The 5 Ps of labor P assenger P assageway P owers P osition P sychologic response Passengers Head Presentation of the Passenger What is the fetal presentation Cephalic 96 ID: 493274
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Slide1
Labor and the Birth ProcessSlide2
The 5 “Ps” of labor
P
assenger
P
assageway
P
owers
P
osition
P
sychologic
responseSlide3
Passenger’s HeadSlide4
Presentation of the Passenger
What is the fetal presentation?
Cephalic (96%)
Breech (3%)
Shoulder (1%)Slide5
Fetal lieSlide6
Fetal AttitudeSlide7
Position of the PassengerSlide8
Station & EngagementSlide9
PassagewaySlide10
Passageway ContinuedSlide11
Powers-Primary
We really do not know what causes the primary powers
ContractionFrequency
,
Duration, and
Intensity
Result in
Effacement and
DilatationSlide12
Secondary PowersSlide13
PositioningSlide14
Pelvic muscles/ligamentsSlide15
A bit of humor found
http://www.youtube.com/watch?v=ppzV6hoPkIcSlide16
Pain Management in LaborSlide17
Pain Perception & Expression
Pain thresholds are similar in everyone, the perception of pain is not.
Pain is expressed
Sensory
Emotionally
PhysiologicallySlide18
How Does Labor Effect Pain
Pain experienced by mother can result in :
Acidosis of the fetus
Impaired Uterine
ContractionSlide19
Non-Pharmacologic Strategies
Position changes
Walking
Rocking
Labor ball
Breathing
May need to breath with mother
Counter-pressure
Application of heat
or
cold
Showering/Tub
Music
Aromatherapy
Imagery
Focal points
Effleurage
Therapeutic touch
Childbirth Education
Hypnosis
Biofeedback
Empty Bladder regularlySlide20
Pharmacologic
Goal
maximum
relief with minimal risk
to mother
and fetusSlide21
Pain Control Depends:
Epidural
Spinal/Epidural
Nerve Block
Local
Pudendal
Spinal
Epidural
Combined Spinal/Epidural(CSE)Slide22
Analgesics 1st
Stage
Systemic analgesia
IM
vs
IV
Narcotics
Opioid
agonist
Demerol,
Fentanyl
, Morphine
Opioid
agonist-antagonist
Stadol
,
Nubain
,
Narcan
EpiduralSlide23
Naloxone (
Narcan
)
Opiate antagonist
Works immediately-may need to be repeated
Used to counteract respiratory depression-Neonatal dose available at every delivery
Adult dose: 0.4-2mg IVP
Neonatal dose: 0-1mg/kg of 0.4mg/ml concentration
Do not give to patient with narcotic dependency-triggers immediate withdrawal and possible seizuresSlide24
Labor Nerve Block Meds
Method
Effects
Criteria
Care
Local-
Lido /
Polocaine
used with
epi
Numbs perineum
Episiotomy
or
repair
of laceration
Normal
perineal
care
Puedendal
Numbs lower vaginal/vulva/
perineal
area
Epis
or vacuum
delivery anticipated
May need more direction in pushing
Spinal
T-6 to feet
C-Section
Uterine displacement, VS monitored
Epidural
Numbs from T10-S5
Labor /C-section
Monitoring line, VS,
Positioning of pt
Intrathecals
1.5-3 hours
Multip
who is
progessing
fast
Same as
Epi
/SpinalSlide25
Pain PathwaySlide26
Epidural CoverageSlide27
General Anesthesia
Only used in an
emergency prior to
infant delivery, if patient
has contraindications
to a Spinal /Epidural,
or demands
to be put to sleep. Slide28
Fetal Circulation
Maternal position
Uterine Contractions
Blood Pressure
Umbilical Blood Flow
Kahn AcademySlide29
Fetal Assessment
Continuously or intermittentlySlide30
Fetal Monitor TracingSlide31
Monitor placement and LieSlide32
Intrauterine Pressure Catheter-IUPC
IUPC use
Montevideo Units (MVU)
Subtract baseline pressure from peak pressure for each contraction in a 10 min period. 100-250 is optimalSlide33
Fetal Heart Rate
Normal FHR Baseline110-160
10 minute segment with no significant periodic changes or change in baseline of >25 BPM
Variability
Absent
Minimal
Moderate
Marked (pg 421)Slide34
Fetal Heart Rate
Tachycardia >160
Can be early sign of fetal hypoxia
Maternal or fetal infection
Maternal hyperthyroidism or fetal anemia
Response to some drugs-cocaine, Meth,
terbutaline
,
Vistaril
Bradycardia
<110
Heart Block
Viral infections such as CMVSlide35
Periodic & Episodic Changes
Periodic-with contractions
Episodic-occur without contractions
Acceleration 15 x 15 above baseline
Deceleration
Early
Late
VariableSlide36
What type of deceleration?Slide37
What type of deceleration?Slide38
What type of deceleration would this cause
True knot
in cordSlide39
Variable decelerationSlide40
Management of FHR tracing
Basic interventions
Oxygen
Reposition
IV fluid bolus
Specific problem
Correct the problem
If can not…..DELIVER BY CESAREANSlide41
Categories of FHR tracings
Category I-normal
Category II-requires interventions and close monitoring
Category III-DeliverSlide42
Category I
Normal FHR:110-160
FHRV: Moderate (6-25beats)
Accelerations or Early Decelerations: Absent or present
Late or Variable Decelerations: AbsentSlide43
Category III
FHRV: Absent + Recurrent late decelerations
FHRV: Absent + Recurrent variable decelerations
FHRV: Absent +
Bradycardia
SinusoidalSlide44
Category II
Bradycardia
without absent FHRV
Tachycardia
FHRV: Minimal or Marked
FHRV: Absent without recurrent
decels
Absent accelerations after induced fetal stimulation (this is only diagnostic-not intervention)
Recurrent variable
decel
+ FHRV: Min or moderate
Prolonged
decel
>
2min but <10 min
Recurrent late
decel
+ FHRV: Moderate
Variable
decel
with other characteristics: Slow return to baseline, overshoots, or shouldersSlide45
Category II ExampleSlide46
ReviewSlide47
ReviewSlide48
ReviewSlide49
ReviewSlide50
Remember the Psychosocial
Labor is anxiety provoking
Is the baby going to be ok?
Was this pregnancy planned?
Does the patient have adequate support both at home and in labor?
Will she have help at home when goes home with infant?Slide51
Questions