Labor and Delivery

Labor and Delivery  Human placental lactogen- causes
decreased insulin sensitivity

Lightening- settling of the fetal head into the
resulting in diabetogenic effect in the
inlet of the true pelvis
mother
Effleurage- light stroking involving a  Estrogen- stimulates the ductile
circular movement made with the palm of structures of breast
the hand to facilitate relaxation and provide
tactile stimulation to fetus Androgen Muscles, growth
Testosterone Sex (M), Gender
MMR- vaccine contraindicated to pregnant Estrogen Sex (F), Breast
women Progesterone Uterus, Pregnancy
Pelvic rocking- exercise which relieve
backache during labor and delivery
Dick- Read Method- psychophysiological
preparation for childbirth; method for pain
management that is built in the premise that
fear leads to tension and pain
Hormones produced by the placenta:
Estrogen, Progesterone, Human Placental
Lactogen
Stages of Labor:
 Cervical Dilation
Development of placenta begins in the 3rd - Begins with onset of regular
week of gestation contractions and ends with
IgG- maternal antibody transferred at 9th complete dilation
week of gestation - Nursing Responsibilities:
o Encourage to ambulate
Hormones: o Encourage to void
 Follicle stimulating hormone- - Length of stage: 8- 12 hours
responsible for the maturation of the o Latent: 0-3 cm dilated;
ovum regular pattern contractions
 Luteinizing hormone- responsible for (5- 20 min apart)
ovulation; transform follicle into o Active: 4-7 cm dilated;
corpus luteum contractions 2-3 minutes
 Progesterone- responsible for the apart
development of the rich spongy o Transition: 8- 10 cm dilated;
lining of the uterus; stimulates the contractions 1 ½ - 2 minutes
acinar structures of breast apart
 Testosterone- affects gender identity,
determine sex typing in uterus
Latent 0-3 cm 5-20
dilated min
apart
Active 4-7 cm 2-3
dilated min
apart
Transition 8- 10 1½-
cm 2 min
apart
 Stage of Expulsion
- Begins with complete cervical
dilation (monitor fetal heart rate
at least every 15 minutes) and
ends with delivery of fetus
- Signs: crowning, effacement
(thinning and shortening of the
cervix)
- Cervix dilation: 10 cm
- Length of stage: 1-2 hours
- Nursing Responsibilities:
o Position comfortably
o Encourage to empty
bladder
 Placental Stage
- Begins immediately after fetus is
born and ends when the placenta
is delivered
- Length of stage: 10 minutes- 1
hour
- Signs of placental separation:
o Sudden gushing of blood
o Lengthening of the cord
o Uterine fundus is firm
o Perineal cleaning Labor dystocia/ Prolonged labor
o Applying of perineal pads - Failure to progress in labor
o Administration of - Reasons why this could happen:
oxytocin o Can relate to the cervix
not dilating enough
o baby’s head not engaging
with the mother’s pelvis
o differences between the
sizes of the baby’s head
and mother’s pelvis
o contractions not
sufficiently strong and
frequent to push the baby
out
Uterine Atony
- occurs when the uterus doesn’t Non- Sonographic Methods for
contract properly during and after determining Gestational Age:
childbirth  Naegele’s Rule
- Signs of uterine atony: profuse Last menstrual period + 1 year + 7
bleeding, fundus relaxed, and days – 3 months
hypotension  Uterine Size
Supine Hypotension - 12 weeks gestation: uterus
palpable just above the pubic
- A condition experienced by a symphysis
pregnant client when lying on her - 16 weeks gestation: fundus of the
back, irregular heart rate, uterus palpable at the midpoint
hypotensive, and apprehensive between the umbilicus and the
Placenta Previa pubic symphysis
- 20 weeks gestation: fundus
- Hemorrhage resulting from the palpable at the level of the
low implantation of the placenta umbilicus
on the interior uterine wall - After 20 weeks: the pubic
- Common in multiparous women symphysis to fundal height in cm
- Cause is unknown should correlate with the week of
- Diagnosed through ultrasound gestation
Abruptio Placenta
- Placenta separates prematurely
from the uterine wall
- The baby can stop receiving
adequate oxygen therefore a
medical emergency
Amniotic Fluid:
10 weeks: 30 ml
20 weeks: 350 ml
37 weeks: 850- 1000 ml
Golden yellow color- may indicate ABO
incompatibility
Blood- streaked- traumatic tap (occurs if a

needle inadvertently has entered an epidural
vein during insertion), abdominal trauma,
intra- amniotic hemorrhage Leopold’s Maneuver
Yellow- hemolytic disease of the newborn - To determine the fetal
(bilirubin) presentation and position
Dark green- meconium stained
o Instruct to empty bladder
Dark red- brown- fetal death o Place woman in dorsal
Oligohydramnios recumbent
o Warm hands by rubbing
- Low amniotic fluid levels together
- Can increase the risk of the baby o Use the palm for
not getting enough oxygen palpation, not the fingers
- Amniotic fluid protects the baby
and helps develop its limbs, First Maneuver: Fundal grip
lungs, digestive system, and What lies in the fundus?
muscles
Third Maneuver: Pawlik’s Grip
What is in the inlet?
 Determines the size, consistency,

shape, and mobility of the form that
is felt  To determine what fetal part is lying
 Fetal head- hard, round, firm, and above the inlet (lower abdomen)
moves independently of the trunk
 Buttocks- soft, symmetric, and has
small bony prominences, moves with Fourth Maneuver: Pelvic Grip
the trunk What is the attitude?
Second Maneuver: Lateral grip

Where is the fetal back?
 To determine the degree of flexion of

the fetal head
 Fetal back- firm and smooth, hard,

resistant surfaces
 Fetal extremities- small irregularities
and protrusions
Accelerations
- Short- term increases in fetal
heart rate by at least 15 bpm that
lasts at least 15 seconds
- Signs that the fetus has an
adequate supply of oxygen
Types of Deceleration
Early Deceleration
- Symmetrical decreases and
return to normal of the fetal heart
rate that is linked to uterine
contractions
- Caused by compression of the
baby’s head during uterine
contractions; compression causes
vagal stimulation, which slows
down fetal heart rate
Variable Deceleration
- Very quick decrease in the fetal
heart rate
Late Deceleration
- Gradual increase in fetal heart
rate after a uterine contraction
- Caused by a decrease in placental
blood flow
- May indicate that a fetus has high
levels of acid in the blood
(impending fetal academia),
caused by lack of oxygen
Normal Fetal Heart Rate: 110- 160 bpm

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Labor and Delivery  Human placental lactogen- causes

decreased insulin sensitivity

Blood- streaked- traumatic tap (occurs if a

 Determines the size, consistency,

Second Maneuver: Lateral grip

 To determine the degree of flexion of

 Fetal back- firm and smooth, hard,

Normal Fetal Heart Rate: 110- 160 bpm

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