Unit 3: Nursing care of the intrapartum family
- Factors of labor
o Need all 5 things to work together to have successful vaginal or c section
delivery
o Passenger
o Passageway
o Powers
o Position
o Physiological response
- Passenger
o The fetus and placenta
o Factors:
▪ Size of fetal head (like if mom has rly small pelvis and baby has big head)
• Bones
o 6 bones in infant head
o 2 temporal
o 2 parietal
o 1 frontal
o 1 occipital
o Same as adult just smaller
• Sutures: where the bones meet
o Lambdoid: horiz across back, sagittal (vertical down
middle of head), coronal (horizontal across front), frontal
(vertical down front)
• Fontanels
o Space in between bones, kinda squishy
o Posterior: triangle shaped
o Anterior: diamond shaped
o Fontanels allow bones to morph to fit thru the birth canal
• Molding
o Where bones of babies skull overlap
• Size of fetal shoulders
o If baby has extremely wide shoulders can be difficult for
vaginal delivery
o A LOT more difficult to move babies head than shoulder
(we can move shoulder out of way)
o Fetal presentation: part of the fetus that enters the pelvis first and leads through
the birth canal during labor
▪ This is what felt when do vaginal check when nurse checks with fingers
▪ Cephalic presentation (head first, what we want)
• Vertex, military, brow, face
▪ Breech presentation (bottom or feet first)
• Frank, full (complete), footling
, ▪ Shoulder presentation
▪ Most of these if baby doesnt turn on own will require a c section
o Presenting part: part of the fetus that lies closet to the cervix (what you feel on
exam)
▪ Lets us know what position they are in
▪ Head, sacrum, scapula, chin, brow, vertex, etc
o Pics on slides
▪ With vertex: will probably feel posterior fontanel on examination
▪ Military: may feel in between fontanels or just anterior
▪ Brow: will feel actual brow bone on their head (starting to extend inside
the pelvis)
▪ Face: will feel eyes, nose, and mouth (baby has fully extended into birth
canal) **not what we want
▪ Frank Breech: feel hips on exam, can literally deliver folded in half
▪ Complete or full breech: babies knees up in chest so may feel feet/ sacrum
▪ Footling breech: may feel foot or feet
▪ Want cephalic and vertex presentation
o Fetal lie: relation of the spine of the fetus to spine of the mother
▪ Longitudinal (vertical): spines of both of them are parallel to each other –
they match
• Can be this way in cephalic or breech
▪ Transverse (horizontal): baby and moms spine perpendicular to each other
• With transverse lie often feel shoulder on exam
• Most require c section
o Fetal attitude: relation of body parts to each other
▪ General flexion (what we assume as fetal position- want baby to be here)
• Chin flexed: ensures that this can go thru the pelvis first
• Rounded back
• Thighs flexed
• Legs bent
• Arms crossed
o Fetal position: relationship of the presenting part to the maternal pelvis (what
you feel on examination in relationship to moms pelvis)
▪ We WANT head to be presenting part
▪ 3 part abbreviation:
• 1st letter: location of presenting part in relation to maternal pelvis
o Right (R) or left (L)
o With sterile vaginal exam will be able to tell
• 2 letter: presenting part of the fetus
nd
o Occiput (O), sacrum (S), Mentum (M), scapula (Sc)
o O: ideal
o Mentum: chin
• 3 letter: location of presenting part in relation to maternal pelvis
rd
o Anterior (A), posterior (P), Transverse (T)
, o Transverse: side of moms pelvis
o Which part of the pelvis is the baby “pushing on
• Most common fetal position: LOA
o Left side, occiput, anterior side of pelvis
o Fetal position
▪ Station: relationship of the presenting fetal part between the maternal
ischial spines
• Measures the degree of descent thru the birth canal
• Measured in cm (-5 to +5)
• Up into mom is from 0 to -5
• As descending into pelvis 1 to +5
• Usually only use –3 to +3
• Think +4 baby is on the floor
• Can have a baby at 0!!
▪ Engagement: the largest transverse diameter of the fetal presenting part
has descended into the maternal pelvis
• Babys usually start to engage at –3 station
• Really starting to engage in moms pelvis
o The “birth canal”- passageway
▪ How and where baby comes out of
▪ Composed of the bony pelvis, cervix, pelvic floor, vagina, and introitus=
(external opening of vagina)
▪ True pelvis vs false pelvis
• False pelvis not used at all in child birth
▪ Shape of pelvis determines if baby can fit thru!
▪ Needs to be determined early in prenatal visits
▪ Top and bottom part both muscular and thick
▪ Start contraction at top and works all the way down uterus which puts
pressure on cervix= cervix effaces and dilates= vaginal tissues also dilate
• All these things need to work together for successful deliver
- Powers
o Contractions: responsible for effacement and dilation of cervix, and descent of
fetus
▪ When contractions accurate and strong leads to dilation
▪ Dilation: enlargement or widening of the cervical opening, measured in 0-
10 cm
• 0 cm: moms cervix is closed, not dilated at all
• 10 cm: mom complete, start pushing
▪ Effacement: shortening and thinning of cervix expressed in percentages
0-100%
• Starts out as thick muscle, as contractions happen= shorten and
thin out
• 0: super thick and long, not effaced at all
, • 100%: can hardly feel any cervix and if you do its paper thin and
soft, almost only feel presenting part
▪ Station: progress of the fetus thru maternal pelvis –5 to +5
o Sterile vaginal exam (SVE): dilation/effacement/ station
▪ 3cm dilated, 25% effaces. -3 station
▪ 3/25/-3
▪ Gonna be an abbreviation on test
▪ Abbreviation of sterile vaginal exam
o If mom decided to push and isn't fully dilated: will rip cervix
▪ Pant and breathe rather than push until 10
- Position
o Affects anatomic and physiologic adaptations to labor
o Frequent changes reduce fatigue, increase comfort, and improve circulation
o Do whatever you can to promote comfort
o May have limitations
- Psychologic response
o A client's emotional structure that can determine their entire response to labor and
influence physiological and psychological functioning, the client may experience
anxiety and fear.
o We need mom to have good coping strategies* #1 with psychological response!
o When dealing w pain/ fear/ anxiety- need a way to cope w it
o We need to know her past history with emotional and psychological problems
o How did past deliveries go? PTSD from it?
o Need to be able to fully express her emotions
- Maternal physiologic adaptations to labor
o Cardiac output increases
▪ When uterus contracts blood shunts out into rest of vascular system
o Blood pressure changes
▪ Systolic and diastolic rise during contraction, then returns to baseline at
relaxed state
o WBC increases
▪ Don’t rly know why, cause of physical work/ strenous labor?
o Respiratory rate increases
▪ Esp when contracting
o Proteinuria
▪ Usually around +1 on labs during labor
▪ Also due to physical labor in body= tissue and muscle breakdown
o Elevated temp
▪ Also due to inc muscular activity
▪ Note that lots of infection signs are seen during pregnancy- so need to be
able to distinguish
▪ Now temp shouldn't be able to go over temp level, just slight elevation
o Blood glucose levels decrease
▪ Also work demand from body depleting while working
- Factors of labor
o Need all 5 things to work together to have successful vaginal or c section
delivery
o Passenger
o Passageway
o Powers
o Position
o Physiological response
- Passenger
o The fetus and placenta
o Factors:
▪ Size of fetal head (like if mom has rly small pelvis and baby has big head)
• Bones
o 6 bones in infant head
o 2 temporal
o 2 parietal
o 1 frontal
o 1 occipital
o Same as adult just smaller
• Sutures: where the bones meet
o Lambdoid: horiz across back, sagittal (vertical down
middle of head), coronal (horizontal across front), frontal
(vertical down front)
• Fontanels
o Space in between bones, kinda squishy
o Posterior: triangle shaped
o Anterior: diamond shaped
o Fontanels allow bones to morph to fit thru the birth canal
• Molding
o Where bones of babies skull overlap
• Size of fetal shoulders
o If baby has extremely wide shoulders can be difficult for
vaginal delivery
o A LOT more difficult to move babies head than shoulder
(we can move shoulder out of way)
o Fetal presentation: part of the fetus that enters the pelvis first and leads through
the birth canal during labor
▪ This is what felt when do vaginal check when nurse checks with fingers
▪ Cephalic presentation (head first, what we want)
• Vertex, military, brow, face
▪ Breech presentation (bottom or feet first)
• Frank, full (complete), footling
, ▪ Shoulder presentation
▪ Most of these if baby doesnt turn on own will require a c section
o Presenting part: part of the fetus that lies closet to the cervix (what you feel on
exam)
▪ Lets us know what position they are in
▪ Head, sacrum, scapula, chin, brow, vertex, etc
o Pics on slides
▪ With vertex: will probably feel posterior fontanel on examination
▪ Military: may feel in between fontanels or just anterior
▪ Brow: will feel actual brow bone on their head (starting to extend inside
the pelvis)
▪ Face: will feel eyes, nose, and mouth (baby has fully extended into birth
canal) **not what we want
▪ Frank Breech: feel hips on exam, can literally deliver folded in half
▪ Complete or full breech: babies knees up in chest so may feel feet/ sacrum
▪ Footling breech: may feel foot or feet
▪ Want cephalic and vertex presentation
o Fetal lie: relation of the spine of the fetus to spine of the mother
▪ Longitudinal (vertical): spines of both of them are parallel to each other –
they match
• Can be this way in cephalic or breech
▪ Transverse (horizontal): baby and moms spine perpendicular to each other
• With transverse lie often feel shoulder on exam
• Most require c section
o Fetal attitude: relation of body parts to each other
▪ General flexion (what we assume as fetal position- want baby to be here)
• Chin flexed: ensures that this can go thru the pelvis first
• Rounded back
• Thighs flexed
• Legs bent
• Arms crossed
o Fetal position: relationship of the presenting part to the maternal pelvis (what
you feel on examination in relationship to moms pelvis)
▪ We WANT head to be presenting part
▪ 3 part abbreviation:
• 1st letter: location of presenting part in relation to maternal pelvis
o Right (R) or left (L)
o With sterile vaginal exam will be able to tell
• 2 letter: presenting part of the fetus
nd
o Occiput (O), sacrum (S), Mentum (M), scapula (Sc)
o O: ideal
o Mentum: chin
• 3 letter: location of presenting part in relation to maternal pelvis
rd
o Anterior (A), posterior (P), Transverse (T)
, o Transverse: side of moms pelvis
o Which part of the pelvis is the baby “pushing on
• Most common fetal position: LOA
o Left side, occiput, anterior side of pelvis
o Fetal position
▪ Station: relationship of the presenting fetal part between the maternal
ischial spines
• Measures the degree of descent thru the birth canal
• Measured in cm (-5 to +5)
• Up into mom is from 0 to -5
• As descending into pelvis 1 to +5
• Usually only use –3 to +3
• Think +4 baby is on the floor
• Can have a baby at 0!!
▪ Engagement: the largest transverse diameter of the fetal presenting part
has descended into the maternal pelvis
• Babys usually start to engage at –3 station
• Really starting to engage in moms pelvis
o The “birth canal”- passageway
▪ How and where baby comes out of
▪ Composed of the bony pelvis, cervix, pelvic floor, vagina, and introitus=
(external opening of vagina)
▪ True pelvis vs false pelvis
• False pelvis not used at all in child birth
▪ Shape of pelvis determines if baby can fit thru!
▪ Needs to be determined early in prenatal visits
▪ Top and bottom part both muscular and thick
▪ Start contraction at top and works all the way down uterus which puts
pressure on cervix= cervix effaces and dilates= vaginal tissues also dilate
• All these things need to work together for successful deliver
- Powers
o Contractions: responsible for effacement and dilation of cervix, and descent of
fetus
▪ When contractions accurate and strong leads to dilation
▪ Dilation: enlargement or widening of the cervical opening, measured in 0-
10 cm
• 0 cm: moms cervix is closed, not dilated at all
• 10 cm: mom complete, start pushing
▪ Effacement: shortening and thinning of cervix expressed in percentages
0-100%
• Starts out as thick muscle, as contractions happen= shorten and
thin out
• 0: super thick and long, not effaced at all
, • 100%: can hardly feel any cervix and if you do its paper thin and
soft, almost only feel presenting part
▪ Station: progress of the fetus thru maternal pelvis –5 to +5
o Sterile vaginal exam (SVE): dilation/effacement/ station
▪ 3cm dilated, 25% effaces. -3 station
▪ 3/25/-3
▪ Gonna be an abbreviation on test
▪ Abbreviation of sterile vaginal exam
o If mom decided to push and isn't fully dilated: will rip cervix
▪ Pant and breathe rather than push until 10
- Position
o Affects anatomic and physiologic adaptations to labor
o Frequent changes reduce fatigue, increase comfort, and improve circulation
o Do whatever you can to promote comfort
o May have limitations
- Psychologic response
o A client's emotional structure that can determine their entire response to labor and
influence physiological and psychological functioning, the client may experience
anxiety and fear.
o We need mom to have good coping strategies* #1 with psychological response!
o When dealing w pain/ fear/ anxiety- need a way to cope w it
o We need to know her past history with emotional and psychological problems
o How did past deliveries go? PTSD from it?
o Need to be able to fully express her emotions
- Maternal physiologic adaptations to labor
o Cardiac output increases
▪ When uterus contracts blood shunts out into rest of vascular system
o Blood pressure changes
▪ Systolic and diastolic rise during contraction, then returns to baseline at
relaxed state
o WBC increases
▪ Don’t rly know why, cause of physical work/ strenous labor?
o Respiratory rate increases
▪ Esp when contracting
o Proteinuria
▪ Usually around +1 on labs during labor
▪ Also due to physical labor in body= tissue and muscle breakdown
o Elevated temp
▪ Also due to inc muscular activity
▪ Note that lots of infection signs are seen during pregnancy- so need to be
able to distinguish
▪ Now temp shouldn't be able to go over temp level, just slight elevation
o Blood glucose levels decrease
▪ Also work demand from body depleting while working
