NCM 107 Module 2F
NCM 107 Module 2F
NCM 107 Module 2F
Labor
- A series of events by which uterine
contractions and abdominal pressure expel a
fetus and placenta from the uterus
- It is the process of delivering a baby and the
placenta, the membranes, and umbilical cord
from the uterus to the vagina to the outside
world
- In our conceptual framework, we have here
a mother who is pregnant First Stage of Labor
- Dilatation
High Level Wellness - The cervix dilates fully to a diameter of about
- If the mother is going through her regular 10 cm (2 inches)
prenatal checkups, the mother is also
performing yoga and exercises, eating a First stage of labor is divided into 2 phases:
lot of healthy foods and fruits and
1. Latent Phase
vegetables, have a good support system
2. Active Phase
and has a good psychological
development Theories of Labor
- The mother is aware of everything that is - Normally begins between 37 and 42 weeks
good for her baby and is educated ➔ As early as 37 or as late as 42
enough, then it will lead her to a high level
- If the labor can begin before fetus is mature
wellness
this is premature labor
- If labor occurs or is delayed until fetus and
placenta have both passed beyond the
optimal point for birth this is termed as post
term labor
Components of Labor
There are four (4) important components of labor
which must work together for a normal labor process - From an obstetrical standpoint, it is useful to
to begin: consider the bony pelvis as a whole rather
than a separated part
1. Passage
- A pelvis is a bony ring formed by four united
➔ Refers to the maternal pelvis itself
bones:
2. Passenger
1. Two innominate (flaring hip) bones
➔ A maternal pelvis should be suitable to
2. The coccyx
also the passenger which refers to the
3. The sacrum
fetus
- These four bones serve both to support and
3. Power
protect the pelvic organs
➔ Refers to the amount of push the mother
- These united bones together also form four
will exert during the delivery
joints
4. Psyche
➔ Or psychological development of the
mother is very important all throughout
her pregnancy process
➔ Could refer to the past experiences a
mother had prior to pregnancy
If one is altered in these four components of labor,
the outcome of labor can be adversely affected.
False Pelvis
- located in the superior half of the pelvis
- the upper portion of the pelvic inlet
→ support the internal organs and upper body
True Pelvis
- located in the inferior half of the pelvis
Pelvis (Parts and Functions) - includes the pelvic inlet, pelvic outlet, and pelvic
- Vital in the birthing process cavity
- Innominate bones: ilium (upper and lateral - Chiefly of concerned of the obstetrician as it forms
portion), ischium (inferior portion), and pubis the canal through which the fetus has to pass
- Hip (the crest of the ilium) Pelvic Inlet
- Ischial tuberosities (important markers - entrance to the true pelvis
used to determine lower pelvic width) - also called as the pelvic brim
- Ischial spines (mark the midpoint of the Pelvic Outlet
pelvis) - inferior portion of the true pelvis
Pelvic Cavity
- Symphysis pubis
- space between the inlet and the outlet
- Sacrum (upper posterior portion of the pelvic
ring)
- Coccyx (below the sacrum)
Front View
2. Android-shaped Pelvis
Male Pelvis - “Male” pelvis
- Its arc is only 70 degrees = acute angle - The pubic arch forms an acute angle, making
- It is much more narrower and longer than the the lower dimensions of the pelvis extremely
female pelvis narrow
- A fetus may have difficulty exiting from this
Female Pelvis type of pelvis
➔ Sometimes it could lead into cesarean
- Its arc is 90 to 100 degrees = obtuse angle
delivery or it could lead to a forceps
anatomically called sub arc
delivery or a vacuum delivery
- It is much broader and larger
➔ It depends on a lot of factors
Types of Pelvis
1. Gynecoid-shaped Pelvis
- “Female” pelvis
- Has an inlet that is well-rounded forward and
backward
- Has a wide pubic arch
- Ideal type for childbirth
- Most common type of pelvis for women
- This is what we call as the “child bearing 3. Anthropoid-shaped Pelvis
hips” - “Ape-like” pelvis
- A lot of women has a very perfect body like a ➔ Shaped as a monkey
wide hips and betty boop type of body, or in - The transverse diameter is narrow
old terms like coca-cola body - The anteroposterior diameter of the inlet is
- Easy passage of the fetal skull and the larger than usual
shoulders - It’s oval with longer anteroposterior diameter
- 50% of women have gynecoid pelvis - Usual mode of delivery (gynecoid): normal
- 20% of women have android pelvis spontaneous vaginal delivery if the position
- 25% of women have anthropoid pelvis of the baby is in occipitoanterior position
- 5% of women have platypelloid presentation is on occiput
Soft Tissues
- Also play a role in labor and delivery
- The lower segment of the uterus expands to
accommodate the intrauterine contents as
the walls of the upper segment thicken - Other 4 bones of the skull:
- There are also a lot of factors which also ➔ Sphenoid
causes the intrauterine wall to soften and that ➔ Ethmoid
also aids the passage of the baby going out ➔ 2 temporal bones
- The cervix is drawn up and over the - The bones meet at suture lines composed of
presenting part as it descends strong, flexible, fibrous tissue which allow the
- The Vaginal Canal distends to accommodate cranial bones to move and overlap, making it
the passage of the fetus possible for the skull to decrease in size
Passenger
- Refers to the fetal skull
- Refers to the fetus and its ability to move
through the passage and affected by several
fetal features:
• Presentation
• Attitude
• Station
- It is very important to know the type of
• Lie sutures of the skull because for example,
• Position during delivery or when the baby is delivered
you will experience conditions like caput
succedaneum, molding, cephalohematoma,
etc…
➔ You will determine that type of specific
condition by the determinants of these
suture lines
Molding
• Normal
• Overlapping of the skull bones along the
suture lines
• Changes in shape of the fetal skull to long
and narrow shape that facilitates passage
through the rigid pelvis
• Molding is also the alteration of the shape
of the fore coming head while passing
through the resistant birth passage during
the labor
➔ There is however very little alteration in Complete Flexion or Full Flexion in other books =
size of the head as a volume of the Vertex Presentation
content inside the skull is
Moderate Flexion = Military Presentation
incompressible, although small
amount of cerebrospinal fluid and • Ang bregma ang makita
blood can escape in the process
• During a normal delivery, usually an Poor Flexion (Extension) = Brow Presentation
alteration of 4 mm in the skull diameter
commonly occurs Full Extension = Face Presentation
• Only last a day or two Complete Flexion
• It is normal during delivery that mugawas • Good Attitude
ang tae because as the baby go outside, • The usual “fetal position” or the ideal one
the baby would compress the surrounding • Advantageous for birth because it helps
tissue or the soft tissue that is why it is also fetus presents the smallest anteroposterior
affected, and the baby would compress
diameter of the skull
the sigmoid colon. That is why the mother
• Occupies the smallest place possible
would poop during the delivery.
Example:
Molding results into that kind of shape kay sige ug Moderate Flexion
push ug balik ang mother. • Chin is not touching the chest anymore
• “Military Position or Military Presentation”
Partial Extension
• Poor flexion
• It presents the brow of the head to the birth
canal
• “Brow Presentation”
Cephalic Presentation
- Head presents first
- Most common type of presentation:
Types of Cephalic Presentation:
Transverse Lie
1. Vertex
- Shoulder presentation 2. Brow
- When the lie is perpendicular to the mother’s 3. Face
axis ➔ Poor Flexion
- When the long axis of the mother is 4. Mentum (Chin)
perpendicular to the fetus ➔ Complete Extension
Frank Breech
Lie: Longitudinal or vertical
Presentation: Breech (incomplete)
Presenting Part: Sacrum
Attitude: Flexion, except for legs at knees
-
LOA
- Most common fetal position
ROA
Four parts of the fetus are also chosen as - Second most common fetal position
landmarks: • Fetus born fastest on either position
1. Right occipitoposterior (ROP)
➔ Right part of the maternal pelvis
➔ Occiput for the fetus
➔ Posterior for the maternal pelvis
2. Left occipitoposterior (LOP)
➔ Left part for the maternal pelvis
➔ Occiput for the fetus
➔ Posterior part of the pelvis
3. Right occipitoanterior (ROA)
➔ Right side of the maternal pelvis
➔ Occiput for the fetus
➔ Anterior portion of the maternal pelvis or
quadrant
4. Left occipitoanterior (LOA)
➔ Left side of the maternal pelvis
➔ Occiput for the fetus
➔ Anterior portion of the maternal pelvis or
quadrant
• Floating
➔ Presenting part is not engaged
• Dipping
➔ Descending but not yet touched the
ischial spine
➔ Nagka anam anam ug ka us us ang ulo
sa baby
Station
- Refers to the relationship of the presenting
part of the fetus to level of the ischial spine
Power
- Refers to the extent of push that the mother
will exert during the delivery
- Third important requirement for successful
labor
- This is very important as it is the force that is
supplied by the fundus of the uterus and
implemented by uterine contractions, which
causes cervical dilatation and expulsion of
the fetus from the uterus
- As the mother felt the contraction, that is the
time that she is going to push.
- What will if dili pa contracted ang abdomen
unya mupush siya?
➔ It could result to laceration
Magisi kay magpataka ug utong
MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA
NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Uterine Contractions Psyche
- There are True Labor and False Labor - A woman’s psychological state which may or
inhibit labor
True Labor - It can be based on past experience as well
• Contractions are: as her present psychological state
➔ Regular
➔ Increase in intensity and duration with There are a lot of women nowadays, the
walking psychological problems increased after giving birth.
➔ Felt in lower back, radiating to lower Taas ang postpartum depression because it started
portion of abdomen in postpartum blues leads to postpartum psychosis
• Bloody Show and leads to postpartum depression.
• Dilatation and Effacement
• Fetus usually engaged - As a nurse, you need to orient, educate, and
give awareness especially to first time
mothers, single mothers, and for those
False Labor mothers who are not financially capable of
• Contractions are irregular having a kid, and also to multigravid.
• Often stop with walking (mawala ra diay
siya)
• Contractions felt in abdomen above
umbilicus (abdominal pain)
➔ But does not radiate in the back or vice
versa
• No change in cervix
• Fetus is ballotable
Leopold’s Maneuver
- Systematic method of palpation to determine
the fetal presentation and position
- Done as a part of physical examination
L1: Fundal Grip
- Findings: Fundal height and Fundal Content
L2: Umbilical Grip
- Findings: Fetal Back, Fetal Small Parts, and
Fetal Heart Tone
L3: Pawlick’s Grip or Pawlik’s Grip
- Determine if Cephalic or Breech
L4: Pelvic Grip
- Engaged or Floating