2 Dod Poep2 Process

The Process of Labor and Birth

Development of this module was supported in part by an unrestricted educational grant from Stryker Medical Inc.

1 ©2004 AWHONN

The purpose of this module is to provide and overview of the physiologic and and anatomical processes of normal labor. Labor support, pain management and nursing care of the laboring woman will be presented. An overview of dysfunctional labor, assisted and cesarean birth are included along with discussion of risk factors for and management of post partum hemorrhage. Note to instructors: The use of visual aids such as anatomic models and charts is recommended to reinforce concepts related to the process of normal childbirth.

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Objectives „

Identify theories of labor onset

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Differentiate between normal and dysfunctional labor progress

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Discuss maternal factors that may affect labor

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Recognize fetal conditions that may affect labor outcomes

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Differentiate between induction and augmentation of labor and agents used

2 ©2004 AWHONN

The objectives for this presentation are to: •Identify theories of labor onset •Differentiate between normal and dysfunctional labor progress •Discuss maternal conditions that may affect labor •Recognize fetal conditions that may affect labor outcomes •Differentiate between induction and augmentation of labor and agents used (Objectives continued on next slide)

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Objectives „

Identify maternal coping behaviors related to labor and birth

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Discuss methods of pain relief utilized during labor

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Describe the four stages of labor

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Discuss guidelines for care pertinent to labor and birth

3 ©2004 AWHONN

(Objectives continued) •Identify maternal coping behaviors related to labor and birth •Discuss methods of pain relief utilized during labor •Describe the four stages of labor •Discuss guidelines for care pertinent to labor and birth

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Fetal Presentations Cephalic (head first) presentations: „

Occiput or vertex

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Sinciput

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Brow

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Face

4 ©2004 AWHONN

Fetal presentation refers to the fetal part that enters the pelvis passing through the birth canal during labor. Cephalic presentations include: occiput or vertex, sinciput, brow and face (Lowdermilk, 2000b). Cephalic presentations are illustrated on this slide and include: • Occiput or vertex • Sinciput • Brow • Face Occiput occurs when the fetal head is fully flexed on the chin. The occiput is the presenting part in the lower uterine segment. Sinciput, also known as “military position,” occurs when the head is neither flexed nor extended. The anterior fontanel is felt as the presenting part. Brow presentation occurs when the fetal head is extended - the brow is the presenting part. Face presentation occurs when the head is hyperextended so that the chin, or mentum, is the presenting part. Brow and chin presentations require a larger pelvic diameter than occiput to fit through the birth canal during a vaginal delivery.

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Fetal Presentations (Cont.) Breech (bottom or feet first) presentations: „

Frank

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Complete

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Footling

5 ©2004 AWHONN

There are three types of breech presentation (Lowdermilk, 2000b): •Frank •Complete •Footling. The buttocks are the presenting part in a frank breech. Typically, the fetal thighs are flexed on the abdomen and the legs are extended onto the chest. With a complete breech presentation, the legs and thighs are flexed onto the abdomen. With a footling breech presentation, one or both feet are extended at the knees and hips. The footling breech may present with one or both feet first.

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Positioning on “All Fours”

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Helps to relieve back labor with occiput posterior position (OP)

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May facilitate rotation of fetal head from occiput posterior to occiput anterior (AWHONN, 2000a; Lowdermilk, 2000b)

6 ©2004 AWHONN

The “all fours” position, which is kneeling in bed and leaning forward with support, helps to relieve back labor when the fetus is in an occiput posterior position (OP); and may also facilitate rotation of the fetal head from occiput posterior to occiput anterior position (AWHONN, 2000a; Lowdermilk, 2000b).

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Kneeling on “All Fours”

7 ©2004 AWHONN

This is how we might help a woman labor in the all fours position.

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