True Signs of Labor

a. Uterine contraction the surest sign that

labor has begun

b. Show the mucus plug that filled the
cervical canal is expelled . The exposed
cervical capillaries seep blood as a result as
a result of pressure exerted by the fetus , the
blood is mixed with mucus

c. Rupture of membrane sudden gush of fluid

from the vagina
- there is dry labor because the amniotic fluid
has ruptured

Duration of Labor:
Primipara 14 hours & not more than 20

hours
Multipara - 8 hours & not > than 14 hours
Effacement softening & thinning of cervix,
use % in unit of measurement
Dilation widening of the cervix, unit used is
cm.

Methods of Assessing Uterine

Contractions
Subjective description given by the woman
Palpation & timing by the nurse or physician,

fingertips are used, more accurate than the

first method since tensing of the uterus
maybe felt by palpation about 5 seconds
before is able to feel the contraction.
Use of electronic monitoring devices that
measure the frequency & duration of
contractions

PLACENTA
May impede labor when implantation took

place in the lower uterine segment . The

placenta may cover part or all of the internal
cervical os known as placenta previa

Placenta Previa

Signs of Placental
Separation:
Fundus rises becomes firm & globular

Calkins sign
Lengthening of the cord
Sudden gush of blood

Types of Placental
delivery:

a. Schulz shiny - begins to separate from

the center to edges presenting the fetal side

shiny
b. Duncan dirty- from edges to center
presenting the natural side beef red or
dirty
Slowly pull cord & wind to clamp - Brant
Andrew Manuever
Hurrying of placental delivery will lead to
inversion of the uterus

Psyche
Women who are relaxed, knowledgeable &

capable of actively participating in the control

of the birth process usually experience shorter
& less intense labor.
How to Assess the psyche:
1. Cultural assessment - values & beliefs
- Nurses more effective if aware of individual
differences

. Challenge for nurses to achieve balance

between cultural awareness & risk of
stereotyping
2. Psychosocial assessment previous ideas,
knowledge & fears about childbearing
- support system

Need to consider if a woman experienced

domestic violence: forced to have sex, hit,

kick, how many times, afraid of her partner
Anxiety : rapid breathing, nervous tremors
,clinching of teeth
-provide support, teach relaxation
technique, may need paper bag if lips are
tingling or hyperventilating

STAGES OF LABOR &

DELIVERY
First stage of labor onset of true
contractions to full dilation & effacement of
cervix
II. 2nd stage full cervical dilatation to the time
the baby is delivered
III. 3rd stage the time the baby is born to the
delivery of the placenta(afterbirth)
I.

Phases of Labor
1. Latent phase changes in the body occurs
in preparation for labor, irregular & painful
contractions will start & last for 24 hours
Assessment
>dilations: 0-3 cm
mom: excited, apprehensive, can
communicate

 Frequency every 5-10 min

Intensity mild

Nursing care: encourage walking will

shorten 1st stage of labor
Encourage to void every 2-3 hours full
bladder inhibits contractions
Breathing chest breathing

2. Active phase
Assessment:
>dilations 4-8 cm
>mom fears of losing control of self
>frequency every 3-5min lasting for 30-60
seconds
> intensity moderate

Nursing care:
M edications- have meds ready
A ssessment includes vital signs, cervical
dilation & effacement , fetal monitoring
D ry lips, oral care (ointment)
B abdominal breathing

3. Transitional phase
Assessment:
Dilations: 8-10 cm
Frequency: every 2-3 min contractions
Duration: 45-90 seconds
Intensity: strong
Mom: mood changes with hyperesthesia

Hyperesthesia increase sensitivity to touch,

pain all over
Health teaching: teach sacral pressure on lower
back to inhibit transmission of pain, keep
informed of progress, controlled chest
breathing

Nursing care:
T- ires
I - inform of progress
R estless support her breathing technique
D- iscomfort
Effacement use % for measurement
Dilation use cm for measurement

1st stage of labor longest part of labor, cervix

is continually dilating, with excruciating pain,
6-10 hours, can be relieved with medications,
longer in the first pregnancy, shorter in
subsequent pregnancies

1st Stage of labor

II 2nd stage of Labor from full dilation to birth

- avergae duration for primis is 1 hour & for
multiparas 20 min
7-8 multi bring to delivery room
10 cm primi bring to delivery room
Lithotomy pos put legs up
Bulging of perineum-sure to come out
Breathing- panting, teach mom

 Panting rapid & shallow breathing

Episiotomy : median-less bleeding, less pain

easy to repair, fast to heal, possible to reach
rectum (urethroanal fistula)
- mediolateral - more bleeding &
pain,slow to heal use local or pudendal
anesthesia

Pudendal anesthesia-pudendal block or saddle

block a form of local anesthesia to relieve pain
during pregnancy, anesthesia is produced by
blocking the pudendal nerves near the ischial
spine of the pelvis.
Pudendal nerves nerve in the pelvic region
that carries sensory & motor fibers

Modified Ritgens Maneuver the nurse or the

midwife places the hand on the perineum &
applies pressure to allow controlled delivery
- pressure on perineum/anus to hasten
process of vaginal delivery.

Importance of Ritgens Maneuver: (place towel

at the perineum)
1. To prevent laceration
2. Will facilitate complete flexion & extension
(support head & remove secretion, check
cord if coiled. Pull shoulder down & up, check
time & identification of baby)

Mechanisms of Labor:
1. Engagement biparietal diameter of the
baby reaches the ischial spines
2. Descent presenting part progresses
through the pelvis; level os station
3. Flexion descending head meets pelvic floor,
chin is brought down

4. Internal rotation fetal head rotates from

transverse to facilitate movement
5. Extension once fetal head re3aches
perineum, it extends to be born
6. Restitution after the delivery of the head, it
rotates back to position
7. External rotation shoulder engage & move
similarly to head
8. Expulsion entire infant emerges from the
mother

Mechanisms of Labor

Descent

Flexion

Complete Rotation

Extension

External rotation

Delivery of the anterior shoulder

Delivery of the Posterior shoulder

Expulsion