5 Ps of Labor

- Passage
- Passenger - Power - Placental

Factor - Psychological Factor

Ability of pelvis and cervix to accommodate passage of fetus True pelvis

Forms bony canal through which fetus must pass

Four classical types of pelvis

Gynecoid Android Anthropoid Platypelloid

Ability of fetus to complete birth process Molding: cranial bones overlap under pressure of the powers of labor and demands of unyielding pelvis

Frank
Flexion at thighs, extension at knees Feet up by head Buttocks present

Complete
Flexion at thighs and knees Feet and buttocks present

Footling
Single or double Extension at thighs and knees Foot or feet present

Kneeling
Extension at thighs, flexion at knees Knees present

Position of fetus in relation to pelvis Fetal attitude refers to relation of fetal parts to one another Fetal lie refers to relationship of cephalocaudal axis of fetus to cephalocaudal axis of woman Station refers to relationship of presenting part to imaginary line drawn between ischial spines of maternal pelvis

Characteristics of contractions and effectiveness of expulsion methods Primary and secondary forces work together to achieve birth of fetus, fetal membranes, placenta
Primary force is uterine muscular contractions Secondary force is use of abdominal muscles to push during second stage of labor

Retained Placenta - Occurs in 2% to 3% of all vaginal births - Retention of placenta beyond 30 minutes after birth - If not expelled, placenta must be manually removed from the uterus

Marginal
Placenta separates at its edges Blood passes between fetal membranes and uterine wall Blood escapes vaginally

Central
Placenta separates centrally Blood trapped between placenta and uterine wall Concealed bleeding

Complete
Total separation Massive vaginal bleeding

Total: The internal os completely covered

Partial: The internal os partially covered Marginal: The edge of the os covered

Understanding and preparing for childbirth experience Amount of support from others Present emotional status Beliefs and values

Depression - Decreased ability to concentrate - Inability to process information - Feeling overwhelmed - Hopeless about outcome of labor
Anxiety Disorders - May experience chest pain, shortness of breath, faintness and feeling terrified

Labor is the time of mixed emotions laboring woman with psychological disorder may have impaired coping mechanisms and be emotionally challenged during labor

Characterized by
Contractions at regular intervals increase in duration and intensity Discomfort begins in back and radiates to front of abdomen Walking intensifies contractions Resting or relaxing in warm water does not decrease intensity Contractions produce cervical dilatation

Characterized by
Irregular contractions that do not increase in duration or intensity Contractions are lessened by walking, rest, or warm water Discomfort felt primarily in abdomen Contractions produce no effect on cervix

Latent phase physiologic changes

Regular, mild contractions begin and increase in intensity and frequency Cervical effacement and dilation begins

Latent phase psychologic changes

Relief that labor has begun High excitement with some anxiety

Active phase physiologic changes

Contractions increase in intensity, frequency, and duration Cervical dilation increases from 4 to 7 cm Fetus begins to descend into the pelvis

Active phase psychologic changes:

Fear of loss of control Anxiety increases

Transition phase physiologic changes

Contractions continue to increase in intensity, duration, and frequency Cervix dilates from 8 to 10 cm Fetus descends rapidly into the birth passage Woman may experience rectal pressure Woman may experience nausea and/or vomiting

Transition phase psychologic changes

Increased feelings of anxiety Irritability Eager to complete birth experience Need to have support person or nurse at bedside

Second stage physiologic changes

Begins with complete cervical dilation and ends with birth of infant Woman pushes due to pressure of fetal head on sacral and obturator nerves Woman uses intra-abdominal pressure Perineum begins to bulge, flatten, and move anteriorly as fetus descends

Third stage physiologic changes

Placental separation: Uterus contracts and placenta begins to separate Placental delivery: Woman bears down and delivers placenta physician may put slight traction on cord to assist delivery of placenta

Fourth stage physiologic changes

Woman experiences increased pulse and decreased blood pressure due to redistribution of blood from uterus and blood loss Delivery of placenta to postpartum hours

Fourth stage physiologic changes

Uterus remains contracted and located between umbilicus and symphysis pubis Woman may experience a shaking chill Urine may be retained due to decreased bladder tone and possible trauma to the bladder