NCM Lecture: Chapter 15 (Nursing Care of a Family During Labor and Birth)
Critical Factors in Labor Structures involved Processes/Physiologic
Events
1. The Birth Passage Pelvis Cervix and Vagina
(The Passage) Size of the pelvis in diameter Cervical dilation
(inlet; cavity; outlet) Effacement
Type: Gynecoid; Android; Distention of vaginal canal
Anthropoid; Platypelloid and opening
2. The Fetus Fetal Head - size and presence of
(The Passenger) molding
Fetal Attitude - flexion and extension of the
fetal body and extremities
Fetal Lie - longitudinal or transverse lie
Fetal Presentation - the part of the fetal body
entering the pelvis first
Placenta - implantation site
3. The relationship Engagement of the fetal presenting part - confirms the adequacy of the
pelvic inlet
between the passage and - location of fetal presenting part
the fetus Station
within the maternal pelvis
- relationship of the fetal
Fetal Position presenting part to the 4
quadrants of the maternal pelvis
4. Primary forces of labor Frequency, duration, and intensity of - the force applied by
(The Power) uterine contractions the fundus of the uterus
Effectiveness of the maternal
pushing effort
and implemented by
Duration of Labor uterine contractions
- full dilatation of the
cervix
5. Psychosocial Physical preparation for childbirth - a woman’s reaction to
considerations Sociocultural values and beliefs labor
Previous childbirth experience
(The Psyche) Support from significant others
- father’s experience of
Emotional Status childbirth and bonding
The Fetus
1. Fetal Head
- 3 major parts: Sutures Fontanelles Landmarks
Face, base, and - membranous - compress to aid in 1. Mentum – fetal chin
vault spaces between molding 2. Sinciput – brow
Bones the cranial bones 1. Anterior Fontanelle 3. Bregma – large
- bones of face Frontal suture Diamond-shaped; diamond-shaped anterior
and base are – becomes the 2x3 cm. fontanelle
fused and fixed anterior - permits growth of the 4. Vertex – area between
brain by remaining the anterior and posterior
- base has 2 continuation of fontanelles
temporal bones the sagittal unossified for as long
as 18 months 5. Posterior Fontanelle –
with sphenoid suture 2. Posterior Fontanelle intersection between posterior
and ethmoid Sagittal suture – Small-triangle shaped cranial sutures
bones runs antero- - much smaller and 6. Occiput – area of the
- vault has 2 posteriorly, skull occupied by the occipital
closes within 8-12 bone, beneath the posterior
frontal, 2 connecting the 2 weeks after birth fontanelle
parietal, and 1 fontanelles
occipital bones Coronal sutures-
- vault bones are extend
not fused so this transversely left
portion can and right from the
adjust in shape anterior
What is fontanelle
MOLDING? Lambdoidal
Typical diameters: Diameters of fetal head are
- the overlapping suture
Occipitofrontal – 11.5 cm shortened or lengthened as
of the cranial extends
Occipitomental – 13.5 cm the head is molded.
bones under transversely left Submentobregmatic &Sub- Fetal head is measured
pressure of the and right from the occipitobregmatic – 9.5 cm between the various
powers of labor &
posterior Biparietal – 9.25 cm landmarks.
demands of the
pelvis fontanelle Bitemporal – 8 cm
2. FETAL ATTITUDE AND FETAL LIE
Fetal Attitude Fetal Lie
- refers to the relation of the fetal parts to - refers to the relationship of the
one another cephalocaudal axis (spinal column) of the
- the degree of flexion a fetus assumes fetus to the cephalocaudal axis of the
during labor mother
- also known as the fetal position 1. Longitudinal Lie – occurs when the
What is the normal attitude of the fetus? cephalocaudal axis of the fetus is parallel
The fetus has moderate flexion of the to the woman
head, flexion of the arms onto the chest, 2. Transverse Lie – occurs when the
and flexion of the legs onto the abdomen. cephalocaudal axis of the fetus is at the
Normal Variations right angle to the woman’s spine
Longitudinal Lies are classified as cephalic,
breech (foot or buttocks as the first portion
to contact the cervix)
* Optimal attitude – fetus is in complete flexion which
helps in presenting the smallest anteroposterior
diameter of the skull
* Moderate attitude – fetus’ chin is not touching the
chest and is in a military position
* Partial extension – presents the “brow” of the head
to the birth canal
* Complete extension – fetus’ back is arched and the
neck is extended, presenting the occipitomental
diameter to the birth canal
3. Fetal Presentation – determined by fetal lie and the body part of the fetus that enters
the pelvic passage first (presenting part).
1. Cephalic presentation
- the fetal head presents itself to the
passage or the cervix
- 96% of term births (most frequent)
- labor and delivery are likely to proceed
normally
- 4 types:
1.1 The Vertex Presentation (ideal) Images of 4 Cephalic Presentations
- the fetal head is completely flexed onto the
chest
- suboccipitobregmatic presents to the
maternal pelvis
- occiput is the presenting part
1.2 The Military Presentation
- the fetal head is neither flexed nor
extended
- occipitofrontal diameter presents to the
maternal pelvis 1.4 The Face Presentation
- the top of the head is the presenting part - the fetal head is completely is extended
1.3 The Brow Presentation - the submentobregmatic diameter presents
- the fetal head is partially extended to the maternal pelvis
- occipitofrontal is presented to the maternal - the face is the presenting part
pelvis Why is the Vertex Presentation the most
- the sinciput is the presenting part ideal presenting part? Because the skull
bones are effective in molding to
accommodate the cervix.
2. Breech Presentation * A good attitude brings the fetal
- about 3% of birth knees up against the fetal abdomen
- classified according to the attitude of * A poor attitude means the knees and
the fetus hips and knees legs are extended
- sacrum is the landmark to be noted
If Complete Breech
- fetal knees and hips are both flexed
- the thighs are on the abdomen
- the calves are on posterior aspect
Shoulder Presentation
- fetal lie is Transverse Images of Shoulder Presentation
- presenting part:
the shoulders (Acromion process),
iliac crest, a hand or an elbow
- Causes:
* Horizontal space is greater than the
vertical space
* Placenta Previa (placenta is located
low in the uterus)
* relaxed abdominal walls (multipara)
4. FETAL POSITION – the relationship of the presenting part to a specific
quadrant and side of the pregnant person’s pelvis
Fetal landmarks:
O – occiput (vertex)
M – mentum (face)
Sa – sacrum (breech)
A – shoulder (transverse)
R – Right
L – Left
A – Anterior
P – Posterior
* Fetus is born faster from ENGAGEMENT Floating
an ROA/LOA position - refers to the settling of - a presenting part is not
* Labor is extended if the the presenting part of a engaged
position is ROP/LOP and fetus far enough into the
painful as its head puts pelvis that it rests at the Dipping
pressure on the sacral level of the ischial spines - part has descended but
nerves - degree is established has not reached the ischial
by a vaginal and cervical spines
examination
Station
Head Floating - refers to the relationship of
the presenting part of the
fetus to the level of the
ischial spines
- designated by centimeters
above or below the ischial
spines
If above the ischial
spines:
Minus stations:
-4/ -3 / -2 / -1
If at the level of
the ischial spines:
0 station/engaged
If below the ischial
spines:
+1 / +2 / +3 / +4
- presenting part is at
the perineum
What is “Crowning”?
The presentation part is
at the perineum and can
be seen if the vulva is
separated
