Intrapartum
Ricci Chapters 13 and 14; ATI Chapters 11-15
1. Discuss the signs/symptoms that may occur in the days or weeks preceding the initiation of labor: “promontory signs”.
Cervical changes cervical softening, cervical dilation with descent. Can occur 1 month to 1 hour before actual labor.
Lightening fetal’s presenting part begins to descend into the true pelvis (breathing is easier, ↓ reflux, ↑ pelvic pressure,
leg cramping, dependent edema, low back discomfort) – more likely to happen w/ the first baby.
↑ energy level “nesting”, occurs 24-48 hours before onset of labor (due to ↑ in epinephrine release caused by ↓ in
progesterone).
Bloody show blood from ruptured cervical capillaries from the mucus plug that fills the cervical canal.
Braxton hicks contractions become stronger and more frequent. It is felt as a tightening or pulling sensation of the top of
the uterus – occurs primarily in the abdomen and groin and gradually spread downward before relaxing.
Usually lasts as long as 30 seconds - 2 minutes. IF contractions last longer than 30 seconds and happens more than 4-6
times an hour, contact her PCP. WON’T SHOW CERVICAL CHANGE.
ROM labor will begin spontaneously within 24 hours after ROM. After ROM, there is a danger of cord prolapse if
engagement has not occurred so it’s important to see the HCP right away.
2. How do we discern “true” labor from “false” labor?
True labor is progressive, regular in duration, and becomes stronger. CERVICAL CHANGE and fetus engaged in the pelvis.
False labor is irregular contractions, does not become stronger or closer together, stops with rest, hydration and activity.
If mom changes activity (going from resting to walking) and the contractions stop, it is FALSE labor.
True labor produces dilation, effacement, engagement and descent (false labor does not produce any of these).
Other events that occur just before true labor occurs:
Lightening Burst of energy can occur 24-48 hours before
Vaginal discharge (“nesting”)
Brown/blood tinged cervical mucus passes Estrogen and progesterone levels fluctuate,
Cervix gets ready by ripening, potentially causing a fluid shift and subsequent weight loss
dilating/effacing of 2.2-6.6 kg approximately 2-48 hours prior to
labor.
Rupture of membranes “water breaking” (can be anywhere from 50-300 ml)
3. Discuss the five “P’s” that affect labor:
(1) PASSAGEWAY (BIRTH CANAL) (students do NOT need to know the details about the bony pelvis; they should be familiar
with the four most common pelvic shapes)
Consists of the maternal pelvis and soft tissues.
Hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to
become more flexible to prepare for childbirth.
Effacement thinning of the cervix to allow fetus to descend into the vagina. Along with dilation, think of it as similar
to pulling a turtleneck sweater over your head.
(2) PASSENGER/PLACENTA – BABY!
Cephalic/Head: size and presence of molding. Go back to
skull and sutures***
Vertex most common, head fully flexed down.
Brow head tipped back slightly, “eyebrows first”
Face head tipped back fully, full face first
Reassure mom that the oblong shape is only
temporary.
Attitude: relationship of fetal head position to maternal
spine (flexion or extension).
Flexion normal attitude, head flexed down with chin to chest. Thighs are flexed on the
abdomen, legs are flexed to the knees.
Extension abnormal attitude, less commonly seen, head extended back.
Lie: relationship of fetal spine to maternal spine
Longitudinal/vertical normal lie, both spines parallel
Transverse abnormal lie; both spines form cross, c-section required.
1
Rev. Fall 2019
, Intrapartum
Presentation: used to describe the way the baby is positioned while coming down the birth canal. Which part is leading
the way?What’s pointing towards mom’s vagina?
Head (look above at cephalic/head. i.e. vertex, brow, face)
Breech: butt; difficult because largest part is born last (skull) and might get “hung up”/stuck in the pelvis. Umbilical
cord may also become compressed because abdomen is born before the skull.
o Frank (A) most common, hips flexed, knees extended
o Full/complete (B) both knees bent, bottom of feet closest to birth canal, cross legged appearance
o Footling (C and D) when a foot presents first
Others: shoulder, side, foot, abdomen, etc.
Position: used to describe the position of the baby in
relation to mom’s pelvis. Described by THREE LETTERS.
Must know landmark occiput/occipital (most
common, back of the head) “O”, scapula/acromion
process “Sc”, sacrum/buttocks “S”, mentum/chin “M”.
look at where landmark is in relation to mom’s spine
right vs left; anterior vs posterior
left occiput anterior is most common and where most babies naturally face… it allows the widest part of the baby’s
head to correspond with the widest part of mom’s pelvis.
o Example1 --- ROA occiput is facing right side of pelvis and is towards the front of the pelvis
o Example 2 --- LOA occiput is facing the left side of the pelvis and is anterior (towards the front)
Station: how far down the baby is in the birth canal in relation to mom’s ischial spine
Mom’s ischial spine is the narrowest of her pelvis, so when the baby is there,
they are at 0 station
Negative numbers mean the baby is farther inside/up (-1, -2, -3)
Positive numbers mean the baby is farther out/closer to delivery (+1, +2, +3)
Measured in cm
Cardinal movements of labor: specific movements the baby does, in this specific order, to exit mom successfully.
Engagement where the presenting part descends through the pelvic inlet. May be called lightening or dropping.
Occurs approximately 2 weeks before delivery.
Descent and flexion process of presenting part (typically the head) going through mom’s pelvis, occur
simultaneously as a fluid movement.
o Baby flexes head down
o Descent is measured by station, continuous process until delivery
o 0, negative or positive station.
Internal rotation baby rotates within the birth canal (baby’s face in line with mom’s rectum).
Extension baby’s head extends. Begins after crowning. Complete when chin is out of perineum.
Restitution and external rotation occur simultaneously as a fluid movement
o Baby re-aligning its head with body
Expulsion baby’s entire body is out.
(3) POWERS: primary and secondary
Primary = Uterine contractions (involuntary)
Frequency how often contractions occur and is measured from the beginning of one contraction to the
beginning of the next contraction.
2
Rev. Fall 2019
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