Steps in checking station & postion of infant.
Check arch, come down to ischial spines, feel ligaments between spines & sacrum. Center your fingers from spines & place middle finger on infant’s head to determine station.
Spines, sutures, & fontanels
Diamond (anterior) –will have sutures on all sides
Triangle (posterior–ideal)
Longest suture on infant’s head
Sagital suture
Cardinal moves of labor:
- Engagement, descent, flexion
- Descent, internal rotation
- Complete rotation, beginning extension
- Complete extension
- Restitution (external rotation)
- Delivery of anterior then posterior shoulder
- Expulsion, following CURVE of CARUS
4 P’s that influence labor
- Passage (Pelvis, cervix, ligaments)
- Passenger
- Power (uterus)
- Psyche
When does cervical change occur?
Goodells sign (softening/remodeling): Starting at LMP (4wks) Chadwicks (inc vascularity) starts at 6wks
Where does effacement & dilation occur?
Internal Os: Effacement
External Os: Dilation
-usually occurs simultaneously
4 Hormone systems interconnected for childbearing:
- Oxytocin
- Beta-endorphins
- Epinephrine & norepinephrine (stress)
- Prolactin
Where is oxytocin (OT) released?
Posterior pituitary from hypothalamus
Roles of oxytocin:
- Sexual behavior & pair bonding (peaks at orgasm, causing rhythmic contractions of pelvic floor contractions)
- Lactation: released in pulses to mediate milk injection & prolactin release, which stimulates milk production
- Maternal adaption
- Warming (vasodilation)
- Social-affiliative behavior (trust, empathy, generosity, eye contact, recognition, etc.)
- Autonomic nervous system
- Stress reduction
Roles of Beta-endorphins
- Endogenous analgesia
- Altered state of consciousness
- Fetal neuroprotection
- peaks during PP period –euphoria
- NB support with stress via colostrum
- Reward & reinforcement of BF
Epinephrine & norepinephrine during labor
Stress hormones–protective via support of family & caregivers (predominantly, female companions).
Roles of Prolactin (PRL)
- Stimulates breastmilk production (lactogenesis)
- Support conception & early pregnancy
- Adjusting appetite & fluid balance
- Immune fxn
- Maternal-infant attachment
- Enhances infant growth & brain development
4 Phases of parturition:
PHASES:
- Quiescence: prelude to parturition-contractile, unresponsiveness, cervical softening
- Activation: Preparation for labor–uterine preparedness, cervical ripening
- Stimulation: processes of labor–uterine cxn, cervical dilation, fetal & placenta expulsion (3 stages of labor)
- Involution: parturient recovery, BF, cervical repair, uterine involution
When does phase 1: quiescence start and finish?
conception to initiation of parturition
When does phase 2: Activation start and finish?
Initiation of parturition to onset of labor
When does phase 3: Stimulation start and finish?
Onset of labor to delivery of placenta
When does phase 4: Involution start and finish?
Delivery of placenta to return of fertility
When should membrane stripping be done?
Anytime after 40 wks, & can be repeated in 36-42hrs
