Labor and Birth

Teri Stone Godena, CNM, MSN

Spring, 2016
1

Parturition: Process of giving

birth
From the Latinparturire, "to be ready

to bear young" and is related

topartus, the past participle
ofparere, "to produce.
In USA called Labor and
Birth or labor and
delivery.
2

Normal Birth, WHO

definition
1996
spontaneous in onset,

low-risk at the start of labor,

remains low-risk throughout labor and
birth.
The infant is born spontaneously
between 37 and 42 weeks of
pregnancy

Copyright 2010, American College of Nurse-Midwives Inc. All Rights reserved.

Basic Principles of
parturition

Women have the innate capacity to

birth and they
remember their
births for their
entire lives
Copyright 2010, American College of Nurse-Midwives Inc. All Rights reserved.

Stages of Parturition (Labor)

4 stages, physiologically distinct

Phases of Labor Stage 1

Not always physiologically distinct
Latent-phase 0-3 cm average 8 hours. Up to 22
hours normal in primip. UCs mild Q 5-10 min.
Active Phase 4-7cm. Average 6 hours. UCs moderate
to strong, 50-60 sec, every 2-5 min
Transition 8-10 cm. Ave 15 60 min. UC strong, 5070 sec, every 2-5 min.
nausea, vomiting, shaking, I cant do it. Most
intense
period
6

How long does labor last?

Second stage of labor

Third stage of labor

Birth the American Way

From Lamaze International

2005
Copyright 2010, American College of Nurse-Midwives Inc. All Rights Reserved

10

Birth the American Way

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Reactions to Birth the American

Way

Birth Center

12

Reactions cont.

Homebirth

13

What women want

14

Why is nursing care at this time

important?

Nurses, because of their sheer

number probably hold the greatest
potential to influence the culture of
birth in the US

Kennedy and Lyndon, 2008

15

How nurses can influence the

culture of birth

Promote Physiologic Labor

Promote physiologic labor:
Educate about letting Labor begins on its own
Encourage freedom of movement throughout labor
Provide Continuous labor support
No routine interventions
Spontaneous pushing in non-supine position
No separation of mother and baby
Physiological practices that are underused:
Oral nutrition in labor
Non-pharmacological approaches to pain management in labor
Intermittent auscultation
A period of rest, then open glottis pushing in the second stage of labor
Delayed cord clamping improves neonatal outcomes
Skin-to-skin contact
Out-of-hospital birth
Declercq 2006, Sakala 2008, Simkin 2004, WHO 1996, ACNM 2003a

Labor induction (25%)

Continuous electronic fetal monitoring
Routine amniotomy (50%)
Epidural analgesia(80% in hospitals)
Routine episiotomy (25%)
Cesarean section (35%)

16

Factors influencing
childbirth

Cultural
Medical
Physical
Psychosocial

17

Your reactions to birth

Physiological practices
Nonphysiological

18

What initiates labor?

Short answer: we dont really know

19

Preliminary signs
Real versus False labor

20

You are a nurse on

Labor & Delivery.
Marie T. calls you at 2
pm stating that shes
been having
contractions for 4
hours and theyre
starting to get really
uncomfortable.
What questions would
you ask her?

Clinical
application

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Is it time?
You learn that Marie is a G1P0 at 39 weeks
gestation. She denies bloody show or ROM. She
is feeling fetal movement.
Her contractions are Q 4-6 minutes, lasting 3040 seconds, and she talks through them. They
space out when she rests. The last time her
cervix was checked, 1 week ago, she was 2-3cm.
dilated and 50% effaced. She has experienced
lightening
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Is she in labor?
What will you advise her to do? To plan
you need to know what some terms mean
Effacement- the passive process of
thinning the cervix from 3 cm length to
the thickness of a sheet of paper
Dilitation-the active process of opening
the cervix from 1 mm to 10 cm.
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Nursing interventions early

labor

24

Cervical change terms

Cervical Effacement (thinning)

25

Is it time yet?
Marie calls back 2 hours later. She thinks
her bag of waters has broken. Her
contractions have been 3-4 minutes apart
lasting 50-60 seconds for the last hour.
She can no longer talk through them.
What other questions do you ask?
Is it time for her to come to the hospital?
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You tell Marie to come to the

hospital
Describe the components of her assessment

What labwork will affect management? You Review her history:

Gestational age, G/TPAL

Is she in labor?
Contraction pattern
Cervical dilation and effacement
Status of membranes
Fetal wellbeing
Any complications.
Significant labs:
GBS-why?
Rh-why?
CBC-why?
Rubella-why?
HSV-why?
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The five Ps of labor

Passenger
Passageway
Powers
Position
Psychology of
birth (or
personality)
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The Passenger (Fetus)

Factors affecting labor:

Lie, presentation, position, attitude
Weight
Size of head
Station of the presenting part
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Leopold Maneuvers

Fetal lie, presentation,

position,attitude ,EFW
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Lie

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Presentation
Portion of the fetus that
lies over the pelvic inlet.
the three main
presenting parts are:
cephalic, breech or
shoulder.

cephalic

32

Position

33

Attitude

34

Fetal station

35

The Passageway
The true bony pelvis:
Soft tissues of the cervix, pelvic floor,
Vagina and introitus

36

Pelvic shapes
inlet nearly round or
blunt, heart-shaped
(45% of women)

inlet oval shaped.

Wider AP diamet
er(35% of women)

Wedge or heart
shaped (15%
of women)

inlet oblong shaped,

transversely (5% or
less of women)
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The Powers
Primary
Secondary

38

Maternal Position

39

The Psyche

40

Decreasing stress in labor

Imagery / focal points

Acupressure/Acupuncture
Massage, effleurage
Counter pressure
Heat, cold compresses
Breathing/relaxation techniques

41

Nursing care 1st Stage cont.

42

43

Nursing Care 3rd stage

44

Nursing Care 4th stage

45

Benefits of skin to skin

Calms and relaxes both mother and baby

Regulates newborn heart rate and breathing
Regulates newborn temperature
Enables colonization of babys skin with mothers
friendly bacteria, providing protection against infection
Stimulates the release of hormones to support
breastfeeding and mothering
Improves breastfeeding duration
Helps preterm babies grow and develop better
46

Beautiful birth
http://www.youtube.com/watch?v=
pQIL0nlquh4&feature=related

47

Questions?

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