LABOR & DELIVERY Prof. Unn Hidle Updated Spring 2010Suggested audio-visual material:Suggested Websites:Critical factors in labor & birthThe Birth PassagePelvic TypesThe FetusFetal headPowerPoint PresentationFontanellesFontanelleSlide 12Fetal attitudeSlide 14Fetal LieFetal lie? Attitude?Fetal lie? Attitude?Slide 18Fetal PresentationExamples of presentationsCephalic Presentation includes all of the following:Breech PresentationSlide 23Shoulder PresentationFunctional relationships of presenting part and passageEngagementStationSlide 28Slide 29Slide 30Slide 31Fetal PositionSlide 33Slide 34Slide 35Slide 36A few examplesSlide 38Slide 39Slide 40How can nurses benefit from this knowledge?Leopold’s maneuversLeopold’s ManeuverFETAL MONITORFetal Heart Rate monitoringPlacement of FHR monitorAssisting with external version of fetusElectronic monitoring of contractionsFetal Heart Rate MonitoringSlide 50Fetal TachycardiaFetal BradycardiaCauses of fetal tachycardiaCauses of Fetal BradycardiaVariabilityThere are two types of variability:Slide 57Slide 58Causes of decreased variabilityCauses of increased variabilityAccelerationFHR AccelerationsDecelerationEarly decelerationsSlide 65Late decelerationsVariable decelerationsSlide 68Possible nursing interventionsTHE END!LABOR & DELIVERYLABOR & DELIVERYProf. Unn HidleProf. Unn HidleUpdated Spring 2010Updated Spring 2010Suggested audio-visual material:Suggested audio-visual material:Leopold’s Maneuver (Video)Leopold’s Maneuver (Video)Labor and Delivery: the LDR – Normal Labor and Delivery: the LDR – Normal Vaginal Delivery (Video)Vaginal Delivery (Video)C-section (Video)C-section (Video)Electronic Fetal Monitoring (Video)Electronic Fetal Monitoring (Video)Suggested Websites:Suggested Websites:International Cesarean Action Network (for International Cesarean Action Network (for information of c-sections, VBACs, etc.):information of c-sections, VBACs, etc.):http://www.ican-online.orghttp://www.ican-online.orgTo correct fetal positioning at home:To correct fetal positioning at home:http://www.spinningbabies.comhttp://www.spinningbabies.comChoices in Childbirth (this site has a lot of Choices in Childbirth (this site has a lot of statistical information on NY state hospitals statistical information on NY state hospitals obstetrical interventions):obstetrical interventions):http://www.choicesinchildbirth.orghttp://www.choicesinchildbirth.orgCritical factors in labor & birthCritical factors in labor & birthThe passageThe passageThe fetusThe fetusThe relationship between the passage and The relationship between the passage and the fetusthe fetusThe forces of laborThe forces of laborThe psychosocial considerationThe psychosocial considerationThe Birth PassageThe Birth PassageThe true pelvis is divided into 3 sections:The true pelvis is divided into 3 sections:- the - the inletinlet, the , the pelvic cavitypelvic cavity (midpelvis), and (midpelvis), and the the outletoutletThe four classic types of pelvis are: The four classic types of pelvis are: gynecoid, android, anthropoid and platypelloidgynecoid, android, anthropoid and platypelloid.. The gynecoid, or female, pelvis is most common The gynecoid, or female, pelvis is most common Size of the pelvis:Size of the pelvis:Diameters of the pelvic inlet, midpelvis or pelvic Diameters of the pelvic inlet, midpelvis or pelvic cavity, and outletcavity, and outletAbility of the cervix to dilate and effaceAbility of the cervix to dilate and effacePelvic TypesPelvic TypesThe Fetus The Fetus Fetal head (size and presence of Fetal head (size and presence of molding)molding)Fetal attitudeFetal attitudeFetal lieFetal lieFetal presentationFetal presentationPlacenta (implantation site)Placenta (implantation site)Fetal headFetal headThe fetal skull or cranium consists of the face, the base The fetal skull or cranium consists of the face, the base of the skull and the vault of the cranium or roof.of the skull and the vault of the cranium or roof.The bones of the face and cranial base are well fused The bones of the face and cranial base are well fused and essentially fixedand essentially fixedMoldingMolding refers to the cranial bones overlapping under refers to the cranial bones overlapping under pressure during laborpressure during laborSuturesSutures of the fetal skull are membranous spaces of the fetal skull are membranous spaces between the cranial bones. between the cranial bones. FontanellesFontanelles are the intersections of the cranial sutures. are the intersections of the cranial sutures. These sutures allow for molding of the fetal head. These sutures allow for molding of the fetal head.FontanellesFontanellesThe The anterior fontanelleanterior fontanelle is diamond is diamond shaped and measures about 2-3cm. It shaped and measures about 2-3cm. It permits growth of the brain by remaining permits growth of the brain by remaining unossified for as long as 18 months.unossified for as long as 18 months.The The posterior fontanelleposterior fontanelle is much smaller is much smaller and closes within 8-12 weeks after birthand closes within 8-12 weeks after birthFontanelleFontanelleFetal attitudeFetal attitudeFetal attitude is the relation of the Fetal attitude is the relation of the fetal parts to one another. fetal parts to one another. The normal attitude of the fetus is The normal attitude of the fetus is one of moderate flexion of the head, one of moderate flexion of the head, flexion of the arms onto the chest, flexion of the arms onto the chest, and flexion of the legs onto the and flexion of the legs onto the abdomenabdomenFetal LieFetal LieFetal lie refers to the relationship of the Fetal lie refers to the relationship of the cephalocaudal (spinal column) axis of the fetus cephalocaudal (spinal column) axis of the fetus to the cephalocaudal axis of the woman.to the cephalocaudal axis of the woman.A A longitudinal lielongitudinal lie occurs when the occurs when the cephalocaudal axis of the fetus is parallel to cephalocaudal axis of the fetus is parallel to the woman’s spinethe woman’s spineA A transverse lietransverse lie occurs when the occurs when the cephalocaudal axis of the fetus is at a right cephalocaudal axis of the fetus is at a right angle to the woman’s spineangle to the woman’s spineFetal lie? Attitude?Fetal lie? Attitude?Fetal lie? Attitude?Fetal lie? Attitude?Fetal lie?