MIDTERM PERIOD

WEEK 7

1.Definition of Labor

2.Theories of Labor

3.Components of Labor

4.Difference Between True and False Labor

5.Mechanism of Labor
6. Stages of labor
Introduction:
Learning about the factors that initiate labor and delivery is important so
that nursing students will know how to assist a laboring woman. Knowing
how to describe the differences between true and false contractions is
also an important thing to consider so that nursing students will be able to
give the right information to the laboring woman and in return, the
expectant mother could have enough time to prepare herself for her
delivery. Furthermore, rendering the corresponding nursing management
during the different stages of labor alleviate the pains of a laboring
woman, help her to cope more effectively during the process until she
delivers her baby. In this way, complications can be prevented and
delivery will be less stressful for the mother and her newborn.
I. Definition of Labor:
>are the series of events by which uterine contractions and abdominal
pressure expel a fetus and placenta from the uterus
II.Theories of Labor
> Labor usually begins between 37 and 42 weeks of pregnancy, when a
fetus sufficiently mature to adapt to extrauterine life, yet not too large to
cause mechanical difficulty with birth
1.The uterine muscle stretches from the increasing size of the fetus,
which results in release of prostaglandins
2.The fetus presses on the cervix, which stimulates the release of
oxytocin from the posterior pituitary
3. Oxytocin stimulation works together with prostaglandins to
initiate contractions
4.Changes in the ratio of estrogen to progesterone occurs,
increasing estrogen in relation to progesterone, which is
interpreted as progesterone withdrawal
5. The placenta reaches a set age, which triggers contractions
6. Rising fetal cortisol levels reduce progesterone formation
and increase prostaglandin formation
7. The fetal membrane begins to produce prostaglandins,
which stimulate contractions
 III. The Components of Labor
1.The passage
➢ Refers to the route a fetus must travel from the uterus through the
cervix and vagina to the external perineum
➢ Known as the woman’s pelvis
➢ Should be of adequate size and contour
2. The passenger (the fetus)
➢ Should be of appropriate size and in an advantageous position and
presentation
➢ The body part of the fetus that has the widest diameter is the head
3. The powers of labor (uterine contractions) are adequate
4. The psyche, or a woman’s psychological state which may either
encourage or inhibit labor.
> This can be based on her past life experiences as well as her present
psychological state

IV.Difference Between True and False Contraction

FALSE CONTRACT. TRUE CONTRACT.

> Begin & remain irregular >begin irregular but become
regular & predictable

>Felt first abdominally >felt first in lower back

and remain confined to the and sweep @ the
abdomen and groin abdomen in a wave
FALSE CONTRACT. TRUE CONTRACT.
>Often disappear with > Continue no matter
ambulation and sleep what the woman’s level of
activity

> Do not increase in > Increase in duration, frequency

duration, frequency & and intensity
intensity
V.Mechanisms (Cardinal Movements) of Labor
1.Descent
>The downward movement of the biparietal diameter of the fetal head
within the pelvic inlet
Nulliparas: descent occurs during 2nd stage
Multiparas: descent usually begins with engagement
Occurs due to :
1.Pressure of amniotic fluid
2.Direct pressure on the breech by the fundus during
contractions
3. Bearing-down of maternal abdominal muscles
2.Flexion
➢ As descent is completed, and the fetal head touches the
pelvic floor, the head bends forward onto the chest, causing
the smallest anteroposterior diameter
➢ Due to resistance from the cervix, pelvic walls, or pelvic floor
➢ Chin is brought towards the chest
➢ Shifts from longer occipitofrontal
diameter (12cm) to shorter
Suboccipito bregmatic diameter (9.5cm)
3. Internal Rotation
➢ As the head flexes at the end of descent, the occiput rotates so
the head is brought into the relationship to the outlet of the pelvis.
➢ This movement brings the shoulders, coming next into the optimal
position to enter the inlet
4.Extension
> As the occiput of the fetal head is born, the back of the neck stops
beneath the pubic arch and acts as a pivot for the rest of the head
>The head extends and the foremost parts of the head, the face and
chin are born
5. External Rotation
6. Expulsion
Cervical Changes
a.Effacement
➢ Is shortening and thinning of the cervical canal
➢ All during pregnancy, the canal is approx. 1-2 cm long
➢ During labor, the longitudinal traction from the contracting
uterus shortens the cervix so much that the cervix virtually
disappears
b. Dilatation
> Refers to the enlargement or widening of the cervical canal
from an opening a few millimeters wide to one large enough
(approx.10cm)
Effacement means that the
cervix stretches and gets thinner.
Dilatation means that the
cervix opens.
> As labor nears, the cervix may start to thin or
stretch (efface) and open (dilate).
>This prepares the cervixforthe baby to pass through thebirthcanal
(vagina).
VI. The Stages of Labor
➢ The first stage of dilatation, which begins with the initiation
of true labor contractions and ends when the cervix is fully
dilated
➢ The second stage, extending from the time of full dilatation
until the infant is born
➢ The third or placental stage, lasting from the time the infant
is born until after the delivery of the placenta
➢ The first 1-4 hours after birth of the placenta is sometimes
termed as the “fourth stage” to emphasize the importance of
close maternal observation needed at this time
First Stage
➢Begins with the initiation of true labor contractions and ends
when the cervix is fully dilated
➢Takes about 12 hours to complete and divided into three
segments:
a.Latent Phase
➢ Also known as the early phase begins at the onset of
regularly perceived uterine contractions and ends when rapid
cervical dilatation begins
➢ Contractions are mild and short lasting - 20 to 40 sec.
➢ Cervical effacement occurs and the cervix dilates minimally
➢If a woman wants an analgesia at this point, she should not be denied
of it, but if given early, this could prolong this phase
Nursing Management:
➢Can be managed by controlled breathing during uterine contractions if
the woman is psychologically prepared for labor
➢Encouraged woman to walk
➢Encourage woman to do some preparation at this point such as doing
last minute packing for her stay in the hospital
➢Woman can give instructions to older children for her departure and
upcoming birth
➢If desired by the woman: pain relief such as aroma therapy, distraction
or even acupuncture
➢Encourage woman to be active and to use any nonpharmacologic
measures she finds effective
b. The Active Phase
➢ Cervical dilatation occurs more rapidly
➢ Contractions grow stronger, lasting 40-60 sec and occur
approx. every 3 to 5 minutes
➢ Show (increased vaginal secretions) and spontaneous
rupture of the membranes may occur
c. The Transition Phase
> Contractions reach their peak of intensity, occurring every 2 to
3 mins. With a duration of 60 to 70 sec.
Nursing Management:
➢Encourage woman to be active participant by keeping active and
assuming whatever position is most comfortable for her during this time
➢Lying flat on her back should be avoided during this time
c. The Transition Phase
➢Contraction reach their peak of intensity; every 2-3 minutes with a
duration of 60 to 70 seconds and a maximum cervical dilatation of 8 to
10 cm
➢Woman is experiencing an intense discomfort that is so strong
➢May accompanied with nausea and vomiting
➢With loss of control, anxiety, panic or irritability
➢The irresistible urge to push usually begins
2. The Second Stage
➢ The time span from full dilatation and cervical effacement to
birth of the infant
➢ A woman typically feels contractions change from the char. of
crescendo-decrescendo pattern to an uncontrollable urge to
push
➢ As the fetal head pushes against the vaginal introitus, this
opens and the fetal scalp appears at the opening to the
vagina and enlarges from the size of a dime, to a quarter, then
a half-dollar
➢ This is termed as “crowning”
3. The Third Stage
➢ Known as the placental stage
➢ Begins with birth of the infant and ends with the delivery of the
placenta
➢ After the birth of an infant, the uterus can be palpated as a
firm, rounded mass just below the level of the umbilicus
➢ After a few minutes of rest, uterine contractions begin again
and the organ assumes a discoid shape
➢ It retains this new shape until the placenta has separated,
aprrox. 5 minutes after the birth of the infant.
Maternal Danger Signs of Labor
1.High or Low BP
➢ A systolic pressure > 140mmHg & a diastolic pressure >
90mmHg or an increase in systolic pressure > 30mmHg or in
the diastolic pressure of > than 15mmHg (the basic criteria for
gestational hypertension) should be reported
➢ Falling BP should also be reported because it may be a sign
of intrauterine hemorrhage
➢ Others signs: apprehension, increased PR and pallor-
hypovolemic shock
2.Abnormal Pulse
➢Most women during pregnancy has a PR of 70-80 beats per
minute
➢Usually increased during the second stage of labor because of
the exertion
➢PR > 100 beats per minute during labor is unusual- indication
of hemorrhage
3. Inadequate or prolonged Contractions
4.Abnormal Lower Abdominal Contour
> Full bladder is dangerous:
1.Bladder may be injured by the pressure of the fetal head
2.Pressure of the full bladder may not allow the fetal head to
descend
Nsg Mgt: Urge woman to void every 2 hours during labor
5. Increasing Apprehension

Fetal Danger Signs of Labor

1.Meconium Staining
➢ Green color in the amniotic fluid reveals the fetus has had a loss
of rectal sphincter control, allowing meconium to pass into the
amniotic fluid
➢ May indicate fetal hypoxia which stimulates the vagal reflex and
leads to increased bowel motility.
2.High or Low FHR
3. Hyperactivity
> Sign of fetal hypoxia
4.Low O2 saturation
> Normal O2 saturation is 40% to 70%
Fetal Heart Rate Patterns
1. Accelerations
> Normal increases in FHR caused by fetal movement, a change
in maternal position or administration of an analgesic.
2. Early Deceleration
> Normal decreases in FHR resulting from pressure on the fetal
head during contractions
> a transient decrease in heart rate that coincides with the onset
of a uterine contraction, resulting in vagal stimulation and
slowing of the heart rate
3. Late Decelerations
➢Decelerations that are delayed after the onset of contractions
that suggest decreased blood flow to the uterus
➢gradual decrease in the fetal heart rate typically following the
uterine contraction
Causes:
a. uteroplacental insuffiency ( not enough oxygen to the baby),
b. amniotic fluid infection which can occur due to excessively
long labor after the water has been broken
c. low maternal blood pressure
4. Variable Decelerations
➢Decelerations that occur at unpredictable times in relation to
contractions that indicate compression of the