The Components of Labor

FOUR Ps
1. Passage (pelvis)
2. Passenger (fetus)
3. Powers (uterine factors)
4. Psyche (psychological state)

A. THE PASSAGE B. THE PASSENGER

= The passage refers to the route a fetus = The passenger is the fetus.
must travel from the uterus through the = The body part of the fetus that has the
cervix and vagina to the external perineum. widest diameter is the head, so this is the
part least likely to be able to pass through
the pelvic ring. Whether a fetal skull can pass
depends on both its structure (bones,
fontanelles, and suture lines) and its
alignment with the pelvis.

STRUCTURE OF THE FETAL SKULL

= CRANIUM, uppermost portion of the skull
= composed of 8 bones
= If the fetus is the cause of the - 4 superior bones => FRONTAL, 2
disproportion, it is often not because the fetal PARIETAL, OCCIPITAL (important in
head is too large but because it is presenting childbirth
to the birth canal at less than its narrowest - sphenoid
diameter. - Ethmoid
- 2 temporal bones
= FONTANELLE SPACES
PELVIC SHAPES - Compresses during birth to aid in
molding of the fetal head
- Palpate this during pelvic examination
to establish the position of the fetal
head & whether it is in a favorable
position for birth
DIAMETERS OF THE FETAL SKULL
● The smallest diameter of the fetal skull is
the biparietal diameter or the transverse
diameter, which measures about 9.25 cm.
● The smallest anteroposterior diameter is
the suboccipitobregmatic measurement
(approximately 9.5 cm) and is measured
from the inferior aspect of the occiput to
the center of the anterior fontanelle.
= The gynecoid pelvis is the most common
● The occipitofrontal diameter, measured
pelvis shape in females and is favorable for a
from the occipital prominence to the
vaginal birth. Other pelvis types, such as the
bridge of the nose, is approximately 12
android and platypelloid shapes, may lead to
cm.
a more difficult vaginal birth or the
● The occipitomental diameter, which is the
recommendation of a C-section.
widest anteroposterior diameter
(approximately 13.5 cm), is measured from
= But pelvis shape alone doesn’t determine
how you give birth. Other factors, such as the the posterior fontanelle to the chin.
position of the baby or if you’re carrying MOLDING
multiples, could also lead to your doctor
= overlapping of skull bones along the suture
recommending a C-section.
lines, which causes a change in the shape of
the fetal skull to one long and narrow, a
shape that facilitates passage through the
rigid pelvis.
= caused by the force of uterine contractions
as the vertex of the head is pressed against
the not yet dilated cervix D. Fetal Position
= only lasts a day or two and will not be a
= relationship of the presenting part to a
permanent condition
specific quadrant and side of a woman’s
= NO MOLDING if breech or CS
pelvis.
● Vertex presentation, the occiput (O) is
FETAL PRESENTATION & POSITION the chosen point.
A. Fetal Attitude ● Face presentation, it is the chin (mentum
[M]).
= describes the degree of flexion a fetus
● Breech presentation, it is the sacrum
assumes during labor or the relation of the
(Sa).
fetal parts to each other
● Shoulder presentation, it is the scapula
or the acromion process (A).
= The first letter defines whether the
landmark is pointing to the mother’s right (R)
or left (L).
= The middle letter denotes the fetal
landmark (O for occiput, M for mentum, Sa for
sacrum, and A for acromion process).
= The last letter defines whether the
landmark points anteriorly (A), posteriorly (P),
or transversely (T).

B. Fetal Lie
= relationship between the long
(cephalocaudal) axis of the fetal body and the
long (cephalocaudal) axis of a woman’s body
= in other words, whether the fetus is lying in
a horizontal (transverse) or a vertical
(longitudinal) position.

C. Fetal Presentation
= denotes the body part that will first contact
the cervix or be born first and is determined
by the combination of fetal lie and the degree
of fetal flexion (attitude).
= cephalic, breech, shoulder

ENGAGEMENT
= refers to the settling of the presenting part
of a fetus far enough into the pelvis that it
rests at the level of the ischial spines, the
midpoint of the pelvis.
● A presenting part that is not engaged is which causes cervical dilatation and then
said to be “floating.” expulsion of the fetus from the uterus.
● One that is descending but has not yet
reached the ischial spines may be Uterine contractions
referred to as “dipping.”
= Tightening and shortening of the uterine
muscles. During labor, contractions
STATION accomplish two things, they cause the cervix
= refers to the relationship of the presenting to thin and dilate (open) and they help the
part of the fetus to the level of the ischial baby to descend into the birth canal.
spines

Phases
Mechanisms (Cardinal Movements) = contraction consists of three phases:
of Labor ● INCREMENT- intensity of the
= descent, flexion, internal rotation, extension, contraction increases.
external rotation, and expulsion ● ACME- contraction at its strongest.
● DECREMENT- intensity decreases.
Contour Changes
= as labor contractions progress and become
regular and string, the uterus gradually
differentiates itself into two distinct
functioning areas:
● UPPER PORTION- thickens
● LOWER SEGMENT- becomes thin-
walled, supple, and passive so the
fetus can be pushed out of the
uterus easily.
Cervical Changes
= even more marked than the changes in the
body of the uterus are two changes that
occur in the cervix:
● EFFACEMENT
= shortening and thinning of the cervical
canal. The canal is approximately 2.5 to 5
cm long.
● DILATATION
= enlargement or widening of the cervical
canal
= uterine contractions gradually increases
the diameter of the cervical canal lumen
by pulling the cervix up over the presenting
part of the fetus.

D. THE PSYCHE
C. THE POWERS OF LABOR = The fourth “P,” or a woman’s psychological
= force supplied by the fundus of the uterus outlook, refers to the psychological state or
and implemented by uterine contractions, feelings a woman brings into labor.
= Women who manage best in labor typically descends into the vaginal canal with or
are those who have a strong sense of self- without maternal pushing efforts.
esteem and a meaningful support person with = The median duration is 40-60 minutes for
them. nulliparous and 20-30 minutes for multiparas.
= Women without adequate support can have
a labor experience so frightening and
stressful that they develop symptoms of
C. THIRD STAGE
posttraumatic stress disorder (PTSD) = The third stage of labor, the placental
stage, begins with the birth of the infant and

STAGES OF LABOR
ends with the delivery of the placenta.
= Two separate phases are involved:
- placental separation
FIRST STAGE OF LABOR
- placental expulsion.
= begins with the initiation of true labor
contractions and ends when the cervix is fully placental separation
dilated = As the uterus contracts down on an almost
SECOND STAGE OF LABOR empty interior, there is such a disproportion
= full dilatation until the infant is born between the placenta and the contracting
THIRD STAGE OF LABOR wall of the uterus that folding and separation
= lasting from the time the infant is born until of the placenta occur.
after the delivery of the placenta = Active bleeding on the maternal surface of
FOURTH STAGE OF LABOR the placenta begins with separation, which
= the postpartum period. helps to separate the placenta still further by
pushing it away from its attachment site. As
separation is completed, the placenta sinks to
A. FIRST STAGE the lower uterine segment or the upper
vagina.
1. Latent Phase
placental expulsion
= begins at the onset of regularly perceived
= Once separation has occurred, the placenta
uterine contractions and ends when rapid
delivers either by the natural bearing-down
cervical dilatation begins.
effort of the mother or by gentle pressure on
= Contractions during this phase are mild and
the contracted uterine fundus by the primary
short, lasting 20 to 40 seconds.
= Cervical effacement occurs, and the cervix healthcare provider (a Credé maneuver).
dilates minimally = Pressure should never be applied to a
uterus in a non contracted state because
2. Active Phase doing so could cause the uterus to evert (turn
= cervical dilations occur more rapidly. inside out), accompanied by massive
= Contractions grow stronger, lasting 40 to 60 hemorrhage. If the placenta does not deliver
seconds, and occur approximately every 3 to spontaneously, it can be removed manually
5 minutes.
= show (increased vaginal secretions) and
perhaps spontaneous rupture of the D. FOURTH STAGE
membrane may occur during this time. = It is the first hour or two after the delivery.
3. Transition Phase From the delivery of the placenta to
= contractions reach their peak of intensity, stabilization of the patient’s condition, usually
occurring every 2 to 3 minutes with a at about 2-6 hours postpartum
duration of 60 to 70 seconds.
= maximum cervical dilatation of 8 to 10 cm
occurs.
= by the end of this phase, both full dilatation
(10 cm) and complete cervical effacement
(obliteration of the cervix) have occurred.

B. SECOND STAGE
= The second stage of labor is the time from
full cervical dilatation to birth of the newborn.
After cervical dilation is complete, the fetus