CRISANTO CAJANG

MARIECOR ENRIQUEZ
KATHLEEN JAYNE RAMOS
KATHLEEN KAYLA BAGUIOEN
ROSEMARIE JOY JUCUTAN
(Process of Labor and Delivery)
INTRAPARTUM
 The time period spanning childbirth from the
onset of labor through delivery of the
placenta.
 Intrapartum can refer to both the woman and
the fetus.
LABOR
 It
is the process by which the fetus and the
placenta leave the uterus. Delivery can occur in
two ways, vaginally (through the birth canal) or by
a cesarean (surgical) delivery.
 Factors affecting labor and
delivery process
 Passenger
 Passageway
 Powers
 Placenta
 Psychological response
 The passenger is the fetus.
 The body part of the fetus that has the widest
diameter is the head.
 These precise movements allow the smallest diameter of the
head to pass through the corresponding diameter of the
mother’s pelvis
 The way the passenger, or fetus, moves through the birth canal is
determined by several interacting factors: the size of the fetal
head, fetal presentation, fetal lie, fetal attitude, and fetal position.
 The route the fetus must travel from the uterus through the cervix
and vagina to the external perineum.
 For the fetus to pass through the pelvis,
pelvis must be adequate of size.
◦ Diagonal Conjugate= the anterior
posterior diameter of the inlet
◦ Transverse diameter of the outlet
 The Gynaecoid or genuine female pelvis
 It has an almost round brim and will permit the passage of
an average-sized baby with the least amount of trauma to
the mother and baby in normal circumstances.
 The Android pelvis
 It has a heart-shaped brim and is quite narrow in front.
 The Anthropoid pelvis
 It has an oval brim and a slightly narrow pelvic cavity.
 The Platypelloid pelvis
 It has a kidney-shaped brim and the pelvic cavity is usually
shallow and may be narrow in the antero-posterior (front to
back) diameter.
 Denotes the body part that will first contact the cervix or be born first. This is determined by a
combination of fetal attitude and fetal lie.
 The fetal attitude describes the position of the parts of your baby's body. The fetal attitude describes
the position of the parts of your baby's body.
 This refers to how the baby's spine lines up with the
mother's spine. Your baby's spine is between his head
and tailbone.
 Position refers to the direction the baby is facing in relation to the mother’s spine. A
baby could be lying face-first against a mother’s spine, or face up towards the
mother’s belly.
 Supplied by the fundus of the uterus, a process that
causes cervical dilation and then expulsion of the fetus to
the uterus.
 Uterine contractions, labor contractions begin at
pacemaker point located at the myometrium.
 Reverse, ineffective contractions, cause tightening rather
than dilation of the cervix.
 The duration of contractions also changes increasing from
20-30 sec. to a range of 60 – 90sec.
 Between contractions the uterus also relaxes, relaxation
interval decreases from 10 – 3mins. In early labor.
 Organ that develops in your uterus during pregnancy.
MATERNAL
 Heart Rate increases 10-20 bpm.

 Cardiac Output increases.

 Blood Pressure increases during uterine contractions.

 White blood cells count increases due to tissue trauma.

 Respiratory rate increases and more oxygen consumed.

 Gastric Motility and food absorption decrease/nausea and vomiting.

 Temperature rises slightly.

 Muscular aches/cramps occur.

FETAL
 Periodic Fetal heart rate accelerations and slight
decelerations related to fetal movement, fundal pressure
and uterine contractions.
 Decrease in circulation and perfusion to the fetus
secondary to uterine contractions.
 Decrease in fetal breathing movements throughout
labour.
 Respiratory changes during labour help to prepare the
fetus for extrauterine respiration immediately after birth.
 Uterine stretch theory- any hollow organ when stretched
to capacity will necessarilly contract and empty.
 Oxytocin theory- labor being considered a stressful event,
stimulates the hypophysis to produce oxytocin from the
posterior pituitary gland. It causes the contraction of
smooth muscles of the body.
 Progesterone deprivation theory- progesterone being the
hormone designed to promote pregnancy is believed to
inhibit uterine motility.
 Theory of aging placenta- because of the decrease in
blood supply the uterus contracts.
 Lightening – descent of the fetal head into the pelvis.
 Increased level of activity
৹sudden increase of energy
◦often referred to as nesting
 Braxton hicks contractions
৹MILD CONTRACTION – pattern less
৹Often mistaken for real labour
৹Often felt in the abdomen and the groin not in the back.
 Ripening of the cervix- an internal announcement that labor is
close at hand.
৹ Is an internal sign seen only on the pelvic examination.
৹ The cervix becomes softer un til describes as “butter-soft.”
 Uterine contractions
◦ The surest sign that the labor has begun.
◦ Contractions cause effacement and dilation of the cervix.
 Bloody show
◦ As the cervix softens and ripens, the mucus plug that filled the cervical
canal during pregnancy is expelled.
 Ruptured membranes
◦ Labor may begin with rupture of the membranes experienced as either
a sudden gush or scanty, slow seeping of clear fluid from the vagina.
1. DILATION OF THE CERVIX
 LATENT PHASE – begins with the onset of regular contractions

- contractions usually mild

- last about 20 to 40 seconds
- recur every 5 to 30 minutes
- time to start timing frequency and length
and assess intensity
 To promote comfort during latent labor
 Take a shower or bath
 Listen to relaxing music
 Have a gentle massage
 Try slow, deep breathing or relaxing techniques
 Change position
 ACTIVE PHASE – contractions are more frequent, longer, and
strong no longer be able to take through them.
- cervix dilates from 4 to 10 cm
- at the end, baby begins to descend into
vaginal canal
- contractions will last about 60 seconds,
every 5 minutes for an hour.
- delivery is immatent.
• To promote comfort during active phase
 Change positions
 Roll on a large rubber ball (birthing ball)
 Take a warm sponge bath
 Take a walk, stopping to breathe trough contraction
 Have a gentle massage between contractions
 TRANSITION – contractions reach maximum intensity, cervix becomes
fully dilated and effaced .

MOTHER – nausea and vomiting, mood swings, pain, shaking and

shivering.
• To promote comfort during transition
• Offer lots of encouragement and praise
• Avoid small talk
• Continue breathing with her
• Help guide her through her contraction with encouragement
• Encourage her to relax between contractions
• Don’t think that there is something wrong if she seems to be
angry. It is normal part of transition.
2.EXPULSION/PUSHING
 Encompasses actual birth

 Begins when cervix is fully dilated

 Ends with delivery of the fetus

 Can be very quick for multipara

 Contractions slow but continue in duration and intensity

 Accompanied by uncontrollable urge to push

Three phases

I II III

Station 0 to +2 2 to +4 4 to birth

Contraction 2-3 mins 2-2.5 mins 2- mins

apart apart apart
Birth
 Fetus pushes on the internal side of perineum.
 Fetal scalp becomes visible at the opening to the vagina (CROWNING) .
 Mothers oxytocin level increases which helps to increase which helps
to intensify the contractions.

3. PLACENTAL STAGE
 Begins with immediately after a neonate is born.
 Ends when placenta is delivered.
 During this stage homeostasis is restablished .
2 PHASES OF PLACENTAL
 1ST Phase is placental separation
- uterine contractions continue.
- uterine walls contracts.
- placenta folds and begins to separate from uterine wall.
- causes bleeding that pushes the placenta away.
 2nd Phase is placental expulsion
• crede’s maneuver/Fundal pressure.
• involves placing one hand on the top of the uterus
(Uterine fundus) and squeezing it between the thumb
and other fingers to help placental separation and
delivery.
 never exert pressure on the uterus when it isn’t
contracted .
• manual removal indicated if not expelled in 30
minutes.
 Pain-is the sensation of discomfort. Is a subjective,
personal symptom; what the person says it is, and present
when the person says it. Also look for subtle signs of pain
such as facial tenseness, flushing, or paleness, hands
clenched in fist, rapid breathing, or rapid pulse rate.
 Anxiety related to lack of knowledge about ‘normal’ labor
process.
 Self-esteem disturbance related to ineffectiveness of
prepared childbirth breathing exercise.
 Decisional conflict related to use of analgesia or
anesthesia during labor.
 Danger signs in labor and child
birth
 Maternal dangers signs
◦ Rising or falling blood pressure
◦ Abnormal pulse
◦ Inadequate or prolonged contractions
◦ Pathologic retraction rings
◦ Abnormal lower abdominal contour
◦ Increasing apprehension
 Fetal danger signs
◦ High or low fetal heart rate
◦ Meconium staining
◦ Hyperactivity
◦ Fetal acidosis
1. ENCOURAGE COMFORTABLE POSITIONING
 An upright, sitting or walking position may be
comfortable for a woman in early labor.
2. PROVIDE PHARMACOLOGIC PAIN RELIEF
 Helping a woman decide if and when indication for
pain relief should be given requires an in-depth
understanding of the available drug, their effects
on the mother and the fetus.
1. Support the labor
2. Guard the labor
3. Changing position in the first stage helps the
mother to cope better with her labour.
4. Helping the mother to manage her contractions
5. Touch
6. Sound
7. Breathing
8. Drinking fluids during labor
 PHYSICAL AND PSYCHOLOGICAL
PREPARATION OF THE CLIENT
*Physical preparation:
 eat healthy preconception and pregnancy diet
 doing kengel exercise
 practicing pelvic tilts and inversion

 also yoga and squats

 try different positions during labor
Psychological preparation:
 do lots of research about what is healthy birth look
like.
 Read up on different ways to deal with
complications and to come up with "Plan B".
 The purpose of monitoring the progress of labor is to
recognize incipient problems, so that their progression to
serious problems may be prevented.
 Prolonged labor can lead to adverse outcomes for both
mother and baby, including maternal exhaustion, perinatal
asphyxia, and even death. Inefficient uterine action can be
recognized and corrected, and some adverse outcomes can
be prevented.
 The progress of labor must be monitored with thought and
consideration, rather than as an unthinking routine or a
Procrustean attempt to make all women fit predetermined
criteria of so-called normality.
PARTOGRAPH
 The partograph is a tool for monitoring maternal and fetal wellbeing during labour, and a decision-
making aid when abnormalities are detected. It is designed to be used at any level of care.
 Also includes other indicators:

Maternal indicators:
• Vital signs (heart rate, blood pressure and temperature)
• Time of spontaneous or artificial rupture of the membranes
• Uterine contractions (number per 10 minutes and duration)
• Urine output
• Administration of any drugs (oxytocin, antibacterial, etc.)
Foetal indicators:
• Foetal heart rate
• Amniotic fluid (colour, odour and quantity)
• Descent of the foetal head and head mouldin.
 PROVISION OF PERSONAL HYGIENE,
SAFETY AND COMFORT MEASURES
 Create calm environment.
 Increase physical comfort.
 Use therapeutic touch.
 Applying heat and cold.
 Assess couple for contributing factors related to the feeling
of loss of control.
 Assist couple with using controlled breathing , exercises
and position changes. Reinforce information learned in
childbirth education classes.
 Slowly and clearly explain the events and changes occurring
with the active stage of labor. Inform the couple of things
that cannot be controlled.
 Reassure, as appropriate, that labor proceeding without
problem.
 Allow opportunities for the couples to manipulate the
environment. Offer couples options.
 Emphasize positive aspects of situation and what can be
controlled.
 Provide continued emotional support throughout labor and
provide privacy as appropriate. Encourage the husband to
continue to actively support his wife.
 Uterine contraction
◦ Duration- from the beginning of one contraction to the end
of the same contraction.
◦ Interval- from the end of one contraction to the beginning
of the next contraction (early in labor 40-45mins. ,labor 2-
3mins.)
◦ Intensity- the strength of a contraction, maybe mild,
moderate or strong.
◦ Frequency- from the beginning of one contraction to the
beginning of the next contraction.
৹ Should be taken every hour during the latent phase, every
half of an hour during the active phase, every 15mins.
during transition phase.
৹ For any abnormality in FHR, the initial nursing action is to
change the mother’s position.
 Sign of fetal distress
o Bradycardia or tachycardia
o Mecronium-stained amniotic fluid in non-breech
presentation.
o Fetal-trashing- hyperactivity of the fetus as it struggles
for more oxygen.
 Emotional support is provided for the woman in labor by
keeping her constantly informed of the progress of labor.
 Blood pressure
◦ Should be taken during a contraction because it tends to
increase.
◦ BP reading should be taken at least every half hour during
active labor.
◦ When a woman in labor complains of a headache, first action
is to take BP.
 Fetal heart rate
◦ Should not be mistaken with uterine soufflé
◦ Normally 120-160bpm
◦ Should not be taken during uterine contractions because it
tends to decrease.
◦ Compression of the fetal head when the uterus contracts
stimulates the vagal reflex which causes bradycardia.
 Health teachings
o Bath- is advisable ,will make the mother comfortable.
o Ambulation- helps shorten the first stage of labor.
o Solid and liquid foods are to be avoidable because:
o Digestion is delayed during labor.
o A full stomach interferes with proper bearing down.
o May vomit and cause aspiration.
 Enema
o Purpose: a full bowel hinders the progress of labor.
o Expulsion of feces during second stage of labor predisposes the mother
and the baby to infection.
o Contradictions to enema in labor:
o Vaginal bleeding
o Premature labor
o Abnormal fetal presentation or position.
o Ruptures membranes
o crowning
 Encourage the mother to void every 3hrs. By offering the bedpan
because:
◦ A full bladder retards fetal descent.
◦ Urinary stasis can lead to urinary tract infection.
◦ A full bladder can be traumatized during delivery.
 Perineal preparation
৹ Done aseptically, always from front to back.
৹ Use 7 strokes method.
 Perineal shave
৹ Done to provide a clean area of delivery.
 SIMS Position
৹ Promotes relaxation between contractions.
৹ Prevents continual pressure of the gravid uterus on the inferior vena
cava.
 Abdominal breathing
৹ advised in order to reduce tension and prevent hyperventilation.
PARTOGRAPH
 The partograph is a tool for monitoring maternal and fetal wellbeing during labour, and a decision-making aid
when abnormalities are detected. It is designed to be used at any level of care.
 Also includes other indicators:
Maternal indicators:
• Vital signs (heart rate, blood pressure and temperature)
• Time of spontaneous or artificial rupture of the membranes
• Uterine contractions (number per 10 minutes and duration)
• Urine output
• Administration of any drugs (oxytocin, antibacterial, etc.)
Foetal indicators:
• Foetal heart rate
• Amniotic fluid (colour, odour and quantity)
• Descent of the foetal head and head mouldin.
• Is an Evidence-based Standard Practices.
• For safe and quality care of the birthing mothers and
their newborns.
The EINC practices during Intrapartum Period
 Continuous maternal support

 Mobility during labor

 Position of choice during labor and delivery

 Non-drug pain relief

 Spontaneous pushing in a semi-upright position

 Episiotomy will not be done, unless necessary
 Active management of third stage of labor(AMTSL)

 Monitoring the progress of labor

Recommended EINC practices for newborn care are

time-bound interventions at the time of birth
 Immediate and thorough drying of the newborn

 Early skin-to-skin contact between mother and the

newborn
 Properly-timed cord clamping and cutting

 Unang Yakap(First Embrace)

  Is a surgical incision of the perineum made to prevent
tearing of the perineum with birth and to release pressure
on the fetal head with birth.

 Two types of episiotomy

1. Midline or Medan
2. Mediolateral
 Reasons for the procedure
 Fetal distress
 Complicated birth
 Prolonged second stage
 Large Baby
 Preterm Baby
 Risks of the procedure
 Bleeding
 Tearing past the incision into the rectal tissues and anal spincter
 Perineal pain
 Infection
 Perineal hematoma
 Pain during sexual intercourse
Before the procedure
 Explain the procedure
 Sign a consent form

 Notify if you are sensitive to/ allergic to any

medications
 Notify all medications and herbal supplements that
you are taking
 Notify them if you have a history of bleeding
disorders or if you are taking any anticoagulant
 Birthing room drapes and materials used for birth are
sterile so no microorganisms are accidentally introduced
into the uterus.
 Also the table with equipments such as sponge, drapes,
scissors, basins and others are prepared in advance.
 The infant equipment available should include radiant
heat warmer, equipment for suction and resuscitation and
others.
 Radiant heat warmer should be turned on well enough in
advance to warm the place of birth.
Obstetrician/ Gynecologist
 Gynecologists specialize in illness, injuries, or diseases of the
female reproductive system such as breast and hormonal
problems, urinary tract and pelvic disorders, and cancer of the
cervix.
Certified Nurse-midwife
 Nurse midwifery is a nursing specialization dealing with
pregnancy, labor, and postpartum concerns. Securing their
safety during the childbirth process as well as the safety of their
newborn child.
Registered Nurse
 Nurses in the Delivery Room Labor and delivery nurses
work alongside obstetricians and other doctors in labor and delivery
rooms, helping administer antepartum (before delivery) and postpartum
(after delivery) care.
Anaesthesiologist
 Obstetric anesthesiologists serve in labor and delivery, ready to assist in
the management of pain of labor and delivery, to
administer anesthesia for cesarean section, and to manage emergencies
that may arise
Thank you!!!