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Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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The Process of BirthThe Process of Birth
IntroductionIntroduction
Intrapartum\Perinatal PeriodIntrapartum\Perinatal Period
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Physiologic Effects of Birth/Adaptation to Physiologic Effects of Birth/Adaptation to LaborLabor
Maternal Response-Alterations in:Maternal Response-Alterations in:
Cardiovascular Cardiovascular Hemopoietic SystemHemopoietic System Respiratory SystemRespiratory System Renal systemRenal system Integumentary SystemIntegumentary System Neurologic System Neurologic System G.I. System G.I. System Endocrine SystemEndocrine System Reproductive SystemReproductive System
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Cervical Dilation
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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B. Fetal Response to Mother’s B. Fetal Response to Mother’s Labor:Labor:
Fetal Heart Rate:Fetal Heart Rate:
Respiratory RateRespiratory Rate
Fetal CirculationFetal Circulation
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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II. Components of The Birth ProcessII. Components of The Birth ProcessCritical Factors in LaborCritical Factors in Labor
The Five P’s:The Five P’s:
1.The Powers1.The Powers
2. The Passage2. The Passage
3. The Passenger3. The Passenger
4. Mother’s position4. Mother’s position
5. The Psyche5. The Psyche
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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PowersPowers
1. 1. Primary: Uterine ContractionsPrimary: Uterine Contractions
2. 2. Secondary: Secondary:
Abdominal and Intercostal MusclesAbdominal and Intercostal Muscles The Perineal MusclesThe Perineal Muscles
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Uterine Muscle Layers
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Uterine ResponseUterine Response
Contractions Measured in:Contractions Measured in: FrequencyFrequency DurationDuration IntensityIntensity
Phases of ContractionsPhases of Contractions:: IncrementIncrement AcmeAcme DecrementDecrement
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Phases of Contractions
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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B. Passage (The Pelvis)B. Passage (The Pelvis)
1. Landmarks: 1. Landmarks:
The True PelvisThe True Pelvis ( divided into 3 ( divided into 3
sections)sections)
InletInlet CavityCavity OutletOutlet
2. Types of Pelvises2. Types of Pelvises
GynecoidGynecoid AnthropoidAnthropoid AndroidAndroid PlatypelloidPlatypelloid
3. Significant 3. Significant Measurement:Measurement:
Bi-ischial diameterBi-ischial diameter
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Pelvic Measurements
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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50% 20% 25% 05%
Comparisons of Pelvises Gynecoid Android Anthropoid Platypelloid
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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C. Passenger ( Baby!)C. Passenger ( Baby!)
1. Fetal head/Fontanels1. Fetal head/Fontanels a. Posteriora. Posterior b. Anteriorb. Anterior c. Bi-Parietal Measurementc. Bi-Parietal Measurement
2. Fetal Presentation2. Fetal Presentation a. Cephalic a. Cephalic b. Breechb. Breech c. Transversec. Transverse
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Passenger (Continued)Passenger (Continued)
Fetal LieFetal Lie
Fetal AttitudeFetal Attitude
Fetal stationFetal station
Fetal Position:Fetal Position:
a. side of Pelvis: a. side of Pelvis: Referred to as: (R or L)Referred to as: (R or L)
b. Fetal Presenting Part b. Fetal Presenting Part Referred to as:( O,S,M Referred to as:( O,S,M or A)or A)
c. Anterior, Posterior or c. Anterior, Posterior or Transverse Lie : Transverse Lie : Referred to as:( A, P or Referred to as:( A, P or T)T)
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Fetal Station
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Mother’s Position in LaborMother’s Position in Labor
Affects anatomical and physiologic Affects anatomical and physiologic adaptation to labor( standing , adaptation to labor( standing , walking, sitting or squatting)walking, sitting or squatting)
Gravity can assist in the decent of Gravity can assist in the decent of baby/increases effacement and baby/increases effacement and dilation of cervixdilation of cervix
Ferguson’s reflexFerguson’s reflex
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Mother’s Psyche !Mother’s Psyche !
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Labor and DeliveryLabor and Delivery III. Normal LaborIII. Normal Labor
A. Premonitory Signs A. Premonitory Signs of Laborof Labor
1. Braxton Hicks 1. Braxton Hicks ContractionsContractions
2. Cervical Changes2. Cervical Changes 3.Bloody Show3.Bloody Show 4.Rupture of 4.Rupture of
MembraneMembrane 5. Sudden Burst of 5. Sudden Burst of
EnergyEnergy
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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B.B. True True vs. vs. False False LaborLaborCharacteristicsCharacteristics
False LaborFalse Labor - no change in cervix- no change in cervix -discomfort in low -discomfort in low
abdomen and groinabdomen and groin -irregular contractions-irregular contractions -no increase in -no increase in
frequency or intensity frequency or intensity of contractionsof contractions
True LaborTrue Labor Progressive cervical Progressive cervical
dilatation and dilatation and effacementeffacement
Discomfort in back Discomfort in back and abdomenand abdomen
Contractions occur at Contractions occur at regular intervalsregular intervals
Progressive increase Progressive increase in frequency and in frequency and intensity of intensity of contractionscontractions
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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C. Initial Maternal Assessments C. Initial Maternal Assessments During LaborDuring Labor
1.PrenatalHistory ie: 1.PrenatalHistory ie: Gestational Age? Gestational Age? wt.gain,EDD/EDC, Lab wt.gain,EDD/EDC, Lab Values, Bld.TypeValues, Bld.Type
2.Risk Factors: Rubella status; 2.Risk Factors: Rubella status; STD’s, Group B Step. STD’s, Group B Step. StatusStatus
3.Prior Obstetrical3.Prior Obstetrical History( GTPAL)History( GTPAL)
4. Asses Labor Progress4. Asses Labor Progress
5.?Education Preparation5.?Education Preparation
6. Educational needs of 6. Educational needs of this Mother/Familythis Mother/Family
7. ? Support System7. ? Support System
8.Maternal Allergies?8.Maternal Allergies?
9. Base line Vital Signs9. Base line Vital Signs
10. Status of the Baby10. Status of the Baby
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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E. E. MMeecchhaanniissmm o of f LLaabboorr
Cardinal Movements of the babyCardinal Movements of the baby 1. Engagement, Descent, Flexion1. Engagement, Descent, Flexion 2.Internal Rotation2.Internal Rotation 3.Extention-Beginning3.Extention-Beginning 4.Extention Complete4.Extention Complete 5.External Rotation(Restitution)5.External Rotation(Restitution) 6.External Rotation(Shoulder Rotation)6.External Rotation(Shoulder Rotation) 7.Expulsion7.Expulsion
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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Four Stages of LaborFour Stages of Labor
1.First Stage (Dilation 1.First Stage (Dilation StageStage))
Divided into three Divided into three phases:phases:
a. latenta. latent b. activeb. active c. transitionc. transition
2.Second Stage 2.Second Stage (Stage of Expulsion)(Stage of Expulsion)
3. Third Stage 3. Third Stage (Placental Stage)(Placental Stage)
4. Fourth Stage 4. Fourth Stage
(Recovery Stage(Recovery Stage))
Prof. Carole A. Devine R.N.,MSProf. Carole A. Devine R.N.,MSN.N.
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