06.01 Process of Labor

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Overview

  1. The process of labor is comprised of both mom and fetus working together to have a successful delivery

Nursing Points

General

  1. Mom’s part in the process (4 P’s)
    1. Powers
    2. Passageway
    3. Passenger
    4. Psyche
  2. Baby’s part in the process (ALPPPS)
    1. Attitude
    2. Lie
    3. Presentation
    4. Presenting part
      1. Occiput (what we want)
      2. Scapula
      3. Mentum
      4. Fetal butt
      5. Leg, hand
    5. Position
      1. Right or left, presenting part, anterior or posterior
    6. Station
      1. Where the presenting part is located

Assessment

Mom’s part in the process → 4P’s: the 4P’s all work together and essential to facilitate a safe and successful delivery

  1. Powers
    1. Voluntary – pushing
    2. Involuntary – contractions
  2. Passageway
    1. The pathway the baby takes out of the mother’s body
    2. How much room?
  3. Essentially, the pelvis and related structures
    1. Passenger
    2. BABY!
  4. Placenta
  5. Psyche
    1. Mom’s emotional state
      1. Supportive, therapeutic environment will facilitate a smoother labor
      2. Fearful, angry, tense emotions will make labor much more

Baby’s part in the process → ALPPPS

  1. Attitude: relationship of fetal head position to maternal spine
    1. Flexion: normal attitude, head flexed down with chin to chest
    2. Extension: abnormal attitude, less commonly seen, head extended back
  2. Lie:  relationship of fetal spine to maternal spine
    1. Longitudinal / vertical: normal lie, both spines parallel
    2. Transverse: both spines form cross, c-section required
  3. Presentation:  This term is used to describe the way the baby is positioned while coming down the birth canal
    1. Which part is leading the way?
    2. Cephalic:  head
      1. Vertex: most common, head fully flexed down
      2. Brow:  head tipped back slightly, “eyebrows first”
      3. Face:  head tipped back fully, full face first
    3. Breech:  butt
      1. Frank: most common, hips flexed, knees extended
      2. Full / complete: both knees bent, bottom of feet closest to birth canal, cross-legged appearance
      3. Footling: when a foot presents first
    4. Shoulder: shoulder, side, arm, back abdomen
  4. Presenting part:  This term is used to describe which part of the baby will lead the way out of the birth canal
    1. Head, shoulder, side, foot, abdomen, etc.
  5. Position:  This term is used to describe the position of the baby in relation to mom’s pelvis  
    1. Must know landmark
      1. Occiput (most common, back of the head)- “O”
      2. Scapula- “Sc”
      3. Sacrum- “S”
      4. Mentum-”M”
    2. Look at where the landmark is in relation to mom’s pelvis
      1. Right vs. left
      2. Anterior vs. posterior
    3. 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
      1. ie:ROA
        1. Occiput is facing right side of pelvis and is towards the front of the pelvis
      2. Ie: LOA
        1. Occiput is facing the left side of pelvis and is anterior (towards the front)
  6. Station:  how far down the baby is in the birth canal in relation to mom’s ischial spine
    1. Mom’s ischial spine is the narrowest part of her pelvis, so when the baby is there, they are at 0 station
    2. Negative numbers mean the baby is farther inside/up (-1,-2,-3)
    3. Positive numbers mean the baby is farther out/closer to delivery (+1,+2,+3)
    4. Measured in centimeters

Therapeutic Management

  1. Help mother through labor process
    1. Focusing her powers
    2. Positioning
    3. Psyche
    4. Medications
      1. pitocin

Nursing Concepts

  1. Reproduction
  2. Comfort

Patient Education

  1. How to focus energy
    1. Into pelvis when pushing
    2. Conserve energy during labor
  2. How to push effectively
    1. Deep breath in, hold and push like they are having a bowel movement  for 10 seconds with each contraction
    2. Only push with contractions
      1. Increases the power

Reference Links

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Video Transcript

In this lesson I will be explaining the process of labor and your role in assisting this patient in the process.
In the process of labor mom and fetus work individually to be successful but also the effort is joint. Mom has a role and fetus plays a part in it too. So the mother’s role is known as the 4 P’s. This is powers, passageway, passenger, and psyche. The fetal role in the process is known as ALPPPS. This is attitude, lie, presentation, position, presenting part, and station. Each of these will be part of the assessment during labor so let’s look at that.

First our maternal assessment. We will be assessing our 4 Ps that were just mentioned. Our first is powers. Powers can be either voluntary or Involuntary. Voluntary are things that the mother has control over. This is her pushing for delivery. Involuntary are the things the mother can not control and this is contractions. Both contractions and pushing will be the “power” to deliver the baby. The passageway is the pathway the baby takes out of the mother’s body. So how much room is there? This is going to really be the pelvis and related structures. The passenger is the baby and the placenta. The last “P” is the psyche. It is her emotional state. If the mother feels supported and believes she can do it then it will facilitate a smoother labor. If she is fearful and tense then it will make labor much more difficult.

Now onto the fetal assessment. So remember ALPPPS. Attitude is the positioning of the fetal head. It is either in flexion or extension. Flexion is the normal and means the head is flexed down with chin to chest. Extension is when the head is extended back and is far less common, thankfully because it is not a good position for delivery. We want that head flexed with chin to chest to more easily get itself out. Lie is the relationship of the fetal spine to maternal spine. Longitudinal or vertica is expected and means both spines are parallel. Transverse is when both spines form cross and a c-section would be required. Presentation describes the way the baby is positioned while coming down the birth canal. What is the position of the presenting part? Which part is leading the way? Cephalic is head, breech is butt first, shoulder is the scapula or arm. The presenting part describes which part of the baby will lead the way out of the birth canal. It is going to be the head, shoulder, side, foot, abdomen? What is the presenting part?

Position is the term is used to describe the position of the baby in relation to mom’s pelvis. So first we have to assess what the presenting part is. So we will label this as “O” if it is the occiput, which is the most common and is the back of the head. Remember the head should be flexed with chin to chest so the occiput would be the presenting part. If it was the scapula then it is labeled as “Sc”. Sacrum is labeled“S” and the chin or mentum is labeled as”M”. Let’s use “O” the occiput for example. Then which way is it facing? In this image look at the presenting part. It Is the occiput. Which way is it facing? Is it towards the mother’s left pelvis or right side? So it’s left. So we label that as “L”. Next we need to know if it is anterior or posterior. The baby is towards the front of the pelvis then this is labeled as anterior. So this baby would be LOA. The station refers to how far down the baby is in the birth canal in relation to mom’s ischial spine. On cervical exam the mother’s ischial spines can be located. If the baby is at the ischial spines then it is at 0 station. If the baby is farther up then it is measured in centimeters and is either -1,-2,-3. As the fetus gets closer to delivery it is measured as positive. Think of it as a go thing that the baby is closer to deliver so it is a plus or positive so +1,+2,+3.

Therapeutic management will revolve around helping the mother through the labor process. We can help her in focusing her powers, repositioning for comfort, and psyche. We can help coach and encourage her to improve the psyche. Other management will involve medications that could help to move the labor process along. Medications such as pitocin will help increase contractions so that can help with the powers in the process.

Education is needed on how to focus energy. This will involve focusing energy into the pelvis when pushing as well as conserving energy during labor so she has energy to push well. She needs to be educated on how to push effectively. The patient should take a deep breath in, hold and push like they are having a bowel movement for 10 seconds with each contraction. She should also only push with contractions because this will increase the power.
The key points to just review are the maternal pieces for the process of labor. So the 4 P’s. This is powers, passageway, passenger, and psyche. The fetal role in the process is known as ALPPPS. This is attitude, presentation, lie, presenting part, and station.They each play individual roles in the labor process. These roles will unite to make them successful together.

Make sure you check out the resources attached to this lesson and review stations and presentation because these are big test questions. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 8

A fetus is being born head first, with the occiput facing the right side of the mother’s pelvis, towards the back. What is the fetal presentation?

  • Question 2 of 8

A nurse receives bedside report on a laboring client that the fetus is at -2 station and transverse. The mother asks what this means. What is the best explanation by the nurse?

  • Question 3 of 8

A nurse performs a pelvic exam on a laboring mother. Findings are that the client is 5 cm and at zero station. What does this mean for the fetus?

  • Question 4 of 8

A client who is 39 weeks’ gestation comes into the hospital and tells the nurse that she thinks she is in labor. The nurse assesses the client and determines that she is in the first stage of labor. Which of the following are associated with this stage of labor? Select all that apply.

  • Question 5 of 8

A nurse is helping a laboring mother to figure out how to focus her energy and pushing efforts during labor. Which of the following pieces of advice would be most beneficial to the client? Select all that apply.

  • Question 6 of 8

A nurse is utilizing effleurage as part of non-pharmacological pain management for a client in labor. Which describes the techniques of effleurage? Select all that apply.

  • Question 7 of 8

A nurse is teaching a class on labor to pregnant clients. The nurse is explaining the role(s) the mother plays in the process of labor. Which of the following should be included? Select all that apply.

  • Question 8 of 8

The nurse is working in an OB clinic. Which of the following client statements is the MOST concerning?

Module 0 – OB Course Introduction

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