterior
- -transverse transverse
- -posterior posterior
4) W/ PPROPRI%E %%I%UDE
W/ W/ PROGRESSIVE PROGRESSIVE DESCENT DESCENT
S%%ION S%%ION
ischial spines: midway in the true pelvis ischial spines: midway in the true pelvis
station 0 station 0
above it: station above it: station 1 to 1 to - -55
below it: station 1 to 5 below it: station 1 to 5
STATION STATION
Negative numbers above Negative numbers above - - indicate the Ietal indicate the Ietal
head is unengaged (Iloating) head is unengaged (Iloating)
Positive numbers beyond (such as 4 or Positive numbers beyond (such as 4 or
5) indicate that the Ietal head is crowning and 5) indicate that the Ietal head is crowning and
about to deliver. about to deliver.
FLOATING FLOATING
ENGAGED ENGAGED
) BBY HS NO CONGENI%L or ) BBY HS NO CONGENI%L or
CQUIRED S%RUC%URL CQUIRED S%RUC%URL
BNORMLI%IES BNORMLI%IES
8) NO% IN CRDIO 8) NO% IN CRDIO- -RESPIR%ORY RESPIR%ORY
DIS%RESS DIS%RESS
FETAL ASSESSMENT DURING FETAL ASSESSMENT DURING
LABOR LABOR
1) uscultate the Ietal heart rate 1) uscultate the Ietal heart rate
- - at posterior chest wall at posterior chest wall
- - every 0 minutes during beginning labor every 0 minutes during beginning labor
every 15 minutes during active labor every 15 minutes during active labor
every 5 minutes during 2 every 5 minutes during 2
nd nd
stage stage
- - use either a) ordinary stethoscope use either a) ordinary stethoscope
b) Ietoscope b) Ietoscope
c) doppler c) doppler
d) external electronic d) external electronic
monitoring monitoring
e) internal electronic e) internal electronic
monitoring monitoring
I) %elemetry I) %elemetry
B. EXTERNAL FETAL MONITORING B. EXTERNAL FETAL MONITORING
C. INTERNAL FETAL MONITORING C. INTERNAL FETAL MONITORING
Normal value: 120 Normal value: 120- -160 BPM Ior 10 minutes 160 BPM Ior 10 minutes
luctuates slightly 5 luctuates slightly 5- -15 BPM when Ietus moves 15 BPM when Ietus moves
or sleeps or sleeps
ccelerations occur when Ietus moves or with ccelerations occur when Ietus moves or with
compression oI umbilical vein during labor compression oI umbilical vein during labor
contraction contraction
Early decelerations Early decelerations
- - Due to pressure oI Ietal head during Due to pressure oI Ietal head during
contractions contractions parasympathetic response parasympathetic response vagal vagal
nerve compression nerve compression reIlex bradycardia reIlex bradycardia
- - Normal iI during late in labor Normal iI during late in labor
Late decelerations Late decelerations
- - %hose delayed until 0 %hose delayed until 0- -40 seconds aIter onset 40 seconds aIter onset
oI contraction and continue beyond end oI oI contraction and continue beyond end oI
contraction contraction
- - Lowest point oI deceleration is near end oI Lowest point oI deceleration is near end oI
contraction contraction
- - Due to uterine placental insuIIiciency Due to uterine placental insuIIiciency
Nursing responsibility Nursing responsibility
- - discontinue or slow down Oxytocin drip iI discontinue or slow down Oxytocin drip iI
present present
- - change patient`s position change patient`s position
- -administer IV or oxygen administer IV or oxygen
- -Prepare Ior 'E CS Prepare Ior 'E CS
Prolonged decelerations Prolonged decelerations
- -last longer than 2 last longer than 2- - minutes but less than 10 minutes but less than 10
minutes minutes
- - Due to cord compression Due to cord compression
maternal hypotension maternal hypotension
- -Nursing responsibility: reIer SP Nursing responsibility: reIer SP
2) etal Movements 2) etal Movements
- - etal movement counting is the easiest and etal movement counting is the easiest and
most reliable screening method to determine most reliable screening method to determine
Ietal distress Ietal distress
- - ways: ways:
a) CardiII a) CardiII- -count count- -ten Method ten Method
- -begin count at 9 am , %ID 20 begin count at 9 am , %ID 20- -0 0
min/session,and count up to 10 movements min/session,and count up to 10 movements
- -less than movements per session, extend count Ior less than movements per session, extend count Ior
1 hr or more 1 hr or more
- -iI less than 10 movements are counted in 12 hrs, iI less than 10 movements are counted in 12 hrs,
reIer SP reIer SP
b. Sadovsky`s Counting aIter meals b. Sadovsky`s Counting aIter meals
- - count Ietal movements 1 count Ietal movements 1- -2 hours aIter meals 2 hours aIter meals
- -should be at least 10 movements in 120 min should be at least 10 movements in 120 min
c. Counting beIore sleeping c. Counting beIore sleeping
- -count at night between 9 count at night between 9- -10 PM beIore 10 PM beIore
sleeping sleeping
- - note duration Ior Ietus to move 10 times note duration Ior Ietus to move 10 times
- - iI longer than 2 hours to move 10 times, iI longer than 2 hours to move 10 times,
need Iurther testing: U%S BPP need Iurther testing: U%S BPP
) Meconium staining oI mniotic Iluid ) Meconium staining oI mniotic Iluid
- -green opaque Iluid green opaque Iluid
FETAL DANGER SIGNS FETAL DANGER SIGNS
1) etal bradycardia and tachycardia 1) etal bradycardia and tachycardia
~ 110 BPM 160 BPM ~ 110 BPM 160 BPM
Nursing responsibility: Nursing responsibility:
Monitor HR in between uterine Monitor HR in between uterine
contractions contractions
2) Meconium 2) Meconium- - stained amniotic Iluid or bag oI stained amniotic Iluid or bag oI
water water
- -Ietal hypoxia Ietal hypoxia stimulation oI vagal stimulation oI vagal
reIlex reIlexincreased bowel motility increased bowel motility relaxation oI relaxation oI
external anal sphincter external anal sphincterpassage oI passage oI
meconium(green color in amniotic Iluid) meconium(green color in amniotic Iluid)
) bnormal Ietal movements ) bnormal Ietal movements
a: hyperactivity a: hyperactivity
b: decreased or no activity b: decreased or no activity
4) etal acidosis 4) etal acidosis
Monitor blood pH using scalp capillary Monitor blood pH using scalp capillary
technique technique
pH lower than .2 pH lower than .2
C. POWER C. POWER
- - refers to the frequency. duration. refers to the frequency. duration.
and strenght of uterine contractions and strenght of uterine contractions
to cause complete cervical to cause complete cervical
effacement and dilation effacement and dilation
1) Uterus 1) Uterus
- -smooth muscle contractions smooth muscle contractions
a) irregular to regular rhythm a) irregular to regular rhythm
b) Irom weak to strong intensity b) Irom weak to strong intensity
c) Irom short to long duration c) Irom short to long duration
d) Irom long to short Irequency d) Irom long to short Irequency
Uterus Uterus
- -thick at Iundus, thin at low uterine segment thick at Iundus, thin at low uterine segment
- -straightens straightens
- -cervix undergoes cervix undergoes
a)dilatation a)dilatation
b)eIIacement b)eIIacement
2) bdomen 2) bdomen
- -skeletal muscles contraction skeletal muscles contraction
Note: should Iollow iI with Iull cervical Note: should Iollow iI with Iull cervical
dilatation dilatation
ugmentation oI uterine contractions via: ugmentation oI uterine contractions via:
a) a) Nipple stimulation Nipple stimulation
b) b) Drugs Drugs
Uterine stimulants like Buscopan and Uterine stimulants like Buscopan and
Oxytocin Oxytocin
c) c) Manual Iundal push Manual Iundal push
d) d) mniotomy mniotomy
e) e) Cervical canal stripping Cervical canal stripping
D. PSYCHE D. PSYCHE -- refers to the client`s refers to the client`s
psychological state . available support psychological state . available support
systems. preparation for childbirth. systems. preparation for childbirth.
experiences. and coping strategies experiences. and coping strategies
- - %his is the mother`s mindset %his is the mother`s mindset
eg anxious eg anxious angry angry
IearIul IearIul awe awe
excited excited
implication: aIIects mother`s ability to cooperate to instructions during implication: aIIects mother`s ability to cooperate to instructions during
labor and delivery labor and delivery
aIIects her outlook regarding aIIects her outlook regarding
Iuture pregnancies, labor and delivery Iuture pregnancies, labor and delivery
E. PERSON / POSITION OF THE E. PERSON / POSITION OF THE
MOTHER MOTHER
Positioning the woman in a manner that allows Positioning the woman in a manner that allows
gravity to assist her eIIorts is helpIul gravity to assist her eIIorts is helpIul
Squatting or using Squatting or using a semi seated a semi seated position is position is
more eIIective than a supine position more eIIective than a supine position