Introduction to labor

Quick review

Question 1 What is labor?

Process of opening and thinning of
the cervix to allow the fetus to be
born.

#2 What are the stages of

labor?
1st : Onset Regular, rhythmic uterine
contractions associated with progressive cervical
dilatation, effacement and fetal descent until
cervix fully dilated.
2nd: Full dilitation of the cervix to birth of the
fetus
3rd: Birth of the newborn to separation/expulsion
of the placenta
4th: First few hours after expulsion of the
placenta, transition time for newborn, family
attachment
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Question 3
How do you distinguish practice versus
true labor?
Labor results in cervical change
Labor often associated with ROM or
bloody show
Labor doesnt go away with position
change or hydration
Labor get stronger, longer and closer
together
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True vs False labor

Q 4 The 5 factors affecting the

labor process

The 5(6) Ps?

Passenger
Passage
Powers
Position
Psyche
Philosophy of Provider
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The Passenger

Q 5 Factors about the

passenger that influence labor

Lie,
Presentation,
Position,
Attitude,
Station,
Size of head and ability to mold,
Fetal weight
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Q 6 Define Fetal Lie

The relationship of the fetal long axis
to the maternal spine

What are the two types of lie?

Longitudinal 99.5%
Transverse .5%
Oblique is a temporary lie that
converts to one of the others
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Q 7 Define Presentation
Portion of the fetus that lies over the
pelvic inlet (over the cervix).
What are the 3 main presentations
Cephalic 96%
Breech (Podalic) 3-5%
Shoulder < 1%
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Presentation

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Presenting Parts

Define: Most dependent fetal part

Cephalic:
Occiput (Vertex)-Flexed
Sinciput Military or deflexed
Bregma (Brow) Extended (.5%)
Mentum (Chin-Face)- Hyperextended .5%
Military and Brow are transient and
convert to occiput or face
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Presenting Parts cont.

Breech (3-4%) at term. Up to 20%
preterm
Types
Frank= lower extremities flexed at hips,
extended at the knees (highest success
with vaginal birth)
Complete= one or more knees flexed
Incomplete= One or more extremities
extended: Footling, kneeling
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Frank Breech

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Footling Breech

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Q 8 Define Position
relationship of the denominator of
the presenting part to the four
quadrants of the maternal pelvis
Front of
mother

If breech, then the O is an S for sacrum. If it is a face it is an M for

mentum
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Q 9 Define Attitude
Relationship of fetal parts to each other
Identify the main attitudes (Flexion or
extension)
Universally Flexed OA (9.5 cm diameter)
Flexed OP (11 cm. diameter)
Deflexed (military) (12-12.5 cm diameter)
Extended (Brow) (13-13.5 cm diameter)
Hyperextended (Face) (9.5 cm diameter)
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Attitude

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Hints to OP
Suspect Posterior if
maternal abdomen is kidney bean
shaped,
you can feel fetal parts everywhere or
fetal heart is best heard in the flank
Not engaged.
ROP most common. (Left oblique
diameter reduced by the sigmoid colon)
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Q 10 Define Station
Presenting part in relation to the ischial spines
Reported in centimeters above (minus
numbers) or below (plus numbers). Some
hospitals use +5 cm. Others use +3 cm. You
need to identify, eg. +2/3 or -3/5
What is engagement?
When the widest portion of the presenting
part has negotiated the pelvic inlet (narrowest
part of the pelvis).
Usually reflects 0 station in a flexed occiput
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The Passage
Q11
Name the types of pelvis

Gynecoid (about 50%)

Anthropoid (25-35%)
Android (10-15%)
Platypelloid (<5%)

Important to know most women have the first

two types of pelvis (to ensure the species goes
on)
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Q 12 Name the types of Powers

Primary (Involuntary)
Secondary (Voluntary) plus resistance
of pelvic muscles and flexion of fetus
(2nd stage only)

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Q 9 Maternal Position
What is the best position for a woman
to assume in latent phase of labor?
What is the best position for active
labor?
What is the best position for second
stage
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Q 10 Psyche
Discuss psychological factors that
may influence labor
Fear
Personal history
Family history
Culture

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Philosophy of Provider

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What is the position

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Name that position

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Name that position

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Name that position

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Name that position

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Questions

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