Mother/Baby: The Five P's of Labor

Psychological response

*Maternal stress, tension, and anxiety can produce physiological changes*: - Fear can lead to anxiety and tension, leading to increased pain perception and ineffective contractions/pushing

Powers

*Uterine Contractions* - Frequency, duration, intensity - Effacement - Dilation - Descent of the fetus *Intra-abdominal pressure* - Urge to push and bear down - Transition phase of stage one - Second stage *Uterine musculature*

Passenger: Fetal Presentation

- Body part of fetus entering pelvis - Breech (sacrum or feet) - Shoulder (scapula) - Cephalic (occiput/vertex, sinciput, face, brow)

How do you measure uterine contractions?

- Can only be measured using an *intrauterine pressure catheter (IUPC)*, which measures in mmHg - An external monitor CANNOT tell us how the intensity of a contraction

What are the maternal position changes we can make to help with labor?

- Lithotomy or recumbent - Left lateral or Sim's position - Squat - Semi-fowler - Sitting - Hands & Knees

Passenger: Placental Implantation

- Placenta previa - Partial previa - *Woman needs to be monitored throughout prenatal care*

Passenger: Fetal Attitude

- Relationship of fetal body parts to one another - Flexion - Extension

Passenger: Fetal Position

- Relationship of presenting part to one of the four quadrants of maternal pelvis - Labeled with three letters: Right (R) or Left (L); Occiput (O), Sacrum (S), Mentum (M), Scapula (Sc); Anterior (A), Posterior (P), Transverse (T)

Passenger: Fetal Head

- Size (Diameter) - Molding: Overlapping of cranial bones; Ability of bones to overlap with one another can determine where a fetus is able to progress through the maternal pelvis - Sutures

Passenger: Fetal Lie

Relationship of long axis of fetus with long axis (spine) of mom - Longitudinal: vertical - Transverse: horizontal - Oblique: diagonal

Passageway

*Birth Canal* - Maternal Bony Pelvis - Cervix - Pelvic Floor - Vagina Introitus (vaginal opening) *Pelvic Types* - Gynecoid: most common and *favorable* - Anthropoid: *favorable* - Android: *not favorable* - Platypelloid: *not favorable*

Position

*Frequent position changes*: - Increases comfort - Relieves fatigue - Promotes circulation - Assists in fetal descent and positioning - Strength and frequency of contractions - Duration of labor - Perineal outcome - Maternal satisfaction

Powers: Uterine Contractions

*Intensity* - Palpation - Toco - IUPC *Frequency* - Timed in minutes - Beginning of one contraction to the beginning of next *Duration* - Timed in seconds - Beginning of contraction to the end of the contraction

What are the 5 P's of labor?

1.) Passageway 2.) Passenger 3.) Powers 4.) Position (fetal and maternal) 5.) Psychologic Response