MATERNITY NOTES PROCESS OF LABOR: chapter 12 & 13 INDICATED BY 4 P: pg. 241 McKinney & Chapter 11 ATI

MATERNITY NOTES

PROCESS OF LABOR : chapter 12 & 13

INDICATED BY 4 P : pg. 241 McKinney & Chapter 11 ATI

I. POWER

• During first stage of labor; primary force that moves the fetus through the maternal pelvis are the uterine contractions • Force acting to expel fetus out • Effacement → shortening and thinning of the cervix during the first stage of labor • Dilation→ enlargement of the cervical oss. and the cervical canal during the first stage of labor • Pushing efforts of mother during the second stage II. Passage way • The route • Consist of maternal pelvis and soft tissues • True pelvis is more important in labor functioning like a curved cylinder III. Passenger • How baby is laying or attitude in that position • Consist of the fetus, membranes and the placenta

IV. PSYCHE

• Nurse acting as advocate for laboring mother and support person to increase amount of control on client • Women emotional structure that determines t=entire response to labor and influence physiological and psychological functioning Fetal lie • Determines whether the baby can come out vaginally or via C-section • Transverse /Horizontal→ C-section • Flexion → best position • Extension → might be c-sectioned

Fetal Attitude • Determines whether the baby is in flexion position or extension position • Flexion is the normal fetal attitude; head flexed toward the chest and arms and legs over the thorax • Relationship of the fetal body part to one another • Full term newborn

Cephalic Presentation

• Head first: most common presentation

• Fetal head is smooth and hard making more effective to dilate

• VERTEX (OCCIPUT/Complete flexion) ➔ More favorable for normal

labor progression

II. MILITARY (MODERATE FLEXION) → Head is in neutral position • Neither flexed nor extended

III. BROW (POOR FLEXION)

• Fetal head is partially extended • Brown presentation is unstable • Longest supraossipitomental diameter is presented➔ C-section

IV. Face (full extension) • Head is extended • Fetal occiput is near the spine➔➔ C-section

Breech Presentation • Fetal buttocks enter the pelvis first, which occurs in about 3 % births • More common in preterm babies

• Frank Breech

• Most common variations when fetal legs area extended across the abdomen toward the shoulders

II. Full (complete) Breech • Reversal of the cephalic presentation • Head, knees and hip flexed but buttocks presented

III. Footling Breech • When one or both feet presented

Variation in Passageway Position

• Position refence point to the pelvis

II. Anything posterior → back pain III. Right (R) or L (L)➔ fetus to right or the left of pelvis IV. Occiput (O), Mentum (M), Sacrum (S)→ fetal reference point)

• Anterior (A), Posterior (P) or Transverse (T) → fetus is anterior or posterior

quadrant of mother’s pelvis VI. If fetus is neither anterior or posterior, then its transverse VII. Best position ROA • Occiput (O) (head) → used in vertex presentation • Mentum (M) (chin) → face presentation • Sacrum (S) → breech presentation • Anterior (A)→ skull is sideways • Posterior (P)→ skull directly hitting spine→ back labor (ROP) • Transverse (T) → C-section