Components of Labor (5 Ps) o Anterior

At least five factors affect the process of  Diamond shaped; Approx

labor and birth. These are easily 2-3 cm
remembered:  Ossifies in 12-18 months
 Passenger (fetus and placenta) o Posterior
 Passageway (birth canal)  Triangle shaped
 Powers (contractions)  Closes in 8-12 weeks
 Psyche (psychologic response)
 Placenta

1. PASSENGER
- The passenger is the fetus. The body
part of the fetus that has the widest
diameter is the head, so this is the part
least likely to be able to pass through
the pelvic ring.
2. PASSAGE
- The cranium, the uppermost portion of
- Refers to the route the fetus must travel
the skull, is composed of eight bones.
from uterus through the cervix & vagina
The four superior bones—the frontal
to external perineum
(actually two fused bones), the two
Pelvis is divided into halves – the false pelvis
parietal, and the occipital—are the
and the true pelvis.
bones that are important in childbirth.
Divisions:
The other four bones of the skull
 False pelvis: wide broad area btw. the
(sphenoid, ethmoid, and two temporal
iliac crests & has no major clinical
bones) lie at the base of the cranium so
significance for L&D (support pelvic
are of little significance in childbirth
organ).
because they are never presenting
 True Pelvis: the actual bony passage
parts. The chin, referred to by its Latin
that the fetus must traverse during
name mentum, can be a presenting
labor and birth. Shape is a curved axis,
part.
not a straight passage.
The Fetal Head & Molding:
 Molding: the change in shape of the
fetal skull produced by the uterine
contractions pressing the vertex against
the non- yet dilated cervix.
 Fontanel's: Intersection of sutures,
allows for molding, helps identify
position of head
3. POWER
- This is the force supplied by the fundus
of the uterus, implemented by uterine
contractions, a natural process that
causes cervical dilatation and then
expulsion of the fetus from the uterus.
Cervical Changes
 Effacement – is the shortening and
thinning of the cervical canal. Normally,
the canal is approximately 1 to 2 cm
long.
 Dilatation - refers to the enlargement
or widening of the cervical canal from
an opening a few millimeters wide to
one large enough (approximately 10 cm)
to permit passage of a fetus.
4. PSYCHE
- Refers to the psychological state or
feelings that a woman brings into labor.
For many women, this is a feeling of
apprehension or fright. For almost
everyone, it includes a sense of
excitement or awe.
- Women who manage best in labor
typically are those who have a strong
sense of self-esteem and a meaningful
support person with them. Women
without adequate support can have an
experience so frightening and stressful
they can develop a posttraumatic stress
syndrome.
- Encouraging women to ask questions at
prenatal visits and to attend preparation
for childbirth classes helps prepare
them for labor. Encouraging them to
share their experience after labor serves
as “debriefing time” and helps them
integrate the experience into their total
life.
5. PLACENTA
Placenta Separation
The following signs indicate that the
placenta has loosened and is ready to
deliver:
 Lengthening of the umbilical cord
 Sudden gush of vaginal blood
 Change in the shape of the uterus
 Firm contraction of the uterus
 Appearance of the placenta at the
vaginal opening
Two types of placenta:
A. Schultze - Appearing shiny and
glistening from the fetal membranes,
smooth
B. Duncan - looks raw, red, and irregular,
with the ridges or cotyledons that
separate blood collection spaces
showing, rough

Placental Expulsion
- After separation, the placenta is
delivered either by the natural bearing-
down effort of the mother or by gentle
pressure on the contracted uterine
fundus by a physician or nurse midwife
(Credé’s maneuver).
LEOPOLD’S MANUEVER
- are four specific steps in palpating the
uterus through the abdomen in order to
determine the lie and presentation of
the fetus.
 First Maneuver – Fundal Grip
 Second Maneuver – Umbilical Grip
 Third Maneuver – Pawlick’s Grip
 Fourth Maneuver – Pelvic Grip