What are the 5 critical factors in labor
1) Birth passage, 2) fetus, 3) the relationship between the passage and the fetus, 4) physiologic forces of labor, 5) psychosocial considerations.
How are the critical factors in labor related
All variables have to work together in order for a successful vaginal birth to occur. The woman’s pelvis has to accommodate the fetus size, the fetus has to be in the right position and be engaged, there has to be contractions in order for the cervix to dilate and to move the fetus down and out, the woman’s psychosocial state will affect her labor on many different levels.
fetal attitude
the relation of the fetal parts to one another –normal is moderate flexion
Fetal lie
the infant’s spine and the mother’s spine in relation to each other
Fetal presentation
the presenting part of the fetus being born first
- cephalic, breech, or shoulder.
- Head down (cephalic presentation) in a OA (occiput anterior) position is ideal for successful vaginal birth.
What is meant by the term engagement
the infant and his/her location into the maternal pelvis which is zero station.
-When the infant is engaged the infant’s head does not float away/move out of the pelvis (ballotable)
What is meant by the term station
the (subjective) assessment for the exact location of the infant’s presenting part into the maternal pelvis.
- Ischial spines is a zero station,
- the closer to the outlet/delivery the station is a positive # (+1, +2, +3, etc.) and the higher up (further away from the outlet/delivery or deeper into the pelvis) the station is a negative # (-1, -2, -3, etc.).
If the fetus is in a negative station, (-3,-2. or -1) what is the significance of this?
early labor or is not progressing normal.
-Rupturing membranes (amniotomy) when the infant is in a negative station, increases the risk for cord prolapse
If the fetus is in a positive station (+1, +2 0r +3) what is the significance of this?
Labor is progressing because the fetus is closer to the outlet/delivering
What is meant by fetal position
the presenting part’s landmark
- vertex-occiput, face-mentum (chin), breech-sacrum
- and its relation to the maternal pelvis
- -anterior-front, left/right-side, or posterior-back
ROA
Right Occiput Anterior, which means the infant’s occiput is facing the front right side of the pelvis.
LOA
Left Occiput Anterior, which means the infant’s occiput is facing the left front side of the pelvis
ROP
Right Occiput Posterior, which means the infant’s occiput is facing the right posterior side of the pelvis
LOP
Left Occiput Posterior, which means the infant’s occiput is facing the left posterior side of the pelvis.
How do you assess contractions
Frequency, duration, and intensity
Frequency
the time between the beginning of one contraction and the beginning of the next contraction
Duration
is the time measured from the beginning of one contraction and the end of that same contraction
Intensity
the strength of the contraction during acme
-mild, moderate, strong which can be assess by palpitation when external monitoring is being used
lightening
s/s-5
the (maternal) effects that occur when the fetus begins to settle into the pelvic inlet (engaged).
-leg cramps, increased pelvic pressure, increased urinary frequency, increased venous stasis (edema in the lower extremities), and increased vaginal secretions.
Cervical effacement
the thinning of the cervix, which occurs when the internal os and the cervical canal draws up into the uterine side walls
Dilation
the opening of the cervix from 0 cm (closed) to 10 cm (complete).
bloody show
pink-tinged vaginal secretion that may be a sign that labor will start within 24-48 hrs.
-caused by the ripening and effacement of the cervix, which leads to the mucus plug being expelled which then leaves the highly vascular cervix open
What is the clinical significance when the membranes rupture-3
the beginning of the labor journey;
- labor will statistically start on its own within 24-28 hrs.
- creates a portal of entry for infection,
- Prolapsed cord=> depending on the situation (engaged or not, negative stations, preterm, polyhydramnios, etc.)
membranes rupture relationship to infection-4
Portal of entry is now created, limit vaginal exams, monitor maternal temp(Q2 hrs. per AWHONN), and monitor FHR baseline
- increasing baseline is a sign of maternal temperature increase (fever–>infection)
- if the patient is a GBS + or unknown, antibiotics need to be initiated immediately to prevent infection of the infant (which can be fatal).
