INTRAPARTUM

PROCESS OF LABOR AND DELIVERY

Presented by GROUP 3A
Andal, Jaybel Ann
Bolagao, Reymart B.
Cortez, Dyan M.
Eridao, Keyne Reenne
Herrera, Reggin Caryl V.
 INTRAPARTUM CARE
refersto the medical and nursing care
given to a pregnant woman and her
family during labor and delivery.

Extends from the beginning of

contractions that cause cervical
dilation to the first 1 to 4 hours after
delivery of the newborn and placenta.
FACTORS AFFECTING
LABOR AND
DELIVERY 
5 P’s of Labor and Delivery
Passageway
Passenger
Power
Placental Factors/Position
Psyche
PASSAGEWAY
refers to the adequacy of
the pelvis and birth canal
allowing fetal descent; and
factors include:
 I. TYPES OF FEMALE PELVIS
 Gynecoid – typical female pelvis with
a rounded inlet.
 Android – normal male pelvis with a
heart shaped inlet
 Anthropoid – is an “apelike” pelvis with
an oval inlet
 Platypelloid – is a flat, female-type pelvis
with a transverse oval inlet
 II. STRUCTURE OF
PELVIS
 False pelvis vs. true pelvis

FALSE PELVIS -Superior half formed by the

iliac. Offers landmark for pelvic
measurements. Supports the growing fetus into
the true pelvis near the end of gestation

TRUE PELVIS -Inferior half formed by the

pubes in front, the iliac and the Ischia on the
sides and the sacrum and coccyx behind.
 III. ADEQUATE DELIVERY
DIAMETER 
a) Pelvic Inlet diameter Inlet – entrance way to the true
pelvis. Its Transverse diameter is wider than its
anteroposterior diameter. Also known as pelvic brim.

b) Pelvic Outlet diameter Outlet – inferior portion of the

pelvis, bounded on the back by the coccyx, on the
sides by the ischial tuberosities and in front by the
inferior aspect
of the symphysis pubis and the pubic arch. Its
anteroposterior diameter is wider than its transverse
diameter.
 Engagement- refers to settling of the presenting part
of the fetus into the pelvis to be at the level of the
ischial spine, a midpoint of the pelvis, descent to this
point means the pelvic inlet is proven adequate for
birth.
 Floating”- a presenting part that is not engaged.

 Dipping”- one that is descending but has not reached

the ischial spine.
 Station- or degree of engagement; refers to the
relationship of the presenting part of a fetus to
the level of the ischial spines.
III. ADEQUATE DELIVERY
DIAMETER
c. Ability of the uterine segment to distend,
the cervix to dilate and the vaginal canal
and introitus to distend.
DILATATION-Enlargement of the external
cervical os from 0 to 10cm. As a result
of uterine contractions and additionally as
a result of pressure on the presenting part.
EFFACEMENT-Shortening and
thinning of cervical canal from 0
to100%.
Primigravida –effacement
occurs before dilatation
Multigravidas –dilatation may
precede effacement
 PASSENGER
This refers to the fetus and its
ability to move through the
passageway .
PASSENGER (CONT…)

Fetal skull 
 Size of the fetal head and capability of the head to
mold to the passageway.
 Molding- change in shape of fetal skull produced by
force of contraction pressing the head against the not-
yet dilated cervix Parents are reassured that molding
only lasts a day or two and is not a permanent condition
 No molding when fetus is breech.
 The fetal skull is the most important part
of the fetus because:

1. It is the largest part of the body

2. It is the least compressible of all parts
3. It is the most frequent presenting part
PASSENGER (CONT..)

Fetal lie or presentation-
The part of the fetus that enters
the maternal pelvis first; the body
part that will be born first
or contact the cervix first
 Cephalic = head first; ideal presentation for NSVD
because the bones of the skull are capable of molding so
effectively to accommodate the cervix and may actually
aid in cervical dilation

 Vertex – head is sharply flexed, making the parietal

bones the presenting parts
1. Face
2. Brow
3. Chin or mentum
Breech – either buttocks or feet first;
difficult birth; can be delivered NSVD.
Complete breech – thighs are flexed on the abdomen and
legs are on thighs.
Frank breech – thighs are flexed and legs are extended,
resting on the anterior surface of the body. Footling
 Double –legs unflexed and extended; feet are presenting parts.

 Single – one leg flexed and extended; one foot is the presenting

part.
Shoulder presentation- presenting part can be one of the
shoulders(acromion process, an iliac crest, a hand an elbow;
CS delivery)
FETAL LIE
 relationship between the long axis of the fetal body and
the long axis f the woman’s body(cephalocaudal).

a. Horizontal (transverse)
b. Vertical (longitudinal)- cephalic or breech
FETAL ATTITUDE
The relationship of fetal parts to one
another; degree of flexion a fetus
assumes during labor.
FETAL ATTITUDE(CONT..)
 GOOD ATTITUDE- if in complete flexion;
the spinal column is bowed forward, the head is
flexed forward so much that the chin touches the
sternum, the arms are flexed and folded on the
chest, the thighs are flexed onto the abdomen
and the calves are pressed against the posterior
aspect of the thighs.
FETAL ATTITUDE(CONT..)

MODERATE ATTITUDE- if
chin is not touching the chest
but is in alert or military
position.
FETAL ATTITUDE(CONT..)

POOR ATTITUDE- the

back is arched, the neck is
extended and a fetus is in
complete extension
FETAL POSITION
The relationship of presenting part and the maternal pelvis
which is divided into4 quadrants:
 right anterior

 right posterior

 left anterior

 left posterior

Four parts of the fetus have been chosen as point of direction

1.Occiput -= in vertex presentation
2.Chin (mentum) – in face presentations
3.Sacrum – breech presentations
4.Scapula (acromion) – in shoulder presentations
Possible fetal positions:
 LOA (left occipitoanterior)- most common fetal position
(birthing is fast)
 LOP (left occipitoposterior)- difficult delivery; more painful

 LOT (left occipitotransverse)ROA (right occipitoanterior)-

second most frequent (birthing is fast)
 ROP (right occipitoposterior)- difficult delivery, more painful

 ROT (right occipitotransverse)

*Posterior positions may be more painful for the mother, because

the rotation of the fetal head puts pressure on the sacral nerves
causing sharp back pain.
 POWER 
refers to the frequency,
duration and strength of
uterine contractions to cause
complete cervical effacement
and dilatation.
3 PHASES OF UTERINE CONTRACTIONS
 crescendo/increment- intensity of the contraction
increase. This phase is longer than the other two phases
combined.
 acme/apex-the height or peak of the contraction.

 decrescendo/ decrement- intensity of the contraction

decreases
 Duration of contractions “How Long” 
“From the beginning of one contraction to the end of the same
contraction”
 Duration during early labor- 20-30 seconds.

 Duration in late labor- 60-70 seconds.

 Should never be longer than 60-70 seconds because any muscle

that is contracted does not have any blood supply and so
will jeopardize the fetus.
 Interval
From the end of one contraction to the beginning of the next
contraction
 Interval during early labor- 40-45 minutes

 Interval in late labor- 60-70 seconds

 It is an important aspect of contraction because it is during this
relaxation period when the uterine blood vessels refill
themselves with blood to supply the fetus with adequate
oxygen
Frequency “How Often” 

 From the beginning of one contraction to the beginning

of the next contraction.
 Three to four contractions are timed to get a good picture
of the frequency.
 Intensity “How Strong” 
 The strength of contraction; may be mild, moderate,
strong or severe
 Measured by the consistency of the fundus at the acme
of the contraction
 When estimating intensity, check fundus at conclusion of
 contraction to determine whether it relaxes.
 More strong: more pain
 PSYCHE

refers to the client’s psychological

state, available support systems,
preparation for childbirth,
experiences and
coping strategies.
 PLACENTAL
FACTORS
refer to the site
of placental insertion.
 /
PRODROMAL SIGNS OF
LABOR
Lightening
is the descent of the fetus and uterus into the pelvic cavity 2-3
weeks before the onset of labor.
Effects of lightening
 Shooting pains down the legs because of pressure on the
sciatic nerve
 Increased lordosis as the fetus enters the pelvis and falls
further forward
 Increased amount of vaginal discharges

 Resurgence of sign of pregnancy like urinary frequency, as

the gravid uterus impinges on the bladder
 Relief of abdominal tightness and diaphragmatic pressure
PREMONITORY/PRELIMINARY/
PRODROMAL SIGNS OF LABOR
 Loss of weight - 2- 3 lbs is loss 2 days prior to onset of
labor, probably due to loss of appetite anddecrease in
progesterone level that leads to fluids excretion thus
causing loss weight.

 Progesterone – is known to cause fluid retention

PREMONITORY/PRELIMINARY/
PRODROMAL SIGNS OF LABOR
Burst of energy or Increased tension and fatigue
 Nesting behavior” – may occur right before the onset of
labor. Sudden burst of energy is due to increase in
epinephrine in response to the stress brought about by
the approaching delivery.
 Pregnant woman should be caution not to use this energy
to carry out household chores because it is meant to
prepare the body for the labor.
PREMONITORY/PRELIMINARY/
PRODROMAL SIGNS OF LABOR
Braxton Hicks contraction
 irregular intermittent contractions that have occurred
throughout the pregnancy, become uncomfortable and
produce a drawing pain in the abdomen and
groin; painless uterine tightening Also known as practice
contraction.
PREMONITORY/PRELIMINARY/
PRODROMAL SIGNS OF LABOR
Cervical changes
 include softening “ripening” describe as butter soft and
effacement of the cervix that will cause expulsion of the
mucous plug (bloody show).
Rupture of amniotic membranes or “the bag of water” 
 may occur before the onset of labor.

 Its rupture may be seen as a sudden gush,

or a scanty, slow seeping of amniotic fluid from the
vagina. It is important to remember that once membranes
(BOW) have ruptured; Therefore labor is inevitable.
Labor pains will set in within the next 24 hours.
 Since the integrity of the uterus has been destroyed,
infection can easily set in.
Thus, ASEPTIC TECHNIQUE 
 should be observed in doing perineal care. Doctors do
less of the IE and enemas no longer given.
 Check for any umbilical cord compression and or cord
prolapsed especially in breech presentation)
A WOMAN SEEKING ADMISSION
CLAIMS THAT HER BOW
HAS RUPTURED.
FIRST NURSING ACTION 
 Put her to bed right away, then take the fetal heart tones. She should
be allowed to remain in the standing position or
sitting position because if its true that BOW has ruptured, the
possibility of cord compression is high.
 If a woman in labor says that she feels a loop of the cord coming out
of her vagina (cord prolapsed),

IMMEDIATE ACTION
 Place her in trendelenberg position – to reduce pressure on the cord.

 REMEMBER: only 5 minutes of cord compression can already lead

to CNS damage or even death
  Apply a warm saline saturated OS on the cord to prevent crying of
the cord.
 Color should be noted
1. Normal: clear, almost colorless and contains
white specks of vernix caseosa.
2. Abnormal:
a. green staining – amniotic fluid has been
contaminated with meconium which signifies fetal
distress if the fetus is in a non-breech
presentation.
b. yellow staining – may mean blood
incompatibility.
c. Pink stain – may indicate bleeding
PREMONITORY/PRELIMINARY/
PRODROMAL SIGNS OF LABOR
 If labor does not occur within the next 24 hours, the woman
will have to be induced to go into labor by administering
intravenous drip of oxytocin (Pitocin).

Show 
 This is the blood-tinged mucus discharged from the vagina
because of pressure of the descending fetal part on the
cervical capillaries, causing their rupture.
 Capillaryblood mixes with mucus when operculum is release
that is why SHOW than a pinkish vaginal discharge.
 Show should be distinguished from bright red vaginal
bleeding because the later is a danger sign during this phase
of pregnancy.
 ONSET OF LABOR

Labor normally begins when a fetus

is sufficiently mature to cope with
extra uterine life, yet not to large to
cause mechanical difficulties with
birth.
 Differentiate TRUE LABOR from a FALSE LABOR….
 Contractions False labor True labor
Timing Irregular, no increase in Regular intervals which
frequency or duration gradually become closely
spaced
Change with motion Stop and start at irregular Progress is continuous
intervals
Location Abdomen Back, then travels to the
front
Intensity Weak and remains weak Intensifies with time

External changes None Mucus plug may dislodge;

membrane rupture; bladder
pressure
Occurrence Happens when you are Anytime
tired, especially in the
evenings
STAGES OF LABOR 

First stage ( Stage of Dilatation)

 begins with the onset of regular contractions which
cause progressive cervical dilation
and effacement. It ends when the cervix incompletely
effaced and dilated.
1.Latent phase - 1-4 cm
2.Active phase - 4-7 cm
3.Transitional phase - 7-10 cm
 Power/Forces at work: involuntary uterine contracts
STAGE OF DILATATION (FIRST STAGE)
LATENT PHASE
 early time in labor

 Regular contraction

 Cervical dilation – 1 to 4 cm

 Intensity: mild to moderate

 Uterine contractions occur Q15-30 minutes and are 15-
30seconds in duration and of mild intensity
 Mother is talkative and eager to be in labor
STAGE OF DILATATION (FIRST STAGE)
ACTIVE PHASE
 Cervical dilation 4-7 cm

 Uterine contractions occur Q3-5 minutes and are 30-
60seconds in duration
 Contraction: moderate to strong, frequent, longer more
painful
 Mother may experience feeling of helplessness and
becomes restless and anxious as contractions intensifies
 Woman fears losing control of herself 
STAGE OF DILATATION (FIRST STAGE)
TRANSITIONAL PHASE-
 Cervical dilation 8-10 cm

 Uterine contractions occur every 2-3 minutes and are 45-

90seconds in duration and of strong intensity
 Mother becomes tired, is restless and irritable and feels
out of control
 Mood change

 AMNIOTOMY (if not yet ruptured)

 Gaping (bulging) of vagina or anus or perineum

AMNIOTOMY is not done if the station is still negative
because this can lead to cord compression
 SECOND STAGE
( STAGE OF EXPULSION)
 Begins with complete dilatation of the
cervix and ends with delivery of the
newborn.
 Duration may differ among primiparas
(longer) and multiparas (shorter),but this
stage should be completed within 1 hour
after complete dilatation.
SECOND STAGE
( STAGE OF EXPULSION)
 Power/Forces at work: INVOLUNTARY UTERINE
CONTRACTIONS; CONTRACTIONS OF THEDIAPHRAG
MATIC AND ABDOMINAL MUSCLES
1. Contractions are severe at 2-3 minute intervals, with a
duration of 50-90seconds
2. Cervical dilation is complete
3. Progress of labor is measured by descent of fetal head thru
the birth canal(change in fetal station)
4. Uterine contractions occur every 2-3 minutes, lasting 60-75
seconds, and the intensity is strong.
5. Increase in bloody show
6. Mother feels the urge to bear down
 The newborn exits the birth canal with the help from the following
cardinal movements, or mechanisms of labor
(D FIRE ERE)
DESCENT- fetus goes down the birth canal (preceded by engagement)
FLEXION- pressure on the pelvic floor causes the fetal chin to bind
towards the chest
INTERNAL ROTATION – from antero-postero to transverse then AP
to AP
EXTENTION – as the head comes out, the back of the neck stops
beneath the pubic arch. Thehead extends and the forehead,
nose, mouth and chin appear
EXTERNAL ROTATION (also known as restitution) – anterior
shoulder rotates externally to the AP position so that it is just behind
the symphysis pubis
EXPULSION – the delivery of the rest of the body
SECOND STAGE ( STAGE OF EXPULSION)
 Episiotomy
 Prevent prolonged & severe stretching of the muscles

 Natural anesthesia (synchronized with pushing of the woman)

 Done to facilitate delivery and avoid laceration of the perineum

 Reduce duration of second stage

 Enlarge outlet in breech presentations or forcep delivery

TYPES OF EPISIOTOMY
 Median
 Mediolateral
 Application of Ritgen’s Maneuver is the best method for
delivery As soon as crowning is taking phase, cover anus with
sterile towel to exert.
 THIRD STAGE (PLACENTAL
EXPULSION)
 Begins with the delivery of the baby and
ends with the delivery of the placenta.
 Placental separation and expulsion occur
 Placental birth occur 5-30 minutes after
birth of baby.
THIRD STAGE (PLACENTAL
EXPULSION)
Placental Separation(Mechanisms)
 SCHULTZE MECHANISM: center portion of placenta
separates first and
its shiny fetal surface emerges from the vagina.
SHINY AND GLISTENING.

 DUNCAN MECHANISM: margin of placenta separates,

and the dull, red, rough maternal surface emerges from
the vagina. DIRTY, RAW, REDAND IRREGULAR
WITH THE RIDGES OR COTYLEDONS.
THIRD STAGE (PLACENTAL
EXPULSION)
Signs of Placental Separation
 uterus becoming globular (calkin’s sign)

 Fundus rising in abdomen

 gushing of blood

 Lengthening of the cord

THIRD STAGE (PLACENTAL
EXPULSION)
Contractions of the uterus controls uterine bleeding and aids with placental
separations and delivery. Generally, oxytocic drugs (oxytocin 10-20 units) are
administered to help the uterus contract (after placenta out)
METHERGINE
 PROMOTES UTERINE CONTACTION AND PREVENTS POSTPARTUM
HEMORRHAGE
 PRODUCE STRONG AND EFFECTIVE CONTRACTION

 ASSESS VITAL SIGNS (BP)

 DO NOT ADIMINISTER IF BP IS 140/90 mmHg

 LEADS TO HYPERTENSION

 DISCONTINUE: MARKED VASOCONSTRICTION (COLDNESS, PALENESS,

NUMBNESSOF THE FEET AND HAND); NOTIFY THE PHYSICIAN
OXYTOCIN
 INCREASES UTERINE CONTRACTION

 MINIMIZED UTERINE BLEEDING

 INCREASES BLOOD PRESSURE (VASOCONSTRICTION)

FOURTH STAGE ( RECOVERY AND
BONDING)
 From the delivery of the placenta until the postpartum
condition of the woman has become stabilized (usually
after 1 hour after delivery).
 the period of time from 1-4 hours after delivery the
mother and newborn recover from the physical process
of birth
 The maternal organs undergo initial readjustment to
the nonpregnant state
  The newborn baby systems begins to adjust to extra
uterine life and stabilize
THIRD STAGE (PLACENTAL
EXPULSION)
Monitoring the Blood Pressure
 Blood Pressure should not be taken during a contraction
as it tends to INCREASE, because no blood supply goes
to the placenta during contraction. All the blood is in the
periphery, which explains the increased BP
during contraction BP taking should be taken at least
every half hour during active labor. Whenever a woman
complains of a HEADACHE, remove the blood pressure
apparatus from the arm right away (priority intervention)
 NURSING MANAGEMENT
DURING LABOR
1.Physical Assessment.
 General physical examination, Leopold’s maneuvers
and/or internal examination are done.
2.Bath.
 Bath is advisable if contractions are still tolerable or are
not too close to one another. Bathing will not
only ensure cleanliness but will also provide comfort and
relaxation.
3.Perineal Preparation.
 Perineal flushing is done to prevent contamination of the
birth canal and reduce possibilities of postpartum
infection.
NURSING MANAGEMENT
DURING LABOR
4. Ambulation.
 Unless contraindicated (by medications, intravenous
infusion or ruptured membranes), ambulation is advised
during the latent phase of labor in order to help shorten the
first stage of labor.
5. Diet 
 .Solid or liquid foods are avoided for the following reasons:

a)Digestion is delayed during labor.

b)A full stomach interferes with proper bearing down.
c)Aspiration may occur during the reflex nausea and
vomiting of the transition phase or when anesthesia is used.
NURSING MANAGEMENT
DURING LABOR
6.Enema Administration.
 Enema is not a routine procedure for all women in labor but maybe done for the
following reasons:
a)A full bowel hinders labor progress; enema increases the space
available for passage of the fetus and improves frequency and intensity of uterine
contractions
b)Enema decreases the possibility of fetal contamination of the perineum during the
second stage of labor.
c)A full bowel can add to the discomfort of the immediate postpartumperiod.

Contraindications of enema:
a)Vaginal bleeding
b)Premature labor
c)Abnormal fetal presentation or position
d)Ruptured membranes
e)Crowning
NURSING MANAGEMENT
DURING LABOR
Voiding.
 The woman in labor should be encouraged to empty her
bladder every2-3 hours because:
a)full bladder retards fetal descent.
b)urinary stasis can lead to urinary
tract infection.
c)a full bowel may be traumatized during delivery.
NURSING MANAGEMENT
DURING LABOR

8.Breathing Technique.
 The woman in the 1st stage of labor should be instructed
not to push or bear down during contractions because it
will not only lead to maternal exhaustion
 but, more importantly, unnecessary bearing down can
lead to cervical edema because of the excessive
pounding of the fetal presenting part of the pelvic floor,
thus interfering with labor progress.
 To minimize bearing, the patient should be advised
to do abdominal breathing during contractions.
NURSING MANAGEMENT
DURING LABOR
9.Position.
 Encourage the woman in labor to assume Sim’s position
because:
 a)It favors anterior rotation of the head.

 b)It promotes relaxation between contractions.

 c)It prevents Supine Hypotensive Syndrome.

 The inferior vena cava, the blood vessel which carries

unoxygenated blood back to the heart, lies just above the
spinal column. When a pregnant woman lies flat on her back,
the inferior vena cava is caught between the gravid uterus and
the spinal column, causing a drop in arterial blood pressure,
which leads the woman to complain of dizziness.
NURSING MANAGEMENT
DURING LABOR

Contractions.
 Uterine contractions are monitored every hour during the
latent phase of labor and every 30 minutes during the
active phase by spreading the fingers lightly over the
fundus.
NURSING MANAGEMENT
DURING LABOR
Vital Signs
 Blood Pressure (BP) and Fetal Heart Rate (FHR) are
taken every hour during the latent phase and every 30
minutes during the active phase. Definitely, BP and FHR
should never be taken during a contraction.
During uterine contractions
 No blood goes to the placenta. The blood is pooled to the
peripheral blood vessels
which results in increased BP. Therefore, the blood
pressure should be taken in between contractions and
whenever the mother in labor complains of a headache.
 NURSING MANAGEMENT
DURING LABOR
Danger Signals.
 The nurse must be aware of the following danger signals
during labor and delivery.
a)Signs of fetal distress
1. Tachycardia (FHR more than 180)
Bradycardia (FHR less than100)
2.Meconium-stained amniotic fluid in non-
breech presentation
3.Fetal thrashing or hyperactivity
due to fetal struggling for more oxygen
NURSING MANAGEMENT
DURING LABOR
Signs of maternal distress
 1. BP over 140/90, or a falling BP associated with
clinical signs of shock (pallor, restlessness or
apprehension, increased respiratory and pulse rates)
 2. Bright red vaginal bleeding or hemorrhage(blood loss
of more than 500 cc)
 3. Abnormal abdominal contour

(may be due to uterine rupture or Bandl’s pathological

ring, a condition wherein the muscles
at the physiological retraction ring become very tense,
gripping the fetus causing possible fetal distress)
NURSING MANAGEMENT
DURING LABOR
 Administration of Analgesics.
 Narcotics are the most commonly used analgesics,
specifically Demerol (meperidine hydrochloride).
 Demerol acts to suppress the sensory portion of the cerebral
cortex. A dose of 25-100 mg is given and it takes effect
within 20 min when the patient experiences a sense of well
being and euphoria.
 Demerol, being also an antispasmodic, should not be given
very early in labor because it will retard labor progress. It
should not also be given when delivery is less than an hour
away because it can cause respiratory depression in
the newborn. It is , therefore, preferably given when
cervical dilatation is around 5-8 cm. 
NURSING MANAGEMENT
DURING LABOR
Administration of Anesthetics.
 Regional anesthesia is preferred over any other form
because it does not enter the maternal circulation and
therefore does not retard labor contractions nor cause
respiratory depression in the newborn.
NURSING MANAGEMENT
DURING LABOR

Transfer of Patients.
 A sure sign that the baby is about to be born is the
bulging of the perineum. In general, multiparas are
transported to the delivery room when cervical dilatation
is about 7-9 cm, while primiparas are transferred to the
delivery room at full dilatation with perineal bulging
when crowning is taking place.
NURSING MANAGEMENT
DURING DELIVERY
Positioning on the Delivery Table.
 When positioning the woman on lithotomy on the delivery
table, the legs should be put up slowly at the same time on the
stirrups in order to prevent trauma to the uterine ligaments and
backaches or leg cramps. The same should be done when
putting the legs down from the stirrups after delivery.

Bearing Down Technique.
 At the beginning of a contraction, the woman is asked to take
two short breaths, then to hold her breath and bear down at the
peak of contraction. She should also be told to use blow-blow
breathing pattern to prevent pushing between contractions.
NURSING MANAGEMENT
DURING DELIVERY
Care of the Episiotomy Wound.
 Episiotomy, a perineal incision done to facilitate the birth of
the baby, is made by the doctor primarily to prevent
lacerations. No anesthesia is necessary during episiotomy b/c
the pressure of the fetal presenting part against the perineum
is so intense that the nerve endings for pain
are momentarily deadened(natural anesthesia).

Breathing Technique.
 As soon as the head crowns, the woman is instructed not to
push any longer because it can cause rapid expulsion of the
fetus. Instead, she should be advised to pant (rapid and
shallow breathing).
NURSING MANAGEMENT
DURING DELIVERY
Ritgen’s Maneuver.
a) Support the perineum during crowning by applying pressure with
the palm against the rectum. This will not only prevent lacerations
of the fourchette but will also bring the fetal chin down the chest
so that the smallest diameter of the fetal head is the one presented
at the birth canal.
b) in order to prevent rapid expulsion of the fetus which could result
not only in lacerations, abruptio placenta, and uterine inversion
but also to shock because of sudden decrease in intra abdominal
pressure, the head should be pressed gently while it slowly eases
out.

Time of Delivery.
 Take note of the time the baby is delivered.
NURSING MANAGEMENT
DURING DELIVERY
Handling of the Newborn.
 Immediately after delivery, the newborn should be held below the
level of the mother’s vulva so that blood from the placenta can
enter the infant’s body on the basis of gravity flow.
 The newborn should be held with his head in a dependent position
to allow drainage of secretions.
 A newborn is never stimulated to cry unless he has been
drained of his secretions because he can aspirate these secretions
into his lungs. The newborn should be immediately wrapped in a
clean diaper to keep him warm because chilling increases the
body’s need for oxygen.
 He should then be placed on his mother’s abdomen so that the
weight of the baby can help contract the uterus; a non contracted
uterus can lead to death due to hemorrhage
NURSING MANAGEMENT
DURING DELIVERY
Cutting of the cord.
 Cutting of the cord is postponed until pulsations have
stopped because it is believed that 50-100 ml of blood is
flowing from the placenta to the newborn at this time.
 It is then clamped twice, an inch apart, and cut in
between.9.Initial Contact. Maternal-infant bonding
is initiated as soon as the mother has eye-to-eye contact
with her baby.
 The mother is informed of her baby’s sex and helped to
hold and inspect her baby if she wishes.
NURSING DIAGNOSIS
 Fear r/t uncertainty about the outcome of the birth
process

 Acute Pain r/t uterine contraction, cervical dilatation

and fetal descent

 Health seeking behaviors: Information about the
fetal monitor r/t an expressed desire to understand
equipment used

 Readiness for enhanced family processes r/t opportunity

to incorporate newborn into the family
Severe bradycardia- FHR less than 80 bpm

Persistent severe bradycardia- severe bradycardia that

persists for longer than 5 minutes
Accelerations-FHR increases than 15 bpm for more than
15 seconds
 Appear as smooth patterns on electronic fetal monitoring
is good indicators of fetal well-being
 Triggered in the normal mature fetus by fetal
body motions, sounds stimulations of the fetal scalp and
other stimuli Early decelerations are normal and
common
 Deceleration pattern matches the contraction with the
most deceleration occurring at the peak of the
contraction FHR rarely goes below 100 bpm.
Cause: head compression during uterine
contraction
Late decelerations
 Decrease in FHR from the baseline rate with a lag time
of greater than 20 seconds from the peak of contraction
 First appear at or after the peak of the uterine
contractions. The FHR improves only after the
contraction has stopped.
 May be mild or severe based on how low the FHR goes
and how long it takes for the FHR to recover
 Caused by reduced blood flow to the uterus and placenta
during contraction
 Associated with
uteroplacental insufficiency and is a consequence of hyp
oxia and metabolic abnormalities Variable deceleration
 Common type of FHR deceleration in labor
 Cause by umbilical cord compression

 Significance depends on how low the heart rate drops

and how long the episode lasts
 Classified severe if they last more than 60 seconds or to
a FHR of less than 90 bpm
NURSING MANAGEMENT
DURING DELIVERY
 Interventions for late or variable decelerations lasting
more than 60 seconds:
1.Reposition the patient
2.Administer oxygen by face mask
3.Discontinue oxytocin’ 
4.IV fluids to increase maternal volume
5.Notify physician
6.Vaginal exam to check for prolapsed of cord
7.Prepare for emergency caesarean section
 TYPES OF CHILDBIRTH

Vaginal delivery

 A natural process that usually does not require

significant medical intervention

 NSVD- normal spontaneous vaginal delivery

TYPES OF CHILDBIRTH

 Forceps delivery- vaginal delivery with the use of obstetric forcep (an

instrumentdesigned to extract the baby’s head)
 Indications

Uterine inertia or poor uterine contraction and the second stage hasgone
pass two hours

 Face presentation; OA in flat pelvis, OP position

 Relative CPD
Cardiac and pulmonary disorders of the mother, maternal exhaustion

 Late deceleration pattern, excessive fetal movement, meconium
stained in cephalic presentation
TYPES OF CHILDBIRTH

Leboyer method
 Postulated that moving from a warm, fluid-filled intrauterine
environment to noisy air filled, brightly lit birth room creates
a major shock for newborn
 He proposed that birthing room should be darkened, kept
pleasantly warm, soft music is played, infant is gently
handled, cord is cut late and placed immediately into a warm
water bath
 Advantage: ideal for most birthing institution

 Disadvantage: warm bath could reduce spontaneous

respiration and high level of acidosis;
 late cutting of the cord causes excess blood viscosity in
newborn
TYPES OF CHILDBIRTH
Hydrotherapy and Water Birth
 Baby is born underwater and immediately brought to the
surface for a first breath
Advantage: reduce discomfort in labor
Disadvantage: Contamination of bath water with feces
expelled, Aspiration of bath water by fetus: pneumonia,
Maternal chilling, Uterine infections- pushing efforts in
2nd stage of labor
TYPES OF CHILDBIRTH
Caesarean birth
 Latin word “caedore” means to cut

 Birth accomplished through abdominal incision into the

uterus, after 28 weeks AOG
 Emergency procedure (under general anesthesia) or
elective procedure (under spinal)
 Indications :CPD, Placenta previa, Abruption placenta,
Malpresentation or malposition, Preeclampsia/eclapmsia,
Previous CS, Cervical dystocia, Cancer of the
cervixFetal distress, Cord prolapsed,
 Other factors: poor obstetrical history, vaginoplasty,
vesico-vaginal fistula
TYPES OF CHILDBIRTH
Complications
 Uterine rupture in subsequent pregnancy

 Postop infection

 Injury to urinary system

 Injury to uterine vessels

 Embolism
TYPES OF CHILDBIRTH
 Types of CAESAREAN DELIVERY
 Classic caesarean section- Incision made vertically
through the abdominal skin and uterus
Advantage: incision is made high on the uterus to avoid
cutting the placenta and be used with placenta previa
Disadvantage:
 Leaves a wide skin scar

 Scar could rupture during labor and not be able to have a

subsequent vaginal birth
TYPES OF CHILDBIRTH
Low segment incision
 Lower segment transverse caesarean section (LSTCS)

 Made horizontally across the abdomen over the cervix

 Referred to as pfannesteil incision or bikini incision

Advantage:
 Less likely to rupture in subsequent labours

 Less blood loss- easier to suture

 Decrease postpartal infections

 Less possibility of GI complications

Disadvantage:
 Longer procedure

 No assurance for small skin incision and small uterine incision.

THE END…