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Elizabeth Gonzalez Dr. Alain Llanes Rojas Advanced Primary Family
Reproductive Health across
Labor and Birth Processes
A woman and the fetus during the late pregnancy prepares for labor process. During this period the fetus is ready for extra uterine life. There are several physiologic adaptations that a woman undergoes which prepares her for birth and motherhood. The end of pregnancy is represented by the labor and birth process which ushers in a extra uterine life for the newborn and a change for the family.
Giving Birth In United States
Model of birth
Site of birth
Stages of Labor
First stage: latent, active, transition
Pushing and birth
Delivery of placenta
First Stage DILATATION
The first stage of labor is divided into three phases: latent, active, and transition.
The first, the latent phase, is the longest and least intense. During this phase, contractions become more frequent, helping your cervix to dilate so your baby can pass through the birth canal
You may feel intense pain or pressure in your back or abdomen during each contraction.
During transition, the cervix fully dilates to 10 centimeters. Contractions are very strong, painful, and frequent, coming every three to four minutes and lasting from 60 to 90 seconds.
Second stage: PUSHING AND BIRTH
Begins when the cervix is completely opened. At this point, your doctor will give you the OK to push. Your pushing, along with the force of your contractions, will propel your baby through the birth canal. The fontanels (soft spots) on your baby's head allow it to fit through the narrow canal.
Your baby's head crowns when the widest part of it reaches the vaginal opening. As soon as your baby's head comes out, your doctor will suction amniotic fluid, blood, and mucus from his or her nose and mouth
Third stage: DELIVERY OF THE PLACENTA
After your baby is delivered, you enter the final stage of labor. In this stage, you deliver the placenta, the organ that nourished your baby inside the womb.
Each woman and each labor is different. The amount of time spent in each stage of delivery will vary. If this is your first pregnancy, labor and delivery usually lasts about 12 to 14 hours. The process is usually shorter for subsequent pregnancies.
Stages of Labor
True Vs False Labor
Discomfort in the abdomen and the back
The cervix dilates
Sedation cannot stop the discomfort
Contractions at regular intervals
Gradually intensity increase
Intensity always remains to be the same
No cervical dilatation
Sedation can relieve discomfort
Contractions at irregular intervals
Pain Management In Active Labor
Several drugs are used to help ease the pain of labor and delivery. Although these drugs are generally safe for the mother and baby, as with any drugs, they have the potential for side effects.
An epidural block continuously administers pain medication to the area around your spinal cord and spinal nerves through a catheter inserted into the epidural space
Anesthetics block all feeling, including pain. They also block muscle movement. General anesthetics cause you to lose consciousness. If you have a cesarean delivery, you may be given general, spinal, or epidural anesthesia.
Non Drug Options
Non-drug methods for relieving pain include acupuncture, hypnosis, relaxation techniques, and changing position frequently during labor.
Even if you choose non-drug pain relief, you can still ask for pain medications at any point during your delivery
Fetal Assessment During Labor
What to asses
Fetal heart rate (FHR): the primary assessment.
The amniotic fluid
Fetal Heart Monitoring
Methods of fetal heart monitoring
Electronic fetal monitoring
Baseline FHR above 160bpm
Baseline FHR less than 120 bpm
*Baseline FHR=10 minutes*
This happens in 5 or less contradictions in 10 minutes which last for in 60 seconds in the active phase
Happens in the second stage 30 mmHg in early labor to 70-90 mmHg
These are accelerations or decelerations which happens in the FHR that are in relation to uterine contractions and do persist over time.
Early deceleration: An early deceleration represents an autonomic response to changes in intracranial pressure or cerebral blood flow caused by intrapartum compression of the fetal head during a uterine contraction and maternal expulsive efforts.
Variable deceleration: Reflects the fetal autonomic reflex response to transient mechanical compression of the umbilical cord
Late deceleration : Is a reflex fetal response to transient hypoxemia during a uterine contraction.
Situations Where The Fetal Heart Rate Pattern Is Abnormal
This means the fetus is not getting enough oxygen
The cause should be found
Steps taken to ensure the baby get enough oxygen
Id the procedure is not successful and the fetus has problems the baby should be delivered immediately
The child will most likely be delivered through cesarean or vacuum delivery or forceps
Buckley, S. J. (2015). Executive summary of hormonal physiology of childbearing: evidence and implications for women, babies, and maternity care. The Journal of perinatal education, 24(3), 145.
King, T. L., Brucker, M. C., Fahey, J., Kriebs, J. M., & Gegor, C. L. (Eds.). (2015). Varney's midwifery (p. 3). Burlington, MA: Jones & Bartlett Learning.
Simpson, K. R. (2016). Research about nurse staffing during labor and birth is greatly needed and long overdue. Nursing for women's health, 20(4), 343-345.