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Labor- series of events by which abdominal pressure
and uterine contraction expels the fetus and placenta
outside the woman’s body
The process of fetal expulsion along with the products of
conception secondary to regular, progressive and
frequently occurring uterine contractions
THEORIES OF LABOR
Prostaglandin is release due to stretching of uterine
muscle from increasing size of fetus.
Oxytocin is release from the posterior pituitary when the
fetus presses on the cervix
The release of oxytocin and prostaglandin stimulates the
uterus to contract /begin labor
Labor begins when progesterone withdraws/falls while
estrogen increases.
Fetal membrane begins to produce prostaglandin that
stimulates contraction.
PRELIMINARY SIGNS OF LABOR
1. lightening- settling or descent of the fetal presenting part into the
brim of the pelvis.
2. Increased level of activity- due to increase release of epinephrine
initiated by decrease of progesterone.
3. Increase Braxton Hick’s contraction
4. Ripening of the cervix
5. Bloody show-pinkish vaginal discharge ( mucus that plug the cervix
during pregnancy )
6. Rupture of membrane
7. Uterine contractions- regular, effective, productive and involuntary
COMPONENTS OF LABOR
1, passage- pelvis of mother should be adequate and the
contour
2. passenger- fetus should be of appropriate size normal
position and presentation
3. powers- uterine functions
4. Psychological response of the mother- should have
positive outlook
PASSAGE- REFERS TO THE ROUTE A FETUS MUST TRAVEL
FROM UTERUS THROUGH THE CERVIX, VAGINA TO EXTERNAL
PERINEUM.

Two important diameter of the pelvis;

1. Diagonal conjugate- anteroposterior diameter of
the inlet.( posterior surface of symphysis and
anterior surface of sacral promontory ) Ave. 10.5 to
11 cm.
2. Transverse diameter of the outlet – narrowest
diameter of the outlet.
PELVIS / PELVIC BONE
Types of pelvis.
1. Gynecoid- female pelvis has an inlet that is rounded forward and
backward and has a wide pubic arch.
2. Anthropoid ape-like pelvis, transverse diameter is narrow, the
anteroposterion diameter of the inlet is larger than usual. Brim is
oval shape.
3. Android – male pelvis, pubic arch forms an acute angle , making
the lower dimensions of the pelvis extremely narrow. Heart shape
4. Platypelloid pelvis –flat or flattened, anteroposterior diameter is
shallow, transverse is wide
PELVIC DIVISION
 False pelvis –shallow upper basin of the pelvis,
supports the enlarging uterus but not important
obstetrically.
 True pelvis- consist of the pelvic inlet , pelvic cavity
and pelvic outlet.
 Linea terminalis – plane dividing the upper and
lower pelvis
PELVIC MEASUREMENT
1. True conjugate- from upper margin of symphysis pubis to sacral
promontory, measurement 11 cm. obtained by xray, ultrasound
2. Diagonal conjugate – lower border of symphysis pubis to sacral
promontory , measurement 12.5 to 13 cm.
3. Obstetric conjugate – inner surface of symphysis pubis to slightly
below upper border to sacral promontory ( most important
pelvic measurement ) estimated subtract 1.5 to 2 cm from
diagonal conjugate.
4. Intertuberous diameter – measures the outlet between the inner
border to ischial tuberosities, should be at least 8 cm
PASSENGER – FETUS ( FETAL SIZE, PRESENTATION ,
POSITION ATTITUDE, LIE )
Fetal head – cranium, composed of 8 bones.
Most important bones:
 Frontal bones - two fused bones
 Parietal bones -2
 Occipital bone - back
 Others bones of the skull are –sphenoid , ethmoid
and 2 temporal bones
SUTURES OF THE CRANIUM.
Sagittal suture- joins the two parietal bones , top of skull
Coronal suture – junction between the frontal bone and two
parietal bones.
Lambdoidal suture – junction between the occipital bone and two
parietal bones.
Bones of the skull are joined by membranous sutures, which allow
for overlapping or molding of cranial bones during birth
process.
Molding is caused by force of uterine contractions as the vertex of
the head is pressed against the undilated cervix.
FONTANELS- USED AS LANDMARK FOR INTERNAL
EXAM DURING LABOR TO DETERMINE POSITION OF
FETUS.
Anterior fontanel - larger, diamond shape or kite, joined by
sagittal , coronal and frontal suture s, closes at 18 months of
age.
another term for anterior fontanel is Bregma.
Posterior fontanel – smaller , triangle in shape, joined by sagittal
and lambdoidal suture. Closes at 3 months of age.
PRESENTATION -PART OF FETUS WHICH ENTER THE PELVIS
IN BIRTH PROCESS.
Types of presentation
1. Cephalic – head is the presenting part
vertex – occiput is the presenting part , normal
brow – forehead
face- chin
2. Breech – sacrum or buttocks or feet
complete or full breech- thighs and legs flexed, buttocks and
feet presenting part
frank breech- thighs flexed legs extended on the anterior body
buttock presenting
footling breech- maybe single or double footling , feet are presenting
3. Shoulder presentation – baby is in horizontal . Transverse position acromion
process (shoulder ) the presenting part
ATTITUDE – degree of flexion a fetus assumes during labor or relation of fetal
parts to each other.
>Fully flexed- the spinal column is bowed forward , head is flexed chin almost
touching the chest ( sternum ), thighs flexed onto the abdomen. vertex
presentation
> Moderate flexion or partial extension- chin is not touching the chest ,
military position. Brow presentation
>Complete extension – the back is arched and the neck extended.
face presentation.
Four parts of the fetus as landmark in relation to fetal
presentation
>vertex – occiput
>face - mentum or chin
 Breech - sacrum
> Shoulder – scapula or acromion process
LIE –THE RELATIONSHIP OF THE LONG AXIS OF THE FETUS
SPINAL COLUMN TO LONG AXIS OF THE MOTHER’S BODY.

 Longitudinal – cephalocaudal axis of the fetus is parallel to the

woman’s spine. ( Cephalic or vertex and breech )
 > Transverse – cephalocaudal axis of the feal spine is in right angle
to the woman’s spine. ( shoulder presentation )

FETAL POSITION – relationship of the fetal part to a specific

quadrants of the woman’s pelvis.
R- right O- occiput P-posterior
L- left A- anterior T- transverse
a. LOA- fetal occiput is on maternal left side and towards front,
face is down. Favorable delivery position.
b. ROA – occiput is on maternal right side ( same as LOA)
c. LOP- fetal occiput is on maternal left side towards back, face
up. Mother experience much back pain, labor is slowed
d. ROP- fetal occiput is on maternal right side ( same as LOP )
e. LOT-fetal occiput is transverse left side of pelvis
f. ROT- fetal occiput is transverse right side of maternal pelvis
DIAMETERS OF THE FETAL SKULL
Biparietal diameter- smallest diameter of the fetal skull or
the transverse diameter. About 9.25 cm.
Suboccipitobregmatic – smallest anteroposterior diameter,
measured from inferior aspect of occiput to anterior
fontanel. About 9.5 cm.
Occipitofrontal diameter- measured from the occipital
prominence to the bridge of the nose. About 12 cm
Occipitomental- widest anteroposterior diameter, measured
from posterior fontanel to the chin, about 13,5 cm.
Engagement – refers to the settling of the presenting
part of the fetus into the pelvis at the level of the
ischial spine, the midpoint of the pelvis.
Floating – when the presenting part is not yet engaged
or above the inlet .
Dipping – when the presenting part is descending but
has not reached the ischial spine
STATION-
Relationship of the presenting part of fetus to the level of
ischial spine of the pelvis.
Presenting part at the level of ischial spine = 0 station
When presenting part is above the spine it is measured as
minus ( -1 to -4cm.
When presenting part is below the ischial spine it is
measured as + 1 to +4 cm.
+3 or +4 presenting part is at the perineum or seen at the
vulva called crowning.
POWER-ABILITY OF THE UTERUS TO CONTRACT ( INVOLUNTARY )
Primary force – ability of the uterus to expel fetus and
placenta
Secondary force – ability of the mother to push or bear
down.
Frequency – timed from beginning of uterine contraction to
the beginning of the next contraction.
Duration – length of contraction, timed from the beginning
of contraction to the end.
Intensity – strength of contraction
VOLUNTARY BEARING DOWN EFFORT
 After full dilation of the cervix, the mother is advice
to push using abdominal muscles to help expel the
fetus
 These effort is similar to defecation
 Contraction of levator ani muscles
DIFFERENCES BETWEEN TRUE & FALSE LABOR
TRUE LABOR FALSE LABOR
Contraction-regular,I ncreases frequency contraction-irregular, no increase in
intensity and duration frequency and intensity
Intervals – becoming shorter between intervals between contraction is
longer
contraction
Pain- back radiates to abdomen not pain lower abdomen, walking has no
relieve by walking effect
Bloody show present no bloody show
With effacement and dilatation, fetal no dilatation and effacement
descent progresses
PSYCHOLOGICAL RESPONSE
 A woman who is relaxed , aware and participating in
the birth process usually have shorter , less intense
labor.
 Whereas, a woman who is fearful has high level of
adrenaline ( epinephrine ) and nonepinephrine -
hormones cathecholamines from the nerve endings ,
brain and adrenal glands which later slow uterine
contractions.
STAGES OF LABOR
1. First stage – dilatation stage , from true labor pains
up to complete dilatation of cervix ( 10 cm )
2. Second stage – expulsion stage, delivery of the baby
3. Third stage – placental stage , delivery / expulsion of
placenta
4. Fourth stage – recovery stage
CARE OF WOMAN DURING THE FIRST STAGE OF
LABOR
>labor should begin on its own not induced
>can still move freely throughout labor
>continuous caring support from the nurse during labor
>normally no interventions done like IV except when needed
 Position of woman- upright or side lying
 After delivery mother and baby should be housed together for
unlimited breast feeding