Maternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & Families

Susan Ward

Shelton Hisley

Chapter 12--Processes &

Stages of Labor and Birth

Critical Factors

In Labor

The Four P’s: passage, passenger, powers & psyche

Passage: adequate pelvis?

cephalopelvic disproportion (CPD)

Suspect if presenting part does not engage in pelvis (0 station)

Passenger

The fetus: head is largest diameter Fetal head: 4 bones with 3 membranous

interspaces (sutures) that allow bones to move & overlap to diminish size of skull

Molding: head becomes narrower, longer, sutures can overlap--normal--resolves 1-2 days after birth

Fontanelles: at junctures of skull bones

Passenger

Fetus and fetal membranes

Molding of head

Fetal lie

Longitudinal

Transverse

Oblique

Fetal Lie

and Presentation

Leopold's maneuvers/US

Longitudinal lie: Vertical

Presenting part:

cephalic (head),

vertex (occiput), chin (mentum)

breech (buttocks or feet) (c-section)

sacrum

Transverse lie: Horizontal (c-section)

Presenting part: shoulder (acromion)

Passenger (cont.)

Fetal attitude—flexion

Fetal presentation

Cephalic

Vertex

Military

Brow

Face

Fetal Attitude

Advantages of

Cephalic Presentations

Head usually largest part of infant

Molding

Optimal shape—smooth and round

Assessment: FHT heard high on the abdomen,

Leopold’s, vaginal exam & US. Higher risk of anoxia from prolapsed cord, traumatic

injury to the after coming head,

fracture of spine or arm,

dysfunctional labor

Usually delivered by

C-section

Breech presentation