Chapter 13: Labor and Birth Process
Stages and Phases of Labor
Labor is divided into four stages, with each stage consisting of different phases:
1. First Stage: The longest stage, involving cervical effacement and dilation.
- **Latent Phase**: Cervix dilates from 0 to 3 cm; mild, irregular contractions.
- **Active Phase**: Cervix dilates from 4 to 7 cm; stronger, regular contractions.
- **Transition Phase**: Cervix dilates from 8 to 10 cm; intense, frequent contractions.
2. Second Stage: Pushing and delivery of the baby.
- Begins with full cervical dilation (10 cm) and ends with the birth of the baby.
3. Third Stage: Delivery of the placenta.
- Begins after the baby is born and ends with the delivery of the placenta.
4. Fourth Stage: Recovery.
- First 1-4 hours after delivery; focus on maternal stabilization and bonding with the baby.
Nursing Care During the Phases and Stages of Labor
Assessments
- Maternal vital signs (blood pressure, heart rate, respiratory rate, and temperature)
- Fetal heart rate monitoring
- Uterine contractions (frequency, duration, and intensity)
- Cervical dilation and effacement
- Fetal position, presentation, and station
- Maternal pain and coping
Nursing Interventions
- Provide emotional support and encouragement
- Educate and inform the client about the labor process
- Promote effective breathing and relaxation techniques
- Encourage position changes to enhance comfort and facilitate progress
- Assist with comfort measures (e.g., massage, warm/cold packs, hydrotherapy)
- Administer pain medications as ordered and monitor for side effects
- Collaborate with the healthcare team to ensure timely interventions if complications arise
Responsibility During Admission and Throughout the Labor Process
- Obtain a thorough prenatal history and assess for any risk factors
- Establish an IV line for fluid administration, if needed
- Monitor maternal and fetal well-being continuously
- Advocate for the client's preferences and needs during labor and delivery
,- Facilitate communication and collaboration among healthcare team members
Position Changes
Encourage frequent position changes to enhance comfort and facilitate labor progress, such as:
- Upright positions (e.g., walking, sitting, standing)
- Side-lying positions
- Hands and knees (all fours) position
- Squatting or sitting on a birthing ball
Comfort Measures
Offer various comfort measures to help the client cope with labor pain, such as:
- Breathing and relaxation techniques
- Massage or counterpressure
- Warm or cold packs
- Hydrotherapy (e.g., shower, bath, or birthing pool)
Signs of Placental Separation After Delivery
- Gush of blood
- Lengthening of the umbilical cord
- Uterus rises and becomes round and firm
The 5 P's
1. Passenger: The fetus and its presentation, position, and size.
2. Passageway: The maternal pelvis and birth canal.
3. Powers: Uterine contractions and maternal pushing efforts.
4. Position: Maternal posture and mobility during labor.
5. Psychological: Maternal emotions, coping mechanisms, and support systems.
Birth Passageway, Passengers, and Powers
- Birth Passageway: Composed of the maternal pelvis and soft tissues of the birth canal.
- Passengers: The fetus, including the size of the fetal head, and the presentation (cephalic,
breech, or shoulder).
- Powers: Involves the uterine contractions that dilate and efface the cervix and the maternal
pushing efforts that help expel the baby.
Types of Pelvises
1. Gynecoid: Most favorable for vaginal birth; round and wide.
2. Android: Triangular or heart-shaped; more common in males.
, 3. Anthropoid: Oval-shaped; narrower front-to-back and wider side-to-side.
4. Platypelloid: Flattened, wide shape; least favorable for vaginal birth.
Cardinal Movements of Labor
1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. External rotation
7. Expulsion
Baby's Position and Presentation and the Effect on Delivery
- Position: The relationship between a designated landmark on the fetal presenting part and the
maternal pelvis (e.g., LOA, ROA, LOP, ROP).
- Presentation: The part of the fetus that enters the birth canal first (e.g., cephalic, breech, or
shoulder).
- The baby's position and presentation can influence the labor process and the ease or difficulty
of delivery. Optimal position and presentation for a vaginal birth is the vertex presentation
(head down) with the occiput anterior position, where the baby's back is towards the mother's
front. Malpositions or malpresentations can lead to longer labor, the need for interventions, or
possibly a cesarean section.
Medical Abbreviations
1. SROM: Spontaneous Rupture of Membranes - The natural rupture of the amniotic sac, usually
occurring during labor, signified by a gush or slow leak of amniotic fluid.
2. PROM: Premature Rupture of Membranes - The rupture of the amniotic sac before the onset
of labor, which can lead to increased risk of infection or other complications if labor does not
begin within a certain timeframe.
3. AROM: Artificial Rupture of Membranes - A medical procedure in which a healthcare provider
deliberately breaks the amniotic sac to induce or accelerate labor, also known as an amniotomy.
Nursing Interventions After Amniotomy or ROM
Following an amniotomy or rupture of membranes (ROM), nurses should:
1. Assess the fluid: Check the color, odor, and consistency of the amniotic fluid. It should be
clear or slightly yellowish and have a mild odor. The presence of greenish or brownish fluid
(meconium staining) or a foul odor can indicate potential complications.
Stages and Phases of Labor
Labor is divided into four stages, with each stage consisting of different phases:
1. First Stage: The longest stage, involving cervical effacement and dilation.
- **Latent Phase**: Cervix dilates from 0 to 3 cm; mild, irregular contractions.
- **Active Phase**: Cervix dilates from 4 to 7 cm; stronger, regular contractions.
- **Transition Phase**: Cervix dilates from 8 to 10 cm; intense, frequent contractions.
2. Second Stage: Pushing and delivery of the baby.
- Begins with full cervical dilation (10 cm) and ends with the birth of the baby.
3. Third Stage: Delivery of the placenta.
- Begins after the baby is born and ends with the delivery of the placenta.
4. Fourth Stage: Recovery.
- First 1-4 hours after delivery; focus on maternal stabilization and bonding with the baby.
Nursing Care During the Phases and Stages of Labor
Assessments
- Maternal vital signs (blood pressure, heart rate, respiratory rate, and temperature)
- Fetal heart rate monitoring
- Uterine contractions (frequency, duration, and intensity)
- Cervical dilation and effacement
- Fetal position, presentation, and station
- Maternal pain and coping
Nursing Interventions
- Provide emotional support and encouragement
- Educate and inform the client about the labor process
- Promote effective breathing and relaxation techniques
- Encourage position changes to enhance comfort and facilitate progress
- Assist with comfort measures (e.g., massage, warm/cold packs, hydrotherapy)
- Administer pain medications as ordered and monitor for side effects
- Collaborate with the healthcare team to ensure timely interventions if complications arise
Responsibility During Admission and Throughout the Labor Process
- Obtain a thorough prenatal history and assess for any risk factors
- Establish an IV line for fluid administration, if needed
- Monitor maternal and fetal well-being continuously
- Advocate for the client's preferences and needs during labor and delivery
,- Facilitate communication and collaboration among healthcare team members
Position Changes
Encourage frequent position changes to enhance comfort and facilitate labor progress, such as:
- Upright positions (e.g., walking, sitting, standing)
- Side-lying positions
- Hands and knees (all fours) position
- Squatting or sitting on a birthing ball
Comfort Measures
Offer various comfort measures to help the client cope with labor pain, such as:
- Breathing and relaxation techniques
- Massage or counterpressure
- Warm or cold packs
- Hydrotherapy (e.g., shower, bath, or birthing pool)
Signs of Placental Separation After Delivery
- Gush of blood
- Lengthening of the umbilical cord
- Uterus rises and becomes round and firm
The 5 P's
1. Passenger: The fetus and its presentation, position, and size.
2. Passageway: The maternal pelvis and birth canal.
3. Powers: Uterine contractions and maternal pushing efforts.
4. Position: Maternal posture and mobility during labor.
5. Psychological: Maternal emotions, coping mechanisms, and support systems.
Birth Passageway, Passengers, and Powers
- Birth Passageway: Composed of the maternal pelvis and soft tissues of the birth canal.
- Passengers: The fetus, including the size of the fetal head, and the presentation (cephalic,
breech, or shoulder).
- Powers: Involves the uterine contractions that dilate and efface the cervix and the maternal
pushing efforts that help expel the baby.
Types of Pelvises
1. Gynecoid: Most favorable for vaginal birth; round and wide.
2. Android: Triangular or heart-shaped; more common in males.
, 3. Anthropoid: Oval-shaped; narrower front-to-back and wider side-to-side.
4. Platypelloid: Flattened, wide shape; least favorable for vaginal birth.
Cardinal Movements of Labor
1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. External rotation
7. Expulsion
Baby's Position and Presentation and the Effect on Delivery
- Position: The relationship between a designated landmark on the fetal presenting part and the
maternal pelvis (e.g., LOA, ROA, LOP, ROP).
- Presentation: The part of the fetus that enters the birth canal first (e.g., cephalic, breech, or
shoulder).
- The baby's position and presentation can influence the labor process and the ease or difficulty
of delivery. Optimal position and presentation for a vaginal birth is the vertex presentation
(head down) with the occiput anterior position, where the baby's back is towards the mother's
front. Malpositions or malpresentations can lead to longer labor, the need for interventions, or
possibly a cesarean section.
Medical Abbreviations
1. SROM: Spontaneous Rupture of Membranes - The natural rupture of the amniotic sac, usually
occurring during labor, signified by a gush or slow leak of amniotic fluid.
2. PROM: Premature Rupture of Membranes - The rupture of the amniotic sac before the onset
of labor, which can lead to increased risk of infection or other complications if labor does not
begin within a certain timeframe.
3. AROM: Artificial Rupture of Membranes - A medical procedure in which a healthcare provider
deliberately breaks the amniotic sac to induce or accelerate labor, also known as an amniotomy.
Nursing Interventions After Amniotomy or ROM
Following an amniotomy or rupture of membranes (ROM), nurses should:
1. Assess the fluid: Check the color, odor, and consistency of the amniotic fluid. It should be
clear or slightly yellowish and have a mild odor. The presence of greenish or brownish fluid
(meconium staining) or a foul odor can indicate potential complications.
