The Stages of Labor & Delivery

Second stage of Labor

-Begins once there is complete cervical dilatation -Uterine contractions remain the same as in transition phase -Pushing begins -Fetal presenting part continuous descent as patient pushes -The head will begin to crown, meaning the head is encircled by the outside of the vagina -The head is then delivered, followed by the rest of the body

Latent Phase

-Begins when uterine contractions become regular and are generally mild -Uterine contractions are mild between 10-30 mins apart lasting around 30 secs increasing to moderate between 5-7 mins apart -The cervix begins to efface and dilate between 0-3cm ****0-3 cm makes it latent phase**** -This phase generally lasts anywhere from 5-14hrs

Cephalic

A cephalic presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvis first; the most common form of cephalic presentation is the vertex presentation where the occiput is the leading part (the part that first enters the birth canal).

True Labor

Contractions are at regular intervals. Intervals between contractions gradually shorten. Contractions increase in duration and intensity. Discomfort begins in the back and radiates to the abdominal. Cervical dilation and effacement are progressive. Contractions do not decrease with rest or warmth bath.

False Labor

Contractions are irregular. Intervals between contractions usually don't change. There is no increase or duration of the contractions. Discomfort is usually only in the abdominal. No change in cervical dilation and effacement. Rest and warm baths lessen the contractions.

Engagement

Engaged means the entrance of the largest diameter of the fetal head into the smallest diameter of the maternal pelvis. The fetus is said to be "engaged" in the pelvis when the presenting part reaches 0 station and is determined by a pelvic exam.

Station

Refers to where the presenting part is in your pelvis.

Spontaneous (SROM)

This term describes the normal, spontaneous rupture of the membranes at full term. The rupture is usually at the bottom of the uterus, over the cervix, causing a gush of fluid.

Fetal Presentation

What part is coming out first? Head or bottom first? The part of the fetus that lies closest to or has entered the true pelvis. Cephalic presentation are vertex, brow, face, and chin.

Breech

a delivery of a baby so positioned in the uterus that the buttocks or feet are delivered first.

Artificial (AROM)

also known as an amniotomy, may be performed by a midwife or obstetrician to induce or accelerate labor.

Cephalic presentation: Brow

brow is coming out first.

Cephalic presentation: Face

face first

Frequency

from the beginning of the contraction to the beginning of the next in minutes.

Dilatation

how far open your cervix is measured in cm. 0 and closed are the same. 10 and complete are the same thing.

Duration

how long the contraction lasts measured in seconds.

Intensity

how strong the contraction are.

Labor

is a result of the increase in the myometrium contractility of the uterus causing contractions that efface and dilate the cervix.

Effacement

is the process by which the cervix prepares for delivery. After the baby has engaged in the pelvis, it gradually drops closer to the cervix. The cervix will gradually soften, shorten and become thinner. You might hear phrases like "ripens" or "cervical thinning," which refer to effacement.

Cephalic presentation: Military/chin

is the same as vertex but chin is not flexed in.

Cephalic presentation: Vertex

is the smallest part of the head coming out.

Fetal Lie

relationship of the fetal spine to the maternal spine. 3 different possibility.

Fetal Attitude

the relationship of the fetal parts to each other. An example is the "military" attitude, in which the fetal head is not flexed and the chin is not on the chest as usual but is held straight up.

Contraction

the tightening of the uterus that dilates the cervix and effaces.

Lightening

when the baby drops and she feels lighter and easier to breath because the baby is not pushing on her diaphragm.

Physiologic Response of Maternal Body to Labor

-Increase in temperature, pulse, respirations, & BP, especially as pain increases -Decrease in gastric motility and urinary output -Sweating, dry mouth, clammy skin, shaking -Altered mental status due to pain (Hence the screaming, crying, and cursing!)

Fourth Stage of Labor

-The "Immediate Postpartum Stage" -From 1-4 hrs. after delivery -The uterus is now firm, midline at the umbilicus -Pt will experience uncontrollable shaking because of the hormones and the stress of labor. -Hypotonic bladder leading to urinary retention

Third Stage of labor

-The uterus continues to contract while it decreases in size -As a result of the decrease in the uterine size, the placenta begins to separate from the wall of the uterus -The placenta is then delivered -Usually lasts 30 mins or less

Transition Phase

-Uterine contractions are now 1.5-2 mins apart, lasting 60-90 secs -Dilatation from 8 cm to 10 cm, or complete dilatation ***8-10 is transition phase**** -Increase amount of bloody show -Pt feels an overwhelming urge to push -Nausea and vomiting may occur -SROM if not occurred before now -Pt feels they have lost control

Active Phase

-Uterine contractions are now 2-5 mins & as close as 2-3 mins apart lasting 40-60 secs -The fetus begins to descend into the pelvis -Dilatation is between 4-7cm ***Dilation is the only thing that makes the women in active phase. ****

Anthropoid

-Wider front to back [anterior to posterior] than side to side [transverse]. -Vaginal birth is more favorable with this pelvic shape compared to the android or platypelloid shape.

The Nurse's Role during labor

-Remain calm, even when patient is not -Offer support and assure patient you are there for them -Allow support person to stay with patient during the duration of the labor experience -Assist MD during delivery -Nursing Process

First Stage of Labor

-Separated into three different phases -Begins with the onset of labor and ends with complete dilatation -Latent Phase, active phase, and transition phase.

Gynecoid

-Ideal pelvis for child birth. -Considered the true female pelvis -Vaginal birth is most favorable -Inlet is round and the outlet is roomy. -This shape offers the optimal diameters in all three planes of the pelvis. -This type of pelvis allows early and complete fetal internal rotation during labor.

Breakdown of Stages of Labor:

-First Stage-Labor -Latent Phase 0-3 cm -Active Phase 4-7 cm -Transition Phase 8-10 cm -Second Stage- Delivery of Fetus -Third Stage- Delivery of Placenta -Fourth Stage- Immediate Postpartum

Palypelloid

-Flat Pelvis. -Shallow & widens at pelvic outlet -Difficult for vaginal delivery. -Poor labor progress. -Requires a C-section

Andriod

-Funnel shape. -The pelvic inlet is heart shaped and the posterior segments are reduced in all pelvic planes. -Descent of the fetal head into the pelvis is slow, and failure of the fetus to rotate is common. -The prognosis for labor is poor, subsequently leading to cesarean birth.

Premonitory Signs of Labor

-Lightening -Contractions -Cervical Changes -Bloody Show - because the rupture of little capillaries during contraction of uterus. -Rupture of Membranes (ROM) - when water breaks.

Fetal Station

Fetal station refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines. Typically, the ischial spines are the narrowest part of the pelvis and are the natural measuring point for the birth progress. Zero (0) station is designated when the presenting part is at the level of the maternal ischial spines. When the presenting part is above the ischial spines, the distance is recorded as minus stations. When the presenting part is below the ischial spines, the distance is recorded as plus stations. For instance, if the presenting part is above the ischial spines by 1 cm, it is documented as being a −1 station; if the presenting part is below the ischial spines by 1 cm, it is documented as being a +1 station. An easy way to understand this concept is to think in terms of meeting the goal, which is the birth. If the fetus is descending downward (past the ischial spines) and moving toward meeting the goal of birth, then the station is positive and the centimeter numbers grow bigger from +1 to +4. If the fetus is not descending past the ischial spines, then the station is negative and the centimeter numbers grow bigger from -1 to -4. The farther away the presenting part from the outside, the larger the negative number (-4 cm). The closer the presenting part of the fetus is to the outside, the larger the positive number (+4 cm).