Chapter 15

Labor and Birth Processes

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Factors Affecting Labor

At least five factors affect process of labor and birth. Five Ps:

Passenger (fetus and placenta) Passageway (birth canal) Powers (contractions) Position of mother Psychologic response

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Factors Affecting Laborcontd

Passenger

Size of fetal head Fetal presentation Fetal lie Fetal attitude Fetal position

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Factors Affecting Laborcontd

Passageway

Passageway, or birth canal, is composed of: Bony pelvis Lower uterine segment Cervix Pelvic floor muscles Vagina Introitus (external opening to the vagina)

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Fig. 15-7. Female pelvis. A, Pelvic brim above. B, Pelvic outlet from below.
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Fig. 15-1. Fetal head at term. A, Bones. B, Sutures and fontanels.

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Fig. 15-2. Examples of fetal vertex (occiput) presentations in relation to front, back, or side of maternal pelvis.
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Fig. 15-10. Uterus in normal labor A, in early first stage; and B, in second stage. Passive segment is derived from lower uterine segment (isthmus) and cervix, and physiologic retraction ring is derived from anatomic internal os. C, Uterus in abnormal labor in second-stage dystocia. Pathologic retraction (Bandl's) ring that forms under abnormal conditions develops from the physiologic ring.
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Fig. 15-11. Cervical effacement and dilation. Note how cervix is drawn up around presenting part (internal os). Membranes are intact, and head is not well applied to cervix. A, Before labor. B, Early effacement. C, Complete effacement (100%). Head is well applied to cervix. D, Complete dilation (10 cm). Cranial bones overlap somewhat, and membranes are still intact.
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Fig. 15-14. Synclitism and asynclitism. A, Anterior asynclitism. B, Normal synclitism. C, Posterior asynclitism.

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Factors Affecting Laborcontd

Powers

Primary powers Effacement Dilation Ferguson reflex Secondary powers Bearing-down efforts

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Factors Affecting Laborcontd

Position of laboring woman

Position affects womans anatomic and physiologic adaptations to labor Frequent changes in position Relieve fatigue Increase comfort Improve circulation Laboring woman should be encouraged to find positions most comfortable to her

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Process of Labor

Labor: process of moving fetus, placenta, and membranes out of uterus and through birth canal Various changes take place in womans reproductive system in days and weeks before labor begins Labor can be discussed in terms of mechanisms involved in process and stages woman moves through
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Process of Laborcontd

Signs preceding labor

Lightening or dropping Bloody show Onset of true labor cannot be ascribed to single cause. Many factors involved, including changes in maternal uterus, cervix, and pituitary gland

Onset of labor

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Process of Laborcontd

Stages of labor

First stage Second stage Third stage Fourth stage

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Process of Laborcontd

Mechanism of labor

Seven cardinal movements of mechanism of labor that occur in vertex presentation Engagement Descent Flexion Internal rotation Extension Restitution and external rotation Expulsion (birth)

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Fig. 15-13. Cardinal movements of the mechanism of labor. Left occipitoanterior position. A, Engagement and descent. B, Flexion. C, Internal rotation to occipitoanterior position. D, Extension. E, External rotation beginning (restitution). F, External rotation.
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Physiologic Adaptation to Labor

Fetal adaptation

These changes occur in: Fetal heart rate Fetal circulation Fetal respiration Other behaviors

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Physiologic Adaptation to Labor contd

Maternal adaptation

As woman progresses through stages of labor, various body system adaptations cause her to exhibit both objective and subjective symptoms

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Physiologic Adaptation to Labor contd

Maternal adaptation

Cardiovascular changes Respiratory changes Renal changes Integumentary changes Musculoskeletal changes Neurologic changes Gastrointestinal changes Endocrine changes

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Key Points

Labor and birth are affected by the five Ps: passenger, passageway, powers, position of the woman, and psychologic responses Because of its size and relative rigidity, the fetal head is a major factor in determining the course of birth

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Key Pointscontd

Diameters at plane of pelvic inlet, midpelvis, and outlet plus axis of the birth canal determine whether vaginal birth is possible and how fetus passes down birth canal Involuntary uterine contractions expel fetus and placenta during first stage of labor

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Key Pointscontd

First stage of labor lasts from beginning of dilation to full dilation of the cervix Second stage of labor lasts from full dilation to birth of the infant Third stage of labor lasts from the infants birth to the expulsion of the placenta Fourth stage is first 2 hours after birth

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Key Pointscontd

Cardinal movements of labor are engagement, descent, flexion, internal rotation, extension, restitution and external rotation, and expulsion of the infant Events precipitating the onset of labor are unknown; but many factors, including changes in the maternal uterus, cervix, and pituitary gland, are thought to be involved

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Key Pointscontd

Healthy fetus with adequate uterofetoplacental circulation will be able to compensate for the stress of uterine contractions Progressing through labor, various body systems adapt to the birth process When pushing, women should be encouraged to use the open-glottis method

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