Chapter 16

Labor and Birth Processes

Copyright 2016 by Elsevier Inc. All rights reserved.

Learning Objectives

Explain the five major factors that affect the labor

process.
Describe the anatomic structure of the bony pelvis.
Recognize the normal measurements of the
diameters of the pelvic inlet, cavity, and outlet.
Explain the significance of the size and position of the
fetal head during labor and birth.
Summarize the cardinal movements of the
mechanism of labor for a vertex presentation.
Examine the maternal anatomic and physiologic
adaptations to labor.
Describe factors thought to contribute to the onset of
labor.
Describe fetal adaptations to labor.
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Factors Affecting Labor:

Passenger

Passenger: fetus

Size of the fetal head

Bones in the fetal skull
Fontanels
Molding
Presentation of the fetus: the part of the fetus that

enters the pelvic inlet first and leads through the birth
canal during labor
Cephalic
Breech
Shoulder

Copyright 2016 by Elsevier Inc. All rights reserved.

Copyright 2016 by Elsevier Inc. All rights reserved.

Copyright 2016 by Elsevier Inc. All rights reserved.

Factors Affecting Labor:

Passenger (Cont.)

Passenger: fetus (Cont.)

Fetal lie: the relation of the long axis (spine) of the

fetus to the long axis (spine) of the mother
Longitudinal
Vertical
Fetal attitude: the relation of the fetal body parts to
one another
General flexion
Critical measurements of fetal head

Biparietal diameter
Suboccipitobregmatic diameter

Copyright 2016 by Elsevier Inc. All rights reserved.

Factors Affecting Labor:

Passenger (Cont.)

Copyright 2016 by Elsevier Inc. All rights reserved.

Factors Affecting Labor:

Passenger (Cont.)

Passenger: fetus

Fetal position: the relationship of a reference point

on the presenting part to the four quadrants of the
mothers pelvis
Position is denoted by a three-part letter abbreviation
Fetal station: a measure of the degree of descent
of the presenting part of the fetus through the birth
canal
Fetal engagement: usually corresponds to 0
station

Copyright 2016 by Elsevier Inc. All rights reserved.

Copyright 2016 by Elsevier Inc. All rights reserved.

Factors Affecting Labor:

Passageway

Passageway: Birth
canal

Bony pelvis: 4 types

Gynecoid
Android
Anthropoid
Platypelloid
Soft tissues

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Factors Affecting Labor:

Powers

Powers
Primary powers: contractions

Frequency, duration, intensity

Effacement
Dilation
Ferguson reflex

Secondary powers: bearing-down efforts

Valsalva maneuver

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Factors Affecting Labor:

Position and Psychologic

Position of laboring woman

Discussed in depth in Chapter 19

Psychologic state of laboring woman

Discussed in depth in Chapter 19

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13

Process of Labor

Labor: process of moving fetus, placenta, and

membranes out of the uterus and through the
birth canal
Signs preceding labor

Lightening
Bloody show

Onset of labor

Cannot be ascribed to a single cause

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Process of Labor (Cont.)

Stages of labor

First stage
Latent phase
Active phase
Transition phase
Second stage
Third stage
Fourth stage

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Process of Labor (Cont.)

Mechanism of labor
Turns and adjustments necessary in human
birth process

Seven cardinal movements of mechanism of

labor
1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. Restitution and external rotation
7. Expulsion

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Physiologic Adaptation to Labor

Fetal adaptation

Fetal heart rate (FHR): reliable and predictive

information about the condition of the fetus related
to oxygenation
Fetal circulation
Fetal respiration

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Physiologic Adaptation to Labor

(Cont.)

Maternal adaptation

Woman exhibits both objective and subjective

symptoms
Cardiovascular changes
Respiratory changes
Renal changes
Integumentary changes
Musculoskeletal changes
Neurologic changes
Gastrointestinal changes
Endocrine changes

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21

Key Points

Labor and birth are affected by the five Ps:

passenger, passageway, powers, position of
the woman, and psychologic response.
Because of its size and relative rigidity, the
fetal head is a major factor in determining the
course of birth.

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22

Key Points (Cont.)

The diameters at the plane of the pelvic inlet,

the midpelvis, and the outlet plus the axis of
the birth canal determine whether vaginal
birth is possible and the manner in which the
fetus passes down the birth canal.
Involuntary uterine contractions act to expel
the fetus and placenta during the first stage of
labor; these are augmented by voluntary
bearing-down efforts during the second stage.

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Key Points (Cont.)

The first stage of labor lasts from the time

dilation begins to the time when the cervix is
fully dilated.
The second stage of labor lasts from the time
of full cervical dilation to the birth of the infant.
The third stage of labor lasts from the infants
birth to the expulsion of the placenta.
The fourth stage of labor begins with the
delivery of the placenta and includes at least
the first 2 hours after birth.

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Key Points (Cont.)

The cardinal movements of the mechanism of

labor are engagement, descent, flexion,
internal rotation, extension, restitution and
external rotation, and expulsion of the infant.
Although the events precipitating the onset of
labor are unknown, many factors, including
changes in the maternal uterus, cervix, and
pituitary gland, are thought to be involved.

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Key Points (Cont.)

A healthy fetus with an adequate

uterofetoplacental circulation is able to
compensate for the stress of uterine
contractions.
As the woman progresses through labor,
various body systems adapt to the birth
process.

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26

Question
1. With regard to fetal positioning during labor,
nurses should be aware that:
a. Position is a measure of the degree of
descent of the presenting part of the fetus
through the birth canal.
b. Birth is imminent when the presenting part is
at +4 to +5 cm, below the spine.
c. The largest transverse diameter of the
presenting part is the suboccipitobregmatic
diameter.
d. Engagement is the term used to describe the
beginning of labor.
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