ALDERSGATE COLLEGE NC107A

SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

Module 4: Normal Labor and Delivery

General Objective:
At the end of the course, the students should have acquired the knowledge, skills and attitudes required in the care
for the normal mothers, infants, children and families and the application of principles and concepts on family and
family health nursing process during the normal labor and delivery processes.

Objectives:
1. To apply the knowledge on the approaches on Growth and Development with the use of Nursing Process
2. To assess the signs and symptoms of normal labor.
3. Prioritize nursing diagnosis.

Learning Focus
NURSING CARE DURING NORMAL LABOR AND DELIVERY

Presentations and Positions

Presentation – denotes the fetal body that comes in contact with the cervix first.
Position – is the relationship of the presenting part to a specific quadrant of the maternal pelvis.

Terms related to Fetal Presentation and Positions

❖ Habitus – is a term used to describe the degree of flexion the fetus assumes or the relation of the fetal parts to
each other.
Types:
1. Complete Flexion/Good Flexion – is the normal fetal position
- spinal column is bowed forward
- head is flexed so that the chin touches the sternum
- the arms are flexed and folded on the chest
- thighs are flexed on the abdomen
- calves of the legs are pressed against the posterior aspects of the thighs
2. Moderate Flexion/ “Military Position” – same with the complete flexion except that the chin does not
touches the sternum of the chest.
3. Partial Extension – the brows present first.
4. Complete Extension – the back is arched, neck is extended with occipitomental presenting.
❖

❖ Engagement – is the entrance of the presenting part into the pelvic outlet. It can be assessed by vaginal o
cervical exams.

❖ Station – refers to the relationship of the presenting part of the fetus to the level of the ischial spines.
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

1. ( - ) Negative Station – the presenting part is above the ischial spines

2. (0) Zero Station – the presenting part is at the level of the ischial spines.
3. (+) Positive Station – the presenting part is below the ischial spines.

❖ Fetal Lie – is the relationship between the long axis of the fetal body and the long axis of the woman’s body
following a cephalo-caudal position.
1. Transverse Lie – fetus is lying in a horizontal position.
2. Longitudinal Lie – 99% fetal lie; the long axis of the fetal body is parallel with the long axis of the mother.
Types:
a. Transverse Lie – the head is presenting first.
b. Breech Longitudinal Lie – the buttocks present first.

TYPES OF FETAL PRESENTATIONS

1. Cephalic Presentations
a. Vertex
b. Brow
c. Face
d. Mentum

2. Breech Presentations – occur only in small cases. It is affected by habitus or attitude.

a. Complete breech – buttocks completely present first.
b. Frank Breech – the buttocks presents first and legs are pointed upwards.
c. Footling – one or both feet present first.

3. Shoulder Presentations (Transverse Presentations) – occur in 1% of cases. The fetus is lying horizontally in
the pelvis so that the long axis is perpendicular to the mother.
Presenting Parts:
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

a. Acromnion Process
b. Shoulder
c. Hands
d. Elbow
e. Iliac Crest

Causes of Shoulder Presentations:

1. Relaxed abdominal walls from grand multiparity
2. Pelvic contractions that is more horizontal than vertical
3. Placenta previa
▪ The mode of delivery is always CS and never thru NSD

FETAL POSITIONS

Maternal Quadrants
1. RA – right anterior
2. LA – left anterior
3. RP – right posterior
4. LP – left posterior

Fetal Anatomical Landmarks

1. Occiput
2. Mentum
3. Sacrum
4. Scapula / Acromnion Process

● A Fetal Position is marked by the abbreviation of THREE LETTERS:

1. First Letter – indicates the landmark pointing to the mother’s right or left;
2. Second Letter – denotes the fetal landmark
3. Third Letter – defines whether the landmark is pointing anteriorly, posteriorly or laterally.

Methods of Determining Fetal Presentation and Position

1. Leopold’s Maneuver
2. Vaginal Exams
3. FHT auscultation
4. Ultrasound

Leopold’s Maneuver – is a systematic method of observation and palpation to determine the ftal presentation and
position.
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

Steps:
1. First Maneuver – facing the patient, palpate the upper portion of the uterus and observe for the following:
a. Consistency
b. Shape
c. Mobility
2. Second Maneuver – facing the patient, locate the fetal back and extremities.
3. Third Maneuver – facing the patient, palpate the lower portion same as step no. 1.
4. Fourth Maneuver – facing the patient’s feet, palpate the abdomen and confirm your assessment.

LABOR – are series of processes or events by which the products of conception are expelled from the woman’s
body.

Theories of Labor Onset:

1. Estrogen Theory – estrogen is known to stimulate uterine muscle contraction to permit softening, stretching and
eventually thinning of the cervix.
2. Progesterone Withdrawal Hypothesis – progesterone produced by the placenta relaxes the smooth muscle so
no uterine contractions occur during pregnancy. At term, it normally decreases or withdrawn resulting to uterine
contraction initiating labor.
3. Prostaglandin Hypothesis – induction of labor can be successfully made by administering Prostaglandin E.
4. Corticotropin-Releasing Hormone Hypothesis – CRH concentration increases throughout pregnancy with
sharp increase at term.
5. Myometrial Activity – in true labor, the uterus is divided into 2 portions:
a. Upper portion (Contractile Segment) – with each contraction, the muscles of the upper portion shorten
and exert a longitudinal traction to the cervix causing EFFACEMENT.
b. Lower Portion (Passive Segment) – as labor continues, it expands and thins out.
6. Muscular Changes in the Pelvic Floor – as the fetal head descends to the pelvic floor, the pressure of the
presenting part causes the perineal structure to thin.
7. Uterine Stretch Theory – when the uterus reaches the maximum resistance, it will stretch out and expel its
contents.

Factors Affecting Labor (The 4 P’s)

1. Passageway (Pelvic Dimensions/Structures) – normal female pelvis has an ample pelvic arch, curved
sacrum, curved sidewalls, blunt ischial spines and movable coccyx.
2. Passenger (Fetus) – take into consideration the following:
a. Fetal head
b. Fetal lie
c. Presenting part
d. Attitude
e. Engagement
f. Station
g. Position
3. Person (Client) – pregnant woman’s behavior and influence upon her:
a. Maternal response to uterine contractions
b. Cultural perceptions and influence about labor and delivery
c. Prenatal and/or birth education
d. Ability to communicate feelings to significant others and staff
e. Support systems
4. Powers (Uterine Contractions)
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

a. Uterine contractions
b. Voluntary bearing down
c. Abdominal muscle contractions
d. Contractions of levator ani muscles
Uterine Contractions – are the contractions of the uterine muscles resulting to the labor process.
Phases:
a. Increment
b. Acme
c. Decrement

Signs of Labor

A. Premonitory Signs – are changes indicating that labor will be approaching shortly.
1. Physiologic Signs
- Lightening
- Braxton Hick’s Contractions
- Increased vaginal secretions
- Softening of the cervix
- Rupture of the membranes
- Bloody show
- Weight loss
- Increased back ache and sacro-iliac pressure
- Frequent urination
2. Psychologic Sign
- Sudden burst of energy

B. Clinical Signs
- Uterine contractions
- Effacement and progressive dilatation

Differential Factors of True and False Labor

Factor True Labor False Labor

1. Uterine Contractions Occurs at regular intervals; intervals Irregular intervals; intervals remain long
gradually shorten and intensity gradually and intensity remain the same
increases
2. Pain Located at the back and intensified by Located at the abdomen and relieved by
ambulation ambulation
3. Show Present Absent
4. Cervix Effaced Uneffaced and remains closed
5. Sedation May not interrupt contractions Stops contractions

Stages of Labor

1. Stage I: Stage of Cervical Dilatation – onset of true labor contractions to a complete cervical dilatation of 10
centimeters. The contractions are short and the client may ambulate.

What are accomplished:

a. Effacement – is the shortening of the cervical canal from a structure of 1-2 centimeters. (“Paper-thin edges
feel of the cervix upon IE)
b. Cervical Dilatation – is the enlargement of the cervical opening to permit the passage of the fetus.
(Forces Involved: Uterine Contractions)

Phases of Cervical Dilatation:

ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

a. Latent Phase – starts from the onset of uterine contractions, takes many hours and accomplishes little
cervical dilatation. (0-3 cms)
Nursing Responsibilities:
● Assessment
✔ Membranes if intact or ruptured and color of fluid
✔ Amount of show
✔ Cervical changes
✔ Time of last ingested food
✔ FHT
✔ Time of onset of uterine contractions
✔ Maternal vital signs
✔ Uterine contractions
✔ Need for bed rest
✔ Progress of descent, station and position
✔ Client’s knowledge on labor process and affect
● Interventions
✔ Admission procedures
✔ Perineal preparation and enema as ordered
✔ Vital signs assessment
✔ Encourage client to void every 2 hours to check for the presence of sugar, acetone and protein
✔ Maintain bed rest PRN
✔ Psychological and physiological support to the client

Methods of Minimizing Discomfort During Delivery

✔ Cutaneous stimulation
✔ Distraction
✔ Reducing anxiety
✔ Approaches to childbirth preparations:
- Health teachings about the process of labor
- Relaxation techniques
- Breathing exercises
- Hygiene

b. Active Phase – cervical dilatation proceeds at an accelerated rate. (4-7 cms)

Phases:
- Acceleration Phase
- Phase of Maximum Slope
- Deceleration/Transition Phase
Nursing Responsibilities
● Assessment
- Cervical changes
- Bloody show
- Membranes
- Station
- Uterine contractions
- Maternal and fetal vital signs
- Client’s affect
● Interventions
- Continue observing the labor progress
- Reinforce breathing techniques
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

- Position client for maximum comfort

- Psychological and physiological management to client or couple and involve them
- Provide comfort measures
- Provide chips or clear fluids if allowed
- Assist with anesthesia
- Update client for labor progress
- Apply sacral pressure or massage to ease pain
- Advise client not to lie on her back
- Administer analgesics as ordered
- Assess FHT every 15 minutes
- Encourage voiding
- Assess status of membranes

c. Transition Phase – cervical dilatation slows as it progresses from 8-10 centimeters. Contractions become
frequent, are longer in duration and increases in intensity. As dilatation approaches to 10 centimeters,
there maybe:
- Increased rectal pressure
- Uncontrollable urge to bear down
- Increase in bloody show
- Rupture of memebranes
- Apprehension of client
Nursing Responsibilities:
● Assessment
- Signs of the Transition Phase
✔ Hyperventilation
✔ Restlessness
✔ Difficulty of understanding instructions
✔ Sense of bewilderment and anger at contractions
✔ Generalized discomfort
✔ Increased sensitivity to touch
✔ Increased apprehension and irritability
✔ Loss of control
✔ Hiccupping, belching, nausea and vomiting
✔ Beads of perspiration
✔ Increasing rectal pressure
✔ Curling of toes
✔ Crying or yelling
- Cervical changes
- Maternal mood changes
- Maternal and fetal vital signs
- Breathing pattern
- Urge to bear down with contractions
● Interventions
- Continues observation of labor progress, maternal and fetal vital signs
- Positive support if client is tired or discharged
- Accept behavioral changes of mother
- Promote appropriate breathing patterns
- Discourage pushing efforts until cervix is fully dilated then assist with pushing
- Monitor contractions lightly with fingers
- Observe signs and symptoms of delivery
- Transfer client to the DR if “crowning” is imminent
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

2. Stage II: Stage of Fetal Expulsion – begins with 10 centimeter cervical dilatation to fetal expulsion. It is
typically completed in 2 hours after 10 centimeterscervical dilatation to primis and 15 minutes for multis.
NOTE:
▪ The use of epidural anesthesia extends the duration of labor.
▪ Increase urge because of the pressure of the fetal head on the sacral area.

What are Accomplished: Fetal expulsion thru the Mechanisms of Labor

Mechanisms of Labor:
a. Engagement – biparietal diameter of the fetal head passes the pelvic inlet. The head is fixed on the pelvis.
b. Descent – movement that occurs simultaneously with the passage of the head thru the pelvis. It occurs
because of the 4 Forces:
▪ Pressure of the amniotic fluid
▪ Direct pressure of the fundus of the uterus on the fetus
▪ Contraction of the abdominal muscles
▪ Extension and straightening of the fetal body.

c. Flexion – the chin of the fetus is in contact with the sternum and the posterior part of the head is presented
to the pelvis.
d. Internal Rotation – the head is rotated internally and comes to lie beneath the symphysis pubis. Crowning
follows.
e. Extension – the frontal portion of the head, face and chin are born.
f. Restitution – head turns to one side and aligns with the position of the birth canal.
g. External Rotation – shoulders are born.
h. Expulsion – the infant’s body is born.

Ritgen’s Maneuver – is the method of delivery of the fetal head by lifting it upwards and forwards thru the vulva
between contractions by pressing the tips of the fingers upon the perineum behind the anus.

Nursing Responsibilities:
● Assessment
- Signs of imminent delivery
- Check contractions every 2-3 minutes
- Evaluate vagina and perineum stretching and thinning
- Check increased bloody show
- Observe bulging of perineum
- Observe vaginal opening
- Observe birth or presenting part
● Interventions
- Transfer client carefully to the DR
- Position client and instruct bearing down techniques
- Cleanse perineum aseptically for delivery
- Auscultate for FHT every 15 minutes
- Administer oxygen as ordered
- Catheterize bladder if distended
- Encourage client to push in between contractions
- Note time of delivery and gender of baby

Maternal Birthing Positions

a. Recumbent /Lithotomy
Advantages”
- Enhance maintenance of asepsis
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

- Enhance assessment of FHT

- Easy performance of episiotomy and repair
Disadvantages:
- Hypotension
- DOB
- Uterine axis is directed towards the symphisis pubis instead of the pelvic intet.
- Aspirations of vomitus
- An embarrassing position
- Tightening of vagina and perineum
- Interferes with frequency and intensity of contractions
- Stirrups cause excessive pressure on legs
- The woman works against gravity

b. Left Lateral Sim’s Position/Side-lying Position – the woman lies on her left side with her left leg extended
and her right knee drawn against her abdomen or flexed by her side or with both legs bent at the knees.
Advantages:
- Increase over-all comfort
- Does not compromise venous return from the lower extremities
- Puts less stress and pressure on the maternal neck
- Decrease chances of aspiration should vomiting occurs
- Loss intrusive with no stirrups or overhead lights required
- Has a positive effect on shoulder dystocia
- Fewer episiotomies are required
Disadvantages:
- Difficulty of cutting and repairing large episiotomies.

c. Squatting Position
Advantages:
- Facilitates entrance of the presenting part into the pelvic inlet
- Second stage, it increases size of pelvic outlet and helps in pushing effort
Disadvantages:
- Perineum is inaccessible
- Difficulty in controlling birth process
- Increases difficulty of administering analgesia using instruments and monitoring fetal status.
- Perineal edema may occur due to prolonged squatting
- Epidural anesthesia causes heaviness on lower extremities

d. Semi-Fowler’s Position – enhances the effectiveness of the abdominal muscles effort while the woman is
pushing and thereby shortens the second stage of labor.

e. Sitting Position – similar to squatting but uses a birthing chair instead of handle bars.

f. Hands and Knees Position

Advantages:
- Less pressure on the maternal back from the fetus
- Fetus may rotate easily from the posterior position
- The mother is well supported by dropping the foot of the birthing bed and supplying extra pillows
where she can rest her forearms
- Less need for episiotomy
- Better access to nose and mouth for suctioning
- Increases placental and umbilical blood flow during episodes of fetal distress
- Increases pelvic diameter and facilitate birth of the infant with shoulder dystocia
Disadvantages:
- Decreased eye contact between the mother and the birth attendant
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

- Inability to use instruments

- Repositioning of the mother for perineal repair
- Easy fatigueability

3. Stage III: Placental Expulsion – is the period from the birth of the baby to the birth of the placenta

What are Accomplished:

a. Placental Separation
Signs:
- Uterus rises into the abdomen
- Uterus becomes firmer and globular in shape
- Lengthening of the cord
- Sudden gush of blood

b. Placental Expulsion – usually occurs 10-15 minutes after the delivery of the baby. It can be accomplished
by Crede;s Maneuver.

Crede’s Maneuver – is the application of gentle pressure on the contracted uterine fundus while applying
traction to the placenta.

Mechanisms of Placental Expulsion

▪ Shultze’s Mechanism – the placenta is born like an inverted umbrella with the glistening fetal surface
presenting. It signifies that the placenta has detached from the center first and blood clots are found at
the sac of the membranes.
▪ Duncan’s Mechanism – the placenta become somewhat rolled up in the vagina with the maternal
surface presenting. It signifies that the placenta has separated at the edges first and bleeding occurs
at the time of separation.

Nursing Responsibilities:
● Assessment
- Signs of placental separation
- Placental fragments
- Maternal and fetal conditions
● Interventions
- Massage fundus after delivery
- Palpate fundus every 15 minutes for the first 1-2 hours
- Observe lochia for color
- Inspect perineum
- Administer oxytocic as ordered
- Assist with maternal hygiene

4. Stage IV: Puerperal Stage – is the period from placental expulsion to 1-4 hours after delivery or until vital signs
are stable.

Nursing Responsibilities:
● Assessment
- Fundal firmness and position
- Lochia
- Perineum
- Vital signs
- IV of patient
- Infant’s heart rate, airway, color, tone, reflexes
- Bonding or family integration
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

● Interventions
- Massage fundus if not firm
- Check bladder fullness especially when fundus is not firm or is displaced
- Check mother’s BP, PR, RR every 15 minutes for the first 1-2 hours
- Inspect perineum every 15 minutes for the first 1-2 hours
- Check amount of bleeding
- Encourage mother to void
- Encourage breastfeeding
- Check episiotomy site
- Administer oxytocic as ordered
- Keep client warm
- Provide food and fluids
- Promote uterine contractions
NOTE: Importance of Uterine Contractions Post-Delivery
▪ To produce placental separation
▪ To control uterine bleeding

Duration of Labor
1. Primi
a. First Stage – 12.5 hours
b. Second Stage – 1 hour and 20 minutes
c. Third Stage – 10 minutes
2. Multi
a. First Stage – 7 hours and 20 minutes
b. Second Stage – 30 minutes
c. Third Stage – 10 minutes

Maternal Responses to Labor

NOTE: The labor process affects nearly every major body system and each system adapts to these changes thru
various compensatory mechanisms.

1. Cardiovascular System

a. Supine Hypotension Syndrome – is caused by the occlusion of vena cava by the heavy uterus
when the pregnant woman lies on her back.
Signs and Symptoms:
- Decreased BP
- Increased PR
- Dizziness
- Pallor
- Cold, clammy skin
b. Cardiac Output – increases by 30-50 %
c. Increased Venous Pressure – due to Valsalva Maneuver that increases intrathoracic pressure leading to
increased venous pressure.
d. Blood Pressure – as a result of increased cardiac output, systolic BP rises during contractions. It may also
rise due to fear, apprehension and pain of the mother. It may drop if the vena cava is compressed.
e. Fluids and Electrolyte Balance – profuse perspiration occurs during labor. Hyperventilation alters
electrolyte and fluid balance from insensible water loss. Muscle activity elevates the body temperature
increasing sweating and evaporation from the skin.

2. Respiratory System – oxygen demand and consumption increases the onset of labor due to the presence of
uterine contractions. A mild increase in RR is normal in labor due to increased in metabolism.
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

3. Renal System – increased in maternal rennin, plasma rennin activity and angiotensin. Polyuria is common.
Hematuria maybe due to the trauma to the lower urinary tract.

4. GIT System – reduced gastric motility and absorption of solid food. Gastric emptying is reduced and prolonged.
Gastric volume remains over 25 ml regardless of the time the last meal was taken.

5. Immune System - increased in WBC making assessment of infection difficult. Maternal blood glucose
decrease leading to decreased in insulin requirements.

6. Pain – comes from complexity of physical causes:

a. First Stage
- Dilataion of the cervix
- Hypoxia of uterine muscles during contraction
- Stretching of the uterus over the lower abdomen and lumboacral area
b. Second Stage
- Hypoxia of muscle cells in the uterus during contractions.
- Distention of the vagina, lower portion of the uterus around the leg margin and perineal area.
c. Third Stage
- Uterine contractions
- Cervical dilatation

Factors Affecting Pain in Labor”

- Knowledge of labor and birth
- Coping abilities
- Fatigue
- Pressure and anxiety
- Cultural factors

Fetal Responses to Labor

Note: When the fetus is normal, the mechanical and hemodynamic changes of normal labor have no adverse
effects.

1. Heart Rate Changes – FHR decelartions can occur with intracranial pressure.
2. Acid-Base Status – the blood flow to the fetus is slowed during the acme of the contraction leading to a slow
decrease in the fetal pH.
3. Hemodyamic Changes – the adequate exchange of nutrients and gases in the fetal capillaries and intervillous
spaces depends in part on the fetal BP.
4. Behavior – a decrease in FHR accompanies quiet sleep state, decreased fetal breathing movements and body
activity
5. Fetal Sensation – the full term can hear music and maternal voice.
Participatory Child Birth Technique
Purposes:
▪ Emphasizes childbirth as a natural event.
▪ Informs clients as an active participant.
▪ Ability to relax effectively results I less labor discomforts.

1. Read Method (Natural Child Birth Method)

Principles:
a. Fear leads to tensions which leads to pain.
b. Discomfort during labor is minimized if the woman is well-informed of the process of labor.
c. Discomfort during labor is minimized if the woman is relaxed.
Preparation:
a. Prenatal classes
b. Breathing techniques
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN

c. Relaxation techniques

2. Bradley Method (Husband-Couched Childbirth) – is a modification of the Read Method emphasizing working
in harmony with the body.

3. Psychoprophylactic Method (Lamaze Method) – is based on utilization of the Pavlovian Conditional

Response Theory. It is based on the theory that the brain can be trained to accept and analyze a given stimulus
and select a response to it.

4. Others:
a. Yoga
b. Hypnosis
c. Wright Method – focuses on the conscious relaxation techniques and progressive chest breathing
techniques.
d. Psychosexual Method – stresses that pregnancy, delivery and the early newborn period are important
points in the woman’s cycle.

Method of Analgesia in Labor

1. Natural Child Birth (Lamaze Method) – is based on the principle that analgesia can be minimized by proper
prenatal education and the application of controlled breathing and voluntary muscle relaxation.
2. Hypnosis – is infrequently used but has same advantage as of the natural child birth approach.
3. Narcotics – are the most common form of analgesics used.
4. Tranquilizer – has anti-emetic effects and reduces anxiety. It is used in combination with narcotics whose action
potentiate or enhance narcotics.
5. Sedatives – help to relieve anxiety.
6. Regional Anesthesia and Analgesia
a. Local Infiltration – can be used for performing and repairing episiotomies as well as lacerations.
b. Pudendal Block – blocks stimulus along pudendal nerve.
c. Paraxervical Block – is the transvaginal injection of anesthetic solution to each side of the cervix.
d. Spinal Anesthesia ( Sub-Arachnoid Block) – provokes a painless delivery and does not interfere with
uterine contractions. It offers good pain relief with little or no effect on the fetus.

Disadvantages:
▪ Hypertension – due to the sympathetic block and to great extent is related to the level of anesthesia
obtained.
▪ Headache – due to the leakage of the spinal fluid at the puncture site with consequent reduction of
spinal fluid pressure.

7. General Anesthesia – implies the use of agent either by inhalation or injection which will provide analgesia and
render varying levels of consciousness.
DIsavantages:
▪ Fetal narcosis
▪ Fetal respiratory depression
▪ Vomiting

Indications of Anesthesia/Special Cases:

1. Breech deliveries
2. Caesarean Section
3. Uterine relaxation in cases of internal version, manual extraction of placenta and IE.
4. Episiotomies and repair of lacerations.
5. Forceps delivery and version.
ALDERSGATE COLLEGE NC107A
SCHOOL OF MEDICAL SCIENCES LETICIA D. SERRANO, RN,MAN