Chapter 8: The Labor Process - PowerPoint Presentation

1. Chapter 8:The Labor Process

2. Four Essential Components of LaborThe Four Ps of LaborPassageway (maternal pelvis and soft tissues)Passenger (fetus)Powers (involuntary and voluntary muscle contractions)Psyche (psychological state of the woman)Problematic areas influence labor negatively

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4. Passageway Consists of bony pelvis, soft tissuesBony pelvis False pelvisThe flared upper portion of the bony pelvis Not part of the bony passagewayTrue pelvisThe portion of the pelvis below the linea terminalisConsists of the inlet, midpelvis, and outlet

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6. Passageway (cont.)Pelvic shapeGynecoidMost favorable for a vaginal birthRounded shapeAnthropoidElongated shapeAndroidHeart-shaped

7. Passageway (cont.)Pelvic shape (cont.)Platypelloid Flat in its dimensionsPelvic dimensionsMost important is obstetric conjugateSoft tissuesCervix must completely efface and dilate for the fetus to be born. Full dilation is equal to 10 cm.Vagina

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9. QuestionState whether the following statement is true or false.The gynecoid pelvis is the most favorable for a vaginal birth.

10. AnswerTrueRationale: The gynecoid pelvis is most favorable for a vaginal birth.

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12. PassengerFetal skullMost important in relation to labor and birth because it is the largest and least compressibleMolding is overlap of bones

13. Longitudinal versus transverse lie. (A) Longitudinal lie (the fetus lies parallel to the maternal spine). (B) Transverse lie (the fetus lies crosswise to the maternal spine).

14. breech presentations. (A) Frank breech. (B) Complete breech. (C) Single footling breech. (D) Double footling breech.

15. Passenger (cont.)Fetal presentationForemost part of the fetus that enters the pelvic inletThree main presentationsHead: cephalic presentation majority of fetusesFeet or buttocks: breech presentationShoulder: shoulder presentation is uncommon

16. Fetal attitude affects the type of presentation in cephalic (head-first) presentations. The degree of fetal flexion affects whether the presentation is classified as (A) vertex, (B) military, (C) brow, or (D) face.

17. Passenger (cont.)Fetal attitude together determine the presenting part.Relationship of fetal parts to one anotherFlexion (ovoid shape)Most favorable for vaginal deliveryMilitary (no flexion or extension)Brow or frontum (partial extension)Face (full extension)

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19. Passenger (cont.)Fetal position presenting part and location to the reference pointFirst letter/designation: refers to side of maternal pelvis toward which presenting part is facingSecond letter/designation: reference point on presenting partThird letter/designation: specifies direction presenting part is facingAnterior; posterior; transverseROA or LOA most favorable fetal positions for vaginal birth

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21. Passenger (cont.)Fetal station: relationship of presenting part to ischial spinesZero stationPresenting part is at the level of the ischial spinesMinus stationPresenting part is above the ischial spinesPlus stationPresenting part is below the ischial spines

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23. PowersThe primary power of labor comes from involuntary uterine contractions, which serve to efface and dilate the cervix. Maternal pushing efforts supply secondary powers during the second stage of labor.The contraction pattern (frequency, duration, and intensity) and the resting interval are important to assess because the fetus can become hypoxic if contractions are too close together, too strong, or if there is not an adequate rest period between contractions.

24. QuestionFetal attitude refers to the relationship of fetal parts to each other. Which fetal attitude is most favorable to a vaginal birth? a. Extension b. Flexion c. Military d. Hyperextension

25. Answerb. FlexionRationale: The most common, most favorable attitude for a vaginal birth, is an attitude of flexion, also called a vertex presentation.

26. PsycheMaternal psyche is an important influence on the labor process. Nursing interventions can help break the cycle of fear, tension, and pain that can interfere with labor.

27. Process of LaborThere are both maternal and fetal factors that stimulate the onset of labor, and research is ongoing as to the exact cause of labor onset. Both the maternal and the fetal factors prepare the cervix to dilate, stimulate labor to begin, and allow for delivery of the fetus.

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29. Process of Labor (cont.)Anticipatory signs of laborGastrointestinal disturbancesExpelling the mucus plugLighteningBraxton Hicks contractionsBurst of energyCervical ripening and dilation

30. Process of Labor (cont.)True labor results in progressive effacement and dilation of the cervix. In true labor, contractions become progressively stronger and occur more frequently and are not stopped with walking.

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32. Mechanisms of a Spontaneous Vaginal DeliveryCardinal movements (mechanisms of delivery)EngagementDescentFlexionInternal rotationExtensionExternal rotationExpulsion

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34. Stages and Duration of LaborFirst stage: Dilation LatentActiveTransitionSecond stage: Birth Third stage: Expulsion of placenta Fourth stage: Recovery

35. QuestionWhich stage of labor is birth? a. First stage b. Second stage c. Third stage d. Fourth stage

36. Answer b. Second stageRationale: The second stage begins when the cervix is dilated fully and ends with the birth of the infant.

37. Labor Impact on Mother and FetusLabor affects the mother in much the same way as vigorous exercise does. The heart rate, cardiac output, and respiratory rate increase to meet the body's increased oxygen need. Other systems, notably the gastrointestinal and urinary systems, are also affected.The healthy fetus is able to withstand the stress that labor places on the cardiovascular system. A vaginal birth helps mature the respiratory system and clears mucus from the respiratory tract.