• Theories of Labor Onset  Presentation – portion of the fetus that enters

the pelvis first.

1. Uterine stretc h theory – any hallowed  Position – relationship of the assigned area of
organ when stretched to its maximum the presenting part of the landmark of the
capacity will contrast and empty. material pelvis.
2. Oxy tocin th eory – Oxytocin, which  Station – measurement of the progress of
causes contractions of the smooth muscles of descent of the presenting part in relation to
the posterior pituitary gland as a result of the ischial spine.
stressful event in labor.  Frequency – from the beginning of one
3. Progesterone Deprivation Theory – contraction to the beginning of the next
Progesterone, secreted by the corpus contraction
Luteum and then by the placenta, is  Duration – from the beginning of contraction
essential in maintaining pregnancy. to its completion
However, the decrease in the level of  Intensity – the strength of contraction to its
progesterone circulating in the body will completion
initiate body pains.  Effacement – progressive thinning and
4. Prostaglandin Theory – Prostaglandins, shortening of the cervix
formed by the uterine deciduas under level  Dilatation – opening of the cervix os during
of concentration in the amniotic fluid and labor
blood of women increases during labor.
Research has shown prostaglandin to be SIGNS of LABOR
very effective in inducing uterine
contraction at any stage of gestation. Preliminary/Prodromal Signs of Labor
Initiation of labor is said to be the result of
the release of arachidonic acid is believed to 1. Ligthening – setting of fetal head into
increase prostaglandin synthesis pelvic brim
contractions.  occurs approximately 10-14 days
5. Theory of Aging Placen ta – as the before labor begins
placenta matures, blood supply decreases  gives the woman relief from
resulting in uterine contractions. diaphragmatic pressure and
shortness of breath
Related Terms:  occurs early in primiparas
 mother may experience: shooting
 Labor – is the process of moving the fetus, leg pains from the increased
placenta and membranes out of the uterus and pressure on the sciatic nerve,
through the birth canal. Synonymous with increased amounts of vaginal
childbirth and parturition. discharge and urinary frequency
 Delivery – is the actual birth of baby from pressure on the bladder
 Crowning – encircling of the largest diameter 2. Increased in Level of Activity – related to
of the baby’s head by the vulvar ring an increase in epinephrine release that is
 Effacement – shortening and thinning of the initiated by a decrease in progesterone
cervical canal. It is expressed in percentage produced by the placenta
(%). 3. Braxton Hicks Contractions – painless
 Dilatation – is the enlargement of the cervical irregular contractions, sometimes strong
os from an orifice a few millimeters in size to that may cause discomfort
an aperture large enough to permit the 4. Ripening of the cervix – Goodell’s sign: the
passage of the fetus. cervix feels softer than normal similar to
 Show – is a mucoid discharge from the cervix earlobe throughout pregnancy; at term
that is present after the mucous plug has been cervix is described butter-soft
discharged.
 Attitude – the relationship of the fetal parts to Signs of TRUE LABOR:
one another
 Lie – relationship of the fetal spine to the 1. Uterine Contractions – surest sign that
spine of the mother. labor has begun
 2. Show – the blood mixed with mucus, takes 2. Passenger – refers to the fetus, its size,
on a pink tinge. It is when mucus plug is presentation, and position.
expelled and capillaries are exposed.
3. Rupture of the membranes – experienced 3. Power – forces acting together to expel
either as a sudden gush or as a scanty, slow fetus from the uterus
seeping of clear fluid from the vagina. 2 TYPES of POWER
a. Primary Powers – involuntary contractions of
False Labor: the uterus
 Irregular contractions b. Secondary Powers- voluntary bearing down
 Pain is confined to the abdominal efforts of the mother
 No increase in duration, frequency, and
intensity. 4. Psyche – reflects the woman’s frame of
 Pain disappears with ambulating mind in dealing with the labor experience
 No cervical change
 Sedation stops contractions Structure of the fetal skull
 Cranium – uppermost portion of the
True Labor: skull, comprises eight bones.
 Regular contractions - the four bones: the frontal
 Pain on the lower back to the abdomen (actually 2 fused bones), 2 parietal
 Increase in duration, frequency and intensity and occipital.
 Pain not relieved upon ambulating - The other four: sphenoid,
 Accompanied with effacement and dilatation ethmoid, and 2 temporal bones
 Sedation does not stop contraction
The Suture Lines:
CHARACTERISTICS of CONTRACTIONS  Sagittal suture- joins the 2 parietal bones
1. Mild – uterine muscle are somewhat tense of the skull
but can be indented by a gentle pressure  Coronal suture – the line of juncture of the
2. Moderate – uterus is moderately firm and a frontal bones and the 2 parietal bones
firmer pressure is needed to indent  Lambdoid suture – the line of juncture of
3. Strong – the uterus becomes very firm that the occipital bone and 2 parietal bones.
at the height of contraction cannot be
indented. Fontanelles:
- significant membrane-covered spaces that
COMPONENTS of LABOR are found at the junction of the main suture
1. Passage – refers to the shape and lines
measurement of maternal pelvis and
distensibility of birth canal Anterior Fontanelle – referred to as bregma;
– refers to the route a fetus must lies at the junction of the coronal and sagittal
travel from the uterus through the sutures
cervix and vagina to the external - diamond-shape
perineum. - anteroposterior diameter is 3-4cm
– Elastic to expand and accommodate - transverse diameter is 2-3cm

4 Basic Classification of Pelvis: Posterior Fontanelle – lies at the junction of

a. Gynecoid – best pelvis; half of the the lambdoidal and sagittal sutures.
population - triangular
b. Android – common in men, 20% in - smaller than the anterior
women; heart shape and difficult for vaginal Fontanelle
delivery - only 2cm across its widest part
c. Anthropoid – common in men; 20-30%,
pelvic inlet oval Vertex – the space between two fontanelles
d. Platypelloid – flat pelvis; least common; Sinciput – the area over the frontal bone
5% of the population, long sacrum Occiput – the area over the occipital bone
Suboccipitobregmatic – narrowest diameter +4 station – head is floating
9.5cm; from the inferior aspect of the occiput to
the center of the anterior fontanelle FETAL LIE – the relationship between the long
axis of the body and the long axis of
Occipitofrontal – measured from the bridge of the a woman’s body
nose to the occipital prominence is 12cm
2 Primary Lie
Occipitomental – the widest which is 13.5cm; 1. Longitudinal 2. Transverse
measured from the chin to the posterior
fontanelle FETAL PRESENTATIONS – denote the body part
that will first contact the cervix of
Molding – the change in shape of the fetal skull be born first.
produced by the force of uterine contractions - this is determined by a
pressing the vertex of the head against the not- combination of fetal lie and the
yet-dilated cervix. degree of flexion

FETAL PRESENTATION and POSITION

3 Main Presentations
Attitude – describes the degree of flexion a fetus
assumes during labor or the relation of fetal parts a. Cephalic – the fetal head is the body part that
to each other will first contact the cervix
- the four types of cephalic presentation:
1) Good Attitude (complete flexion) – the vertex, brow, face and mentum
spinal column is bowed forward that the
chin touches the sternum, the arms are b. Breech – either the buttocks or the feet are the
flexed and folded on chest, the thighs are first body part that will contact the
flexed onto the abdomen and the calves cervix
are pressed against the posterior aspect of - the 3 type of breech presentation: complete,
the thighs. frank, and footling)
2) Moderate flexion – the chin is not
touching the chest but is in an alert or c. Shoulder – the presenting part is usually one of
military position the shoulders (acromion process, an
3) Poor flexion – the back is arched, the neck iliac crest, a hand, or an elbow
in extended and a fetus is in complete
extension, presenting the occipitomental POSITION – the relationship of the presenting
diameter of the head to the birth canal part to a specific quadrant of a
(face presentation) woman’s pelvis

Engagement – refers to the settling of the UTERINE CONTRACTIONS:

presenting part of a fetus far enough into the
pelvis to be at the level of the ischial spines. Origins
 Labor contractions begin a “pacemaker”
Floating – a presenting part that is not point located in the myometrium near one
engaged of the uterotubal junctions
Dipping – one that is descending but has not  In some women, contractions appear to
yet reached the ischial spines originate in the lower uterine segment
rather than in the fundus.
Station – refers to the relationship of the
presenting part of a fetus to the Phases
level of ischial spines  3 Phases: increment, acme, decrement
 Increment- when the intensity of the
0 station – presenting part of a fetus is at the contraction increases
level of the ischial spines  Acme- when the contraction is at its
-4 station – head is at outlet strongest
  Decrement- when the intensity decreases
 As labor progresses the relaxation intervals 1. Stage 1 (stage of dilatation) – begins with the
decrease from 10 minutes to 2 – 3 minutes true labor pains and ends when the cervix has
 The duration also changes from 20-30 sec reached full dilatation
to a range of 60-90 sec Nursing Care:
Stay with woman; provide constant support
Reminds, reassures and encourages woman
to reestablish breathing patterns and
Contour Changes concentration as needed
 Upper segment becomes thicker and Prompts partial respirations if woman begins
active, preparing it to be able to exert the to push prematurely accepts woman
strength necessary to expel the fetus when inability to comply with instructions
the expulsion phase of labor is reached Keeps woman aware of progress
 The lower segment becomes thin-walled, 4 Phases:
supple, and passive so that the fetus can be • Latent Phase
pushed out of the uterus easily Begins at the regularly perceived
 Physiologic retraction ring – a ridge on the uterine contractions and ends when
inner uterine surface that marks the rapid cervical dilatation begins
boundary between the 2 portions Contractions are mild and short lasting
 Pathologic retraction ring (Bandl’s ring) – 20-40 seconds
it is a danger sign that signifies impending Cervix dilates from 0-3cm
rupture of the lower uterine segment if the 6 hours in nullipara
obstruction to labor is not relieved 4.5 hours in multipara
Nursing Care:
Cervical Changes - Assists woman to cope with
contraction
Effacement - Helps to concentrate in breathing
 Shortening and thinning of the cervical techniques
canal - Assists into comfortable position
 Normally the canal is 1-2cm - Informs woman of the progress of
 With effacement the canal virtually labor
disappears because of longitudinal traction - Explains procedure and routines
from the contracting uterine fundus - Offer fluids, ice chips, food as
ordered
Dilation • Active Phase
 Refers to the enlargement or widening of Dilatation increases from 4 – 7 cm
the cervical canal from an opening of few Contraction lasts 40-60 sec and occur
millimeters wide to one large enough every 3-5 minutes
(10cm). 3 hours in nullipara
 First reason why dilation occurs is uterine 2 hours in multipara
contractions gradually increase the Show and spontaneous rupture of
diameter of the cervical canal lumen by membranes may occur
pulling the cervix up over the presenting
part of the fetus
 Second, the fluid-filled membranes press Nursing Care:
against the cervix - Finds assessment techniques
 As dilation begins there is large amount of between contractions
vaginal secretions (show) because the last - Assists with frequent position
of the operculum or mucus plug in the change
cervix is dislodged and capillaries in the - Applies counter pressure to
cervix rupture sacrococcygeal area
- Encourages and praises
- Keeps woman aware of progress
STAGES OF LABOR
 - Check bladder and encourages o External Rotation – almost immediately
voiding after the head of the infant is born, the
- Gives oral care head rotates (from the anteroposterior
• Transition Phase position it assumed to enter the outlet)
Contractions reached their peak of back to the diagonal or transverse position
intensity occurring every 2-3 minutes of the early part of labor
with duration of 60-90sec o Expulsion – the rest of the baby is born
Maximum dilatation 8-10cm easily and smoothly because of its smaller
Complete cervical effacement part size. The end of the pelvic division of
Woman experiences intense labor.
discomfort accompanied by nausea and
vomiting Nursing Care:
Woman may also experience a feeling
of loss of control, anxiety, panic or Put both legs at the same time when
irritability positioning to the lithotomy position
Instruct mother to push as fetal head
2. Stage 2 (Stage of Expulsion) – the period from crowns. If hyperventilation occurs, let
full dilatation to birth of the infant patient breathe into a brown paper or a
Contractions change from the cupped hand.
characteristic crescendo-decrescendo
pattern to overwhelming uncontrollable 3. Stage 3 (Placental Stage) – begins from the
urge to push or bear down with each delivery of the baby up to the delivery of the
contraction as if to move her bowels placenta
Woman perspire and the blood vessels in
her neck may become distended 2 Phases:
Crowning takes place a. Placental Separation
The need to push become intense and the Signs:
woman cannot stop herself - Lengthening of the cord
- Sudden gush of blood
6 Cardinal Movements of the Mechanism of - Change of shape of the uterus
labor
b. Placental Expulsion
o Descent – downward movement of the - Brandt Andrew’s Maneuver – tract the
biparietal diameter of the fetal head to cord slowly, winding it around the clamp until
within the pelvic inlet placenta spontaneously comes out rotating it
- full descent occurs and the fetal slowly so that no membranes are left
head extrudes beyond the dilated
cervix and touches the posterior Nursing Care:
vaginal floor Don’t hurry the expulsion of the placenta,
just watch for the signs of placental
o Flexion – the head bends forward onto the separation
chest, making the smallest anteroposterior Take note of the time of placental delivery
diameter Inspect for the completeness of the
o Internal rotation – the occiput rotates until placenta
it is superior, or just below the symphysis Palpate the uterus to determine degree of
pubis, bringing the head into the best contraction. If relaxed, massage gently and
relationship to the outlet of the pelvis apply ice cap
o Extension – as the occiput is born, the Inspect for lacerations
back of the neck stops beneath the pubic
arch and acts as a pivot for the rest of the Types of Placental Presentation
head. The head extends, and the foremost
parts of the head, the face and chin are  Schultze’s – appearing shiny and
born. glittering from the fetal membranes
  Duncan – it looks raw, dirty, meaty, a. Early Deceleration – are periodic decreases
red and irregular in the FHR resulting from pressure on the fetal
head during contraction (head compression)
4. Stage 4 (Puerperium Stage) – first 4 hours after
delivery of placenta b. Late Deceleration – indicative of fetal
hypoxia because of deficient placental perfusion
Degrees of Perineal Lacerations: (uteroplacental insufficiency)

1. First Degree – skin and superficial to muscle c. Variable Deceleration – occurs at

2. Second Degree – muscles of the perineum unpredictable times during contractions and
3. Third Degree – continues to anal sphincter indicates cord compression
4. Fourth Degree – involves the anterior anal wall
Anesthesia – encompasses analgesia amnesia,
Episiotomy – incision made to the perineum to relaxation and reflex activity. It abolishes pain
enlarge the vaginal opening for easy delivery perception by interrupting the nerve impulses to
the brain. The loss of sensation may be partial
Types: incomplete, sometimes with loss of consciousness.
a. Midline/Median
b. Mediolateral Analgesia – refers to the alleviation of the
c. Lateral sensation of pain or in the raising of the threshold
for pain perception without loss of consciousness
Advantages:
1. Enlarging of the vaginal opening
2. Shortening of the second stage of labor
3. Minimizing the stretching of the perineal
muscle
4. Preventing perineal tearing

Fetal Monitoring – periodic change or fluctuation

in FHR occur in response to contractions and the
fetal movements are described in terms of
accelerations or decelerations
- done through intermittent
auscultation
- electronic monitoring

1. External – transabdominal, noninvasive,

monitors uterine contraction and FHR; client
needs to decrease extra-abdominal movements

2. Internal – membranes must be ruptured, cervix

sufficiently dilated and presenting part; invasive
procedure; continuous monitoring
- results of monitoring: normal FHR 120-
160; must obtain a baseline

Acceleration – 15 bpm rise above baseline

followed by return; usually in response to fetal
movement or contractions; indicates fetal well-
being

Deceleration – fall below baseline lasting 15

seconds or more, followed by a return: