NCMC 107 REVIEWER II she is too young to get

pregnant; a woman in the

FERTILIZATION AND CONTRACEPTION immediate postpartum period may
believe she cannot conceive
REPRODUCTIVE PLANNING immediately, especially if she
An ideal contraceptive should is breastfeeding)
be:
• Safe • Sexual practices, such as
• Effective frequency, number of partners,
• Compatible with spiritual and feelings about sex, and body
cultural beliefs and personal image.
preferences of both the user
and sexual partner NATURAL FAMILY PLANNING
• Free of bothersome side
effects • Convenient to use and • Also called periodic
easily obtainable abstinence method
• Affordable and needing few • No chemical is introduced in
instructions for effective use to the body
• Free of effects (after • The effectiveness of these
discontinuation) on future methods varies greatly from a
pregnancies 2% ideal failure rate to about
a 25% failure rate,depending
Before a patient begins using a mainly on the couple’s ability
new method of contraception, to refrain from having sexual
information that should be relations on fertile days or
obtained includes: days in which a woman is most
likely to become pregnant
● Vital signs
Pap smear, pregnancy test • ABSTINENCE
gonococcal and chlamydial • Periodic abstinence
screening, and perhaps • LACTATION AMENORRHEA METHOD
hemoglobin for detection of (LAM)
anemia • COITUS INTERRUPTUS
(withdrawal)
● Obstetric history • Post coital douching
STIs, past pregnancies, previous • FERTILITY AWARENESS METHOD
elective abortions, failure of • Calendar (Rhythm) Method
previously used methods, and • BASAL BODY TEMPERATURE
compliance history with • Cervical Mucus Method
previously used methods (Billing’s Method)
• Symptothermal Method
● Subjective assessment • Standard Days Method:
of the patient’s desires, needs, CycleBeads
feelings, and understanding of
conception (a teen may believe

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• No side effects. because they might further
• no effect if a woman should irritate the cervix.
get pregnant while using them
as well as no effect on future • Male and Female Condoms
pregnancies *There are no
• coitus interruptus may be contraindications to the use of
unenjoyable because of the need either male or female condoms
to withdraw before ejaculation. except for sensitivity or
• Perimenopausal women are good allergy to latex.
candidates for natural family
planning methods because they • Diaphragms and Cervical Caps
may not be able to use hormonal • may not be effective if a
methods such as birth control uterus is prolapsed,retroflexed,
pills or anteflexed to such a degree
• Postpartal women are good the cervix is also displaced in
candidates for natural family relation to the vagina.
planning.
Other contraindications
BARRIER METHODS OF CONTRACEPTION include:
birth control that place a • History of toxic shock
chemical or latex barrier syndrome (TSS; a staphylococcal
between the cervix and advancing infection introduced through
sperm so sperm cannot reach and the vagina)
fertilize an ovum • Allergy to rubber or
spermicides
• Spermicides • History of recurrent
advantages of spermicides UTIs
include:
• purchased without a contraindicated in any woman
prescription, allow for greater who has:
independence and lower costs An abnormally short or long
• conjunction with another cervix
contraceptive, they increase the • A current abnormal Pap smear
other method’s effectiveness. • A history of TSS
• Various preparations: • An allergy to latex or
gels, creams, sponges, films, spermicide
foams, and vaginal • A history of cervicitis or
suppositories cervical infection
• A history of cervical cancer
• Undiagnosed vaginal bleeding
Side Effects and • may not be as effective in
Contraindications: parous women as they are for
Vaginally inserted spermicidal those who have never had
products are contraindicated in children because the cervix
women with acute cervicitis

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does not conform as well to a • Iron deficiency anemia because
thimble shape after childbirth. of the reduced amount of
menstrual flow
SUBDERMAL HORMONE IMPLANTS • Acute pelvic inflammatory
• Contraceptive implants are a disease (PID) and resulting
long-term birth control. A tubal scarring
contraceptive implant is a • Endometrial and ovarian
flexible plastic rod about the cancer, ovarian cysts, and
size of a matchstick that is ectopic pregnancies
placed under the skin of the • Fibrocystic breast disease
upper arm. • Possibly osteoporosis,
• It releases a low, steady endometriosis, uterine myomata
dose of a progestational (fibroid uterine tumors), and
hormone to thicken cervical possibly rheumatoid arthritis
mucus and thin the lining of • Colon cancer
the uterus (endometrium) and
suppress ovulation as well. • Women can set a start date
• radio opaque and can be seen for a cycle of pills in one of
on X-rays four ways:
• Sunday start: first Sunday
• INTRAMUSCULAR INJECTIONS after the beginning of
• Intrauterine Devices menstrual flow.
• Quick start: as soon as they
HORMONAL CONTRACEPTION are prescribed.
• First day start: first day of
- as the name implies, hormones menses.
that when taken orally, • After childbirth, a woman
transdermally, intravaginally, should start the contraceptive
or intramuscularly, cause such on a day (or Sunday) closest to
fluctuations in a normal 2 weeks after birth; begin on a
menstrual cycle that ovulation chosen day or the first Sunday
or sperm transport does not • Because COCs are not
occur. effective for the first 7 days,
advise women to use a second
ORAL CONTRACEPTIVES form of contraception during
Benefits in addition to the initial 7 days that they
preventing pregnancy, such as take pills.
decreasing incidences of:
*
• Dysmenorrhea, because of lack
of ovulation Side Effects and
• Premenstrual dysphoric Contraindications of All Oral
syndrome and acne because of the Contraceptives
increased progesterone levels The main side effects women may
experience with COCs are:

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• Nausea • inserted vaginally and left
• Weight gain in place for 3 weeks and then
• Headache removed for 1 week with
• Breast tenderness menstrual bleeding occurring
• Breakthrough bleeding during the ring-free week
(spotting outside the menstrual
period) Surgical Methods of
• Monilial vaginal infections Reproductive Life Planning
• Mild hypertension
• Depression • VASECTOMY
• a small puncture wound
* (referred to as “no-scalpel
technique”) is madeon the
ESTROGEN/PROGESTERONE scrotum. The vas deferens on
TRANSDERMAL PATCH each side are then pulled
• refers to patches that slowly forward, cut and tied,
but continuously release a cauterized, or plugged,
combination of estrogen and blocking the passage of
progesterone spermatozoa
• Patches are applied each week
for 3 weeks. No patch is • TUBAL LIGATION
applied the fourth week. During
the week on which the woman is Essure procedure blocks the
patch free, a menstrual flow fallopian tubes by a coiled
will occur. spring introduced vaginally
• After the patch-free week, a
new cycle of 3 weeks on, 1 week FERTILIZATION
off begins again. union of the ovum and sperm
• The efficiency of transdermal • It is also termed conception,
patches is equal to COCs, fecundation, impregnation
although they may be less • occurs at the outer third of
effective in women who are the fallopian tube (ampulla)
obese. Because they contain
estrogen, they have the same SPERM TYPES
risk for thromboembolic
Androsperm Gynosperm
symptoms as COCs.
Carries Y-sex Carries X-sex
VAGINAL ESTROGEN/PROGESTIN chromosome chromosome
RINGS (NUVARING)
Fast-moving Slower
• An etonogestrel/ethinyl
estradiol vaginal ring Smaller, weaker, Bigger,
(NuvaRing) is a flexible short lived stronger, long
silicone vaginal ring, releases lived
a combination of estrogen and
progesterone Dies in acid Acid-resistant

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 • Decidua basalis – part of
Capacitation is a final process endometrium lying directly
that sperm must undergo to be under the embryo; future
ready for fertilization. placenta.
FERTILIZATION AND IMPLANTATION • Decidua Capsularis – portion
of the endometrium that
•Fertilization – union of ova stretches or encapsulates the
and sperm surface of the trophoblast;
•Implantation – contact between future amniotic sac.
the growing structure and • Decidua vera – the remaining
uterine endometrium portion of the uterine lining;
•Also called as Nidation not directly responsible for
•Usually happens on 8th -10th development of the fetus.
day following fertilization
EMBRYONIC AND FETAL GROWTH AND
DEVELOPMENT
1st Week of Site
Human STAGES OF HUMAN PRENATAL
Development DEVELOPMENT
Day 1 – Fallopian tube
Fertilization 1. First 12-14 days = zygote
2. From 15th day up to the 8th
Day 2 – 1st Fallopian tube week = embryo
cell division 3. From 8th week to the time of
(cleavage) - birth = fetus
Day 3 – Morula Fallopian tube
(ball of
cells) Formation and development of
the Embryonic and Fetal
Day 4 – Structures
Blastocyst

Day 8-10 – Uterus Formation of fetal membranes

Formation of
Trophoblast 1. Chorion – outside embryonic
cell - Uterus membrane that develops from the
(adhere to the trophoblast; contains the
endometrium)
chorionic villi at the surface.
Day 10 – Uterus
Implantation 2. Amnion – innermost membrane
that develops from the interior
cells of the blastocysts.
• Decidua – specialized
endometrium for implantation,
“falling off” Structure arising from amnion

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Amniotic fluid/ Bag of Water Structure arising from Chorion
(BOW)
• Clear albuminous fluid in •Chorionic Villi – projections
which the baby floats. of the trophoblast that produce
• Begins to form at 11-15 weeks human chorionic gonadotropin
gestation and begin osmosis of nutrients
• Alkaline in nature (pH to the embryo.
1.0-1.25) with specific gravity
of (1.007-1.025) Parts of Chorionic Villi
•Near term is clear, colorless,
containing little white specks •Central core – loose
of vernix caseossa and other connective tissue that contains
solid particles the fetal capillaries
•500ml-1000ml up to maximum of
1200ml •Syncytiotrophoblast/ syncytial
•Sources of are: amniotic cells, layer – outer layer of chorionic
fetal urine, and maternal serum. villi where production or
•Functions include: various placental hormones (HCG,
•Cushions somatomammotropin, human
•Equalize pressure placental lactogen, estrogen,
•Prevents adhesion and progesterone) during the first 2
umbilical cord compression months of gestation happen.
•fetal movement
•thermoregulation •Cytotrophoblast or Langerhan’s
•Oral source of fluid layer – inner layer of the
•Medium of excretion chorionic villi.

Umbilical Cord/ Funis •present as early as 12

•21-23 inches or 50-53cm long days of gestation.
with 2 ¾” thick.
•Has 1 vein (carrying blood •Protects the growing fetus
from the placental villi to the from certain infectious
fetus) and 2 arteries (carrying organisms such as
blood from the fetus back to spirochete of syphilis.
placental villi). AVA
•Approximately 350ml/min blood •Disappears between 20th
flow rate. and 24th week of
•Covered with gelatinous gestation.
mucopolysaccharide substance
called wharton’s jelly that • Placenta – rose from chorion
gives body to the cord and together with decidua basalis.
prevents pressure on the vein
and arteries. •function by the 4th week
of gestation

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 •independently functioning
organ by 14th week
• Acts a protective barrier
to some substances and
organisms like heparin and
bacteria, ineffective for
virus, alcohol, nicotine,
antibiotics, depressants
and stimulants. STAGES OF FETAL DEVELOPMENT
•Transmit nutrients and
oxygen to the fetus and TERMS USED TO DESCRIBE FETAL
removes waste and carbon GROWTH
dioxide by diffusion.
Ovum - from ovulation to
•The endocrine organ of fertilization
pregnancy Zygote from fertilization to
•Estrogen implantation
•Progesteron Embryo from implantation to 5–8
•Human Chorionic Gonadotropin weeks
•Human Placental Lactogen/ Fetus from 5–8 weeks until term
Human Chorionic Conceptus developing embryo and
Somatomammotropin placental structures throughout
pregnancy
Placental Mechanism Age of viability the earliest
•Diffusion – movement of age at which fetuses survive if
molecule from the area of higher they are born is generally
concentration to the area of accepted as 24 weeks or at the
lower concentration. point a fetus weighs more than
•Facilitated Diffusion - 500–600 g
placental crossing of some
substances that is more *
rapid and more easily that
requires less energy. EMBRYONIC AND FETAL STRUCTURES
(glucose)
•Active Transport – a process • DECIDUA - “falling off”. -
that requires energy and action -Discarded after birth. -
of enzyme to facilitate - -Endometrium
transport.
•Pinocytosis – absorption by the • CHORIONIC VILLI
cellular membrane of - Outer membrane
microdroplets of plasma and - Becomes vascularized and forms
dissolve substances. the fetal part of the placenta

EMBRYONIC AND FETAL STRUCTURES

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• AMNION - Encloses the
amniotic cavity
- Amniotic sac/BOW
- The inner membrane that forms
about the second week of
embryonic development
- Forms a fluid-filled sac that
surrounds the embryo and later FETAL CIRCULATION
the fetus
• UMBILICAL CORD
• AMNIOTIC FLUID - formed from the fetal
- 800 to 1200ml by the end of membranes, the amnion and
pregnancy chorion,
- Surrounds, cushions, and - provides a circulatory pathway
protects the fetus and allows that connects the embryo to the
for fetal movement chorionic villi of the placenta.
- Maintains the body temperature - transport oxygen and nutrients
of the fetus to the fetus from the placenta
- Contains fetal urine and is a and to return waste products
measure of fetal kidney from the fetus to the placenta.
function - about 53 cm (21 in.) in
- Is modified through the length at term and about 2 cm
process of swallowing, (0.75 in.) thick.
urinating and movement through - Wharton jelly, which gives
the respiratory tract the cord body and prevents
pressure on the vein and
• PLACENTA arteries that pass through it.
- Provides exchange of nutrients - AV
and waste products between the
fetus and the mother • FETAL HEART RATE (FHR)
- Begins to form at - Depends on gestational age
implantation; complete by week - 160 to 170 bpm in the 1st
12. trimester.
- Produces hormones to maintain - Slows down to 120 to 160 bpm
pregnancy near or at term.
- Passive immunity during 3rd - About twice the maternal heart
trimester. rate.

• FETAL CIRCULATION BYPASS

- Present because of
nonfunctioning lungs.
- Bypasses must close after
birth to allow blood to flow
through lungs and liver.

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• DUCTUS ARTERIOSUS connects the • Facial features are definitely
pulmonary artery to the aorta, discernible; arms and legs have
bypassing the lungs. developed.
• External genitalia are
• DUCTUS VENOSUS connects the forming, but sex is not yet
umbilical vein and the inferior distinguishable
vena cava, bypassing the liver. • The abdomen bulges forward
• FORAMEN OVALE is the opening because the fetal intestine is
between the right and left atria growing so rapidly.
of the heart, bypassing the • A sonogram shows a gestational
lungs. sac

End of 12th Gestational Week

FETAL DEVELOPMENT (First Trimester)
• The length 7 to 8 cm; weight
•Pre-embryonic (first 2 weeks, is about 45 g.
beginning with fertilization) • Nail beds are forming on
•Embryonic (weeks 3 through 8) fingers and toes.
•Fetal (from week 8 through • Spontaneous movements are
birth) possible, too faint to be felt
by the mother
End of Fourth Gestational Week • Babinski reflex, are present.
• The length of the embryo is • Bone ossification centers
0.75 cm; Weight 400 mg. begin to form.
• The spinal cord is formed and • Tooth buds are present.
fused at the midpoint. • Sex is distinguishable on
The head is large in proportion outward appearance.
and represents about one third • Urine secretion begins
of the entire structure. • The heartbeat is audible
• The rudimentary heart appears through Doppler technology.
as a prominent bulge on the
anterior surface. End of 16th Gestational Week
• Arms and legs are bud-like • The length 10 to 17 cm; weight
structures; rudimentary eyes, is 55 to 120 g.
ears, and nose are discernible • Fetal heart sounds are audible
by an ordinary stethoscope.
End of Eighth Gestational Week • Lanugo is well formed.
• The length of the fetus is • Both the liver and pancreas
about 2.5 cm (1 in.); weight is are functioning.
about 20 g. • The fetus actively swallows
• Organogenesis is complete. amniotic fluid, demonstrating
• The heart, with a septum and an intact but uncoordinated
valves, beats rhythmically. swallowing reflex; urine is
present in amniotic fluid.

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• Sex can be determined by achieved a practical low-end
ultrasonography. age of viability if they are
cared for after birth in a
End of 20th Gestational Week modern intensive care nursery.
• The length is 25 cm; weight is
223 g. End of 28th Gestational Week
• Spontaneous fetal movements • The length of is 35 to 38 cm;
can be sensed by the mother. weight is 1,200 g.
• Antibody production is • Lung alveoli are almost
possible. mature; surfactant can be
• Hair, including eyebrows, demonstrated in amniotic fluid.
forms on the head; vernix • Testes begin to descend into
caseosa begins to cover the the scrotal sac from the lower
skin. abdominal cavity.
• Meconium is present in the • The blood vessels of the
upper intestine. retina are formed but thin and
• Brown fat, a special fat that extremely susceptible to damage
aids in temperature regulation, from high oxygen concentrations
begins to form behind the (an important consideration
kidneys, sternum, and posterior when caring for preterm infants
neck. who need oxygen).
• Passive antibody transfer from
mother to fetus begins. End of 32nd Gestational Week
• Definite sleeping and • The length is 38 to 43 cm;
activity patterns are weight is 1,600 g.
distinguishable as the fetus • Subcutaneous fat begins to be
develops biorhythms that will deposited (the former stringy,
guide sleep/wake patterns “little old man” appearance is
throughout life lost).
• Fetus responds by movement to
End of 24th Gestational Week sounds outside the mother’s
(Second Trimester) body.
• The length is 28 to 36 cm; • An active Moro reflex is
weight is 550 g. present.
• Meconium is present as far as • Iron stores, which provide
the rectum. iron for the time during which
• Active production of lung the neonate will ingest only
surfactant begins. breast milk after birth, are
• Eyelids, previously fused beginning to be built.
since the 12th week, now open; • Fingernails reach the end of
pupils react to light. fingertips.
• Hearing can be demonstrated
by response to sudden sound. End of 36th Gestational Week
• When fetuses reach 24 weeks, • The length is 42 to 48 cm;
or 500 to 600 g, they have weight is 1,800 to 26.

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• Body stores of glycogen, ASSESSMENT OF FETAL GROWTH AND
iron, carbohydrate, and calcium DEVELOPMENT
are deposited. • Tests for fetal growth and
• Additional amounts of development are commonly done
subcutaneous fat are deposited. for a variety of reasons,
• Sole of the foot has only one including to:
or two crisscross creases • Predict the outcome of the
compared with a full crisscross pregnancy
pattern evident at term. • Manage the remaining weeks of
• Amount of lanugo begins to the pregnancy
diminish. • Plan for possible
• Most fetuses turn into a complications at birth
vertex (head down) presentation • Plan for problems that may
during this month. occur in the newborn infant
• Decide whether to continue the
End of 40th Gestational Week pregnancy
(Third Trimester) • Find conditions that may
• The length is 48 to 52 cm affect future pregnancies
(crown to rump, 35 to 37 cm);
weight is 3,000 g (7 to 7.5
lb).
• Fetus kicks actively,
sometimes hard enough to cause
the mother considerable 1. Health history
discomfort. 2. Physical examination
• Fetal hemoglobin begins its 3. Estimating fetal health
conversion to adult hemoglobin. 4. Fetal growth - Fundic
• Vernix caseosa starts to height/ Mc Donald’s rule
decrease after the infant • Over the symphysis pubis
reaches 37 weeks gestation at 12 weeks
• Fingernails extend over the • At the umbilicus at 20
fingertips. weeks
• Creases on the soles of the • At the xiphoid process at
feet cover at least two thirds 36 weeks
of the surface.
5. ASSESSING FETAL WELL-BEING
• FHR
• Non stress test
• Test for placental
function and
oxygenation
• Determines fetal
well-being

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 • Evaluates fhr • Establish a fetus is
response to fetal growing and has no gross
movement anomalies
• Results: REACTIVE • Establish the sex if a
(Normal, Negative, penis is revealed.
healthy fetus) • Establish the
NONREACTIVE presentation and position
(Abnormal) of the fetus.
• Kick counts • Predict gestational age
• Sidelying / sitting by measurement of the
• Notify if less than biparietal diameter of the
10 kicks in 1-2hr head or crown-to-rump
period measurement.
• Contraction stress test • Discover complications of
• Performed if Non pregnancy, such as the
stress test is presence of an
abnormal. intrauterine device,
• Test for placental hydramnios (excessive
function and amniotic fluid) or
oxygenation oligohydramnios (lessened
• Determines fetal amniotic fluid), etc.
ability to tolerate • After birth, a sonogram
labor and determines may be used to detect a
fetal well-being. retained placenta or poor
• Attached to a fetal uterine involution in the
monitor (20 – 30 mins new mother.
baseline strip record).
• Nipple stimulation or 7. Alpha-fetoprotein screening
oxytocin until 3 palpable - assesses the quantity of
contractions with a fetal serum proteins,
duration of 40 seconds or elevations are often
more in 10 minute period. associated with neural
• Results: (-) is NORMAL tube defects and abdominal
(+) is wall defects.
- can detect spina bifida
6. UTZ and Down Syndrome
• Diagnose pregnancy as
early as 6 weeks 8. Biophysical Profile
gestation. • a fetal Apgar score.
• Confirm the presence, • may be done as often as
size, and location of the daily during a high risk
placenta and amniotic pregnancy.
fluid. • The fetal scores are as
follows:

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 • score of 8 to 10 means
once in
the fetus is considered to 30 min.
be doing well.
• A score of 6 is
considered suspicious. Amniotic Sonogram A pocket
• A score of 4 denotes a fluid of
volume amniotic
fetus potentially in
fluid
jeopardy measuring
more than
2 cm in
Assessment Instrument Criteria
vertical
(Score:2)
diameter
Fetal Sonogram At least must be
breathing one present
episode
Fetal heart Nonstress Two or
of 30 s
reactivity test more
of
accelerat
sustained
ions of
fetal
fetal
breathing
heart
movements
rate of
within 30
15
min of
beats/min
observati
lasting
on
15 s or
more
Fetal Sonogram At least following
movement three fetal
separate movements
episodes in a
of fetal 20-min
limb or period
trunk
movement
within a Amniocentesis
30-min
observati • Aspiration of the amniotic
on fluid
• Best done between 15 to 20
Fetal tone Sonogram The fetus weeks of pregnancy
must • Determines genetic disorders,
extend metabolic defects and fetal
and then
flex the lung maturity.
extremiti • Risks:
es or • Maternal bleeding
spine at • Infection
least • Rh isoimmunization
• Abruptio placentae

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• Amniotic fluid emboli • B – reast tenderness and
• Premature ROM changes
• Interventions: • E – xcessive fatigue
• Informed consent • Q – uickening (18th-20th weeks
• Baseline V/S and monitor of gestation)
q15mins
• Position client supine during
examination and left side after Presumptive (subjective) Signs
the procedure • P – periodic absent
(amenorrhea)
• R – really tired
• E – enlarged breast
• S – sore breast
• U – urination
• M – Movement perceived
(quickening)
• E – emesis (n/v)

BIOPHYSICAL AND PSYCHOLOGIC

CHANGES IN PREGNANCY
Probable (objective) Signs
• C – hadwicks – bluish
NORMAL ADAPTATION IN PREGNANCY discoloration of vaginal wall
• H – egar – softening of the
lower uterine segment
• U – terine enlargement – felt
just above the symphysis pubis
(12th wks)
• P – ostive Pregnancy test –
presence of HCG in urine
• B – allotment – sinking and
rebound of fetus
• O – utlining of fetal body
• G – oodells – softening of the
cervix
• B – raxton Hicks – painless
SIGNS AND SYMPTOMS OF PREGNANCY contraction

Presumptive (subjective) Signs Probable (objective) Signs

• A – menorrhea - cessation of • P – positive pregnancy test
menses • R – returning fetus when
• N – ausea and Vomiting uterus pushed w/ fingers
• U – rinary frequency “ballotment”
• O – outline of fetus palpated

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• B – Braxton Hick’s • Hypotension
contractions • Physiologic anemia
• A – a softening of the cervix • Palpitations
“Goodell’s sign” • Edema of the lower extremities
• B – bluish discoloration of • Varicosities
the vagina “Chadwick’s sign” • Vulvar and rectal varicosities
• L – lower uttering segment
softens “hegar’s sign” 2. Gastrointestinal Changes
• E - enlarged uterus •Ptyalism
•Morning sickness (nausea and
Positive Signs vomiting)
• Fetal Heartbeat – 12th weeks •Hyperemesis gravidarum
by Doppler ; 18-20 weeks by •Constipation and flatulence
Fetoscope •Hemorrhoids
• Fetal Movement – (felt by •Heartburn
examiner) 16th -20th weeks AOG
• Skeleton – by sonogram 3. Respiratory Changes
•Shortness of breath

Positive Signs
• F – fetal movement felt by the 4. Urinary Changes
nurse/doctor •Urinary frequency
• E – Electronic device detects •Decreased renal threshold for
• (FHT) sugar
• T – the delivery of the baby
• U – Utz 5. Temperature
• S – see visible movement •Slight increase in BBT due to
(nurse/MD) presence of progesterone

6. Musculoskeletal Changes
SYSTEMIC CHANGES •Lordotic position (“pride of
pregnancy)
1. CIRCULATORY CHANGES •Wobbly gait
• Increase of about 30%-50% in •Leg cramps
the total cardiac volume,
reaching its peak during the 7. Endocrine Changes
6th month (plasma). •Moderate enlargement of the
• Easy fatigability and SOB thyroid gland
(inc.workload of the •Increased size of the
heart) parathyroid, probably to satisfy
• Slight hypertrophy of the the increased in need of the
heart fetus for calcium
• Systolic murmurs •Increased in size and activity
• nosebleeds of the adrenal cortex, thus

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 increase in amount of
on what it feels
circulating cortisol, like to be
aldosterone, and ADH – pregnant.
hyperglycemia •Common reaction
•Gradual increase in insulin is ambivalence,
production but the body’s or feeling both
sensitivity to insulin is pleased and not
pleased at the
decreased during pregnancy pregnancy

8. Weight Second Trimester Woman and partner

• Total allowable wt gain during Task: Accepting move through
the entire period of pregnancy the baby emotions such as
is 25-35 lbs. narcissism and
introversion as
•Pattern of weight gain is more they concentrate
important than the amount of on what it will
weight gain. feel like to be a
parent.Roleplayin
g and increased
dreaming are
common.

Third Trimester Woman and partner

1st 1 lb/ 3 lbs Task: Preparing grow impatient
trimester month for the baby and with pregnancy as
end of pregnancy they ready
2nd 1 lb/ 12 lbs themselves for
trimester week birth. Woman and
partner grow
3rd 1 lb/week 12 lbs impatient with
trimester pregnancy as they
ready themselves
total 27 lbs for birth.

9. Emotional Responses
LOCAL CHANGES
Common Psychosocial Changes
That Occur With Pregnancy UTERUS
•Wt increases to about 1000gms
Psychosocial Change
Description at full term; due to increase
in the amount of fibrous and
First Trimester •Woman and elastic tissues.
Task: Accepting partner both •Hegar’s sign (6th wk)
the pregnancy spend time •Operculum
recovering from
•Goodell’s sign (softening of
shock of learning
they are pregnant the cervix)
and concentrate
VAGINA

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•Chadwick’s sign
• Leukorrhea Fatigue
• Schedule rest period daily
ABDOMINAL WALL • Have a regular bedtime
• Striae gravidarum routine
•Umbilicus pushed out • Use extra pillow for comfort
• Encourage sim’s position when
Ovaries lying
•No activity whatsoever since
ovulation does not take place Muscle Cramps
during pregnancy •Avoid pointing toes
•Straighten your legs and
Skin dorsiflex your ankle
• Linea nigra •Increase calcium in the diet
•Melasma or chloasma •Nausea and Vomiting
•Active sweat glands •Encourage small frequent
•Breast feeding (6 small meals rather
•Increase in size than 3 large meals)
• Feeling of fullness and •Eat a piece of dry toast or
tingling sensation some crackers before getting
•Nipples more erect •Areola out of bed
becomes darker •Ice chips
• Skin surrounding areolae •Divert attention
turns dark
• Formation of colostrum by 4th Heart burn
month •Small frequent feeding
•Chew food properly
DISCOMFORTS OF PREGNANCY •Encourage ambulation after
meal
1ST TRIMESTER •Bend knees when picking up
something
Breast Tenderness •Avoid fatty, spicy, and fried
• Wear supportive bra with wide foods
straps •Avoid using sodium bicarbonate
• Dress warmly as antacid
• Consult physician if breast
abscess and nipple fissure is Leukorrhea
noted •Daily bath or shower
•Don’t douche
Constipation •Do not use tampons
•Increase Oral Fluid Intake •Use cotton panty or sleep
•Increase fiber in the diet without underwear
• Avoid gas-forming foods •Contact physician if there is
• Have a regular time for bowel a change in color, odor, or
movement character of discharge.

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 •Avoid caffeine intake
Nasal Stuffiness •Kegel’s exercise (alternate
•Use cool air vaporizer and contracting and relaxing
humidifier perineal muscles)
•Increase oral fluid intake •Perineal care
•Place moist towel on the •Avoid using nylon panty
sinuses •Void when there is the urge
•Massage sinuses •Avoid using pantyliners
•Void before and after sexual
Ptyalism intercourse
•Use mouthwash as needed
•Chew gum or suck on hard candy Backache
•Hypotension •Wear shoes with low moderate
•Instruct the woman to rise heels
slowly • Encourage to walk with pelvis
•Avoid extended periods of tilted forward
standing •Application of local heat
•Sit with head lowered • Squat rather than bend over
when picking up something
Varicosities •Pelvic rock or tilting
• Elevate legs no longer 15-20 • Tylenol as pain reliever
mins at least twice daily •Headache
•Avoid crossing legs/ bending •Avoid eye strain
knees when sitting •Rest with cold towel on
•Avoid constrictive knee-high forehead
hose or garters • Tylenol/ acetaminophen
•Use support stockings
• Encourage exercise (walking) Dyspnea
• Encourage intake of vitamin C •Assume proper posture
•Use pillows behind head and
Hemorrhoids shoulders at night
• Same with intervention in
preventing constipation Ankle Edema
•Rest in modified sim’s •Rest with feet elevated
position •Assume knee-chest •Avoid standing for long
position for 15 minutes daily periods
(in a gradual increase length •Avoid restrictive garments on
of time) lower half of body
• Stool softener (with
prescription)
Antepartum Care
Heart Palpitation The prenatal Visit
•Gradual and slow movement
a. care given to mother from
Urinary Frequency conception up to birth

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 •266-280 days •Chief concern – is there nausea
•38-42 weeks (ave of 40) and vomiting
•9 calendar months •DANGER SIGNS
•10 lunar months • Vaginal bleeding, no
matter how slight
b. Primary factor in the • Swelling of face or
improvement of maternal and fingers
infant morbidity and mortality • Severe, continuous
statistics. headache
• Dimness or blurring of
c. Patient’s understanding of vision
the modalities of care and • Flashes of light or dots
cooperation are basics to the before the eyes
success of the program • Pain in the abdomen
• Persistent vomiting
Components of a Prenatal Visit •Chills and fever
1. History taking • Sudden escape of fluids
2. Physical assessment from the vagina
3. Important estimates • Absence of FH sounds
4. Health teachings after they have been
initially auscultated on
the 4th or 5th month

1. HISTORY TAKING •Medical data – is there a

history of kidney, cardiac or
•Personal data-patient’s name, liver disease; hypertension;
age, address, civil status and tuberculosis; STIs
family history.
•Obstetric data
•Gravida - # of 2. ASSESSMENT
pregnancies a woman has •Physical examination
had •Pelvic examination
•Para - # of viable •Vital Signs
pregnancies, regardless of • TPR
number and outcome • BP
•TPAL Score • Ht and Wt
(Term,Preterm,Abortion,Live •Blood studies
birth • Blood typing
•Past Pregnancies • CBC
•Method of delivery • Serologic test
•Where Risks involved •Urine examinations
• G5P4 (T3P1A1L4) • Heat and acetic acid
test
•Present Pregnancy

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 • Benedict’s test for •Measurement of Fundal Height
glycosuria (urine should and Fetal Heart Sounds
be collected before
breakfast; should not be • 12th-14th weeks of pregnancy
more than +1 sugar) – uterus is palpable over
• Determination of pyuria the symphysis pubis
• 20th- 22nd weeks of pregnancy
Physical Examination – uterus is palpable over
• General Appearance and Mental the umbilicus.
Status • 36th weeks of pregnancy
• Head and Scalp - uterus is palpable over
• Eyes the xiphoid process.
•Nose • 40th week of pregnancy – often
•Ears returns to about 4cm below the
•Mouth, Teeth, and Throat xiphoid process due to
•Neck lightening.
•Lymph Notes
•Heart •Pelvic Examination – the
•Lungs pelvic examination reveals
•Back information on the health of
•Rectum both internal and external
•Extremities and skin reproductive organs.

•External Genitalia – assess

Breasts – as pregnancy begins, for any signs of inflammation,
the breast undergo the irritation, or infection, such
following: as redness, ulcerations, or
•Breast areola darkens. vaginal discharge.
•Montgomery tubercles become
prominent. •Internal Genitalia – assess
•Breast size increases for cervix by the use of vaginal
•Breast tone firms. speculum while the woman is
•Secondary areola may develop placed in lithotomy position.
surrounding the natural one.
•Blue streaking of veins becomes PELVIC EXAMINATION
prominent. •IE – to determine Hegar’s,
•Colostrum may be expelled as Chadwick’s, and Goodell’s sign
early as the 16th week of •Ballottement – fetus will
pregnancy. bounce when lower uterine
•Any supernumerary nipple also segment is tapped sharply (5th
may become darker (assure the month of pregnancy)
woman that this is a normal • PAP smear – cytological
pregnancy change) examination to diagnose cervical
carcinoma

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• Pelvic Measurements – •McDonald’s Method – determine
preferably done after the 6th age of gestation by measuring
lunar month from the fundus to the symphysis
• X-ray pelvimetry- the pubis (in cm.) then divide by 4.
most effective method of
diagnosing CPD (can be Example: Fundic Ht = 16 cm
done only 2 wks before 16/4 = 4 mos AOG
EDD)
• Leopold’s Maneuver (fundal ht in cm normally
approx. the age of gestation in
DIAGNOSTIC PROCEDURES weeks until 36th week)
•Routine CBC – hgb and hct
•Maternal serum • BARTHOLOMEW’S RULE –
alpha-fetoprotein ***
•Increased (neural tube
defect) •Haase’s Rule – determines the
•Decreased (down syndrome) length of the fetus in
•Amniocentesis centimeters.
•15-18 weeks (fetal •Square the age in months for
anomaly) the 1st half of pregnancy (1-5
•37-38 weeks (fetal lung months)
maturity) •4x4 = 16 cm
•L:S ratio = 2:1 •Multiply the age in months to 5
Lecithin for the 2nd half of pregnancy
Sphingomyelin (6- 10months)
•Chorionic villi sampling •6x5 = 30 cm

•JOHNSON’S RULE – estimates the

weight of the fetus in grams:
3. IMPORTANT ESTIMATES •Fundic Ht in cm – n x k
Where: “k” = 155 (constant)
•AGE OF GESTATION “n” = 12 (engaged)
• Nagele’s Rule - To calculate 11 (unengaged)
the EDD by Nagele rule, subtract
3 calendar months from the month
in which the last menstrual 4. HEALTH TEACHINGS
period occurred, and add 7 days 1. Nutrition – most impt. aspect
to the date of the first day of 2. Smoking – causes
LMP. Change the year if vasoconstriction, leading to
necessary. – 3 mos + 7 days low birth weight babies.
3. Drinking – can cause
•If LMP is in the 1st three transient respiratory
months of the year, add 9 months depression in the newborn and
and 7 days. fetal withdrawal syndrome

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4. Drugs – has teratogenic
effects
5. Employment – advise pregnant EXERCISE
women to walk about every few •encourage consecutive 30-minute
hours of her work day during exercise daily
long periods of standing or •An exercise program should
sitting to promote circulation. consist of 5 mins warm up, 20
6. Sexual activity mins active stimulus phase, and
7. Exercise 5 mins cool down.
8. Prepared childbirth education •Encourage exercises that
9. Immunization exercise large muscle groups
10. Clinic appointment rhythmically, like walking
•Discontinue exercise if there
is presence of complication.
NUTRITION •Avoid jerky or bouncy
•Most important aspect movements, jumping and jarring,
•Malnutrition during pregnancy or fast changes of direction.
can result to prematurity; •Do not overstretch joints
preeclampsia, abortion, low
birth weight babies, congenital • Recommended exercise
defects or even stillbirths. • Tailor sitting
•Women who need special • Squatting
attention • Pelvic rock
•Pregnant teenagers • Kegel’s exercise
• Extremes in weight scale • Shoulder circling
• Low income women • walking
• Successive pregnancies
• vegetarians
IMMUNIZATIONS
SEXUAL ACTIVITY •Given 0.5mL IM (deltoid)
•Sexual desires continue anytime during pregnancy for
throughout pregnancy, but level the first dose
change •It shall be given in two doses
•Sex in moderation is permitted at least 4 weeks apart, with the
during pregnancy but not during 2nd dose at least 3 wks before
the last 6. delivery
•Counsel the couple to look for •Booster doses shall be given
more comfortable position during succeeding pregnancies
regardless of interval
Contraindications •3 booster doses will confer
•Spotting or bleeding (2 weeks lifelong immunity.
until bleeding stops)
•Ruptured BOW OTHERS
•Incompetent cervical OS •Bathing
•Deeply-engaged presenting part • avoid tub bath

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 •observe proper hygiene by •garters, extremely firm girdles
bathing daily with panty legs and knee high
•Breast Care stockings
•wear a firm, supportive •buy nursing bra if she prefer
bra with wide straps to to breastfeed the infant post
spread weight across the partum
shoulders. •use shoes with moderate to low
•Use a larger bra halfway heel to minimize pelvic tilt and
through pregnancy to backache.
accommodate increase
breast size •Sleep
•Instruct to wash her •encourage practices that could
breast with clear tap water induce sleep at night like warm
(no soap) daily to remove bath and drinking of milk.
the colostrums, thus •Encourage relaxation exercises
minimizing the risk of such as lying quietly,
infection systematically relaxing neck
•Dry well the nipples by muscles, shoulder muscles, arm
patting. muscles, and so on.
•Advise to place gauze •Encourage afternoon nap or rest
squares or breast pads period
inside the bra if •Encourage sim’s position, with
colostrums secretion is the top leg forward when lying.
profuse or change bra •Advise to avoid resting in a
frequently to maintain supine position and bending
dryness. knees when sitting or lying.

•Dental Care
•encourage good tooth brushing •Travel
habits •avoid taking any medication
•encourage to have a regular for motion sickness without
dental clinic visit prescription
•Limit consumption of food that •emphasize the need for the
has high sugar intake woman to be certain she knows
•Encourage snacking of the location of health care
nutritious foods, such as fruits facility should an expected
and vegetables. complication occur, if she
plans to spend time at a remote
•Perineal Hygiene location.
•no douching due to risk of •Encourage the woman to make
infection these plans far enough in
advance to allow her records be
•Dressing copied and taken with her or be

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forwarded to the interim health
care provider. (with consent)
•Make sure that she has enough CLINIC APPOINTMENTS
vitamin supplement plus adequate •1st 7 calendar months: 1/mo =
prescription for refills as 7
necessary. •8 th calendar month: 2/ mo = 2
•Advise her to plan for frequent •9 th calendar month: q week =
rest or stretch period when she 4
is taking long trips. 12
(Preferably every hour, or at
least every 2 hours.)
•Encourage the use of seatbelts
when traveling

PREPARED CHILDBIRTH EDUCATION

•Preparing the pregnant couple
for childbearing
•Operates basically on the “Gate
Control Theory” of pain
•Discomfort during labor can be
minimized if the woman comes
into the labor informed about
what is happening and prepared
with breathing exercises to use
during labor.
•Discomfort during labor can be
minimized if the woman’s abdomen
is relaxed and the uterus is
allowed to rise freely against INTRAPARTUM
the abdominal wall during LABOR AND DELIVERY
contractions.
DEFINITION:
• The Lamaze Method • Intrapartum
• Lamaze or psychoprophylactic - is the portion of pregnancy
method combines relaxation, that occurs during labor.
concentration, focusing, and - It begins as labor begins and
complex, well-paced breathing ends following the third stage
patterns to reduce the of labor.
perception of pain through a
conditioned response to labor • Intrapartum care - medical
contractions. (Implications: and nursing care given to a
Nurse should not interrupt the pregnant woman and her family
couple doing breathing during labor and delivery.
exercises.)

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Goals: • Changes in the ratio of
• To promote physical and estrogen to progesterone occurs,
emotional well-being in the increasing estrogen in relation
mother and fetus. to progesterone, which is
• To incorporate interpreted as progesterone
family-centered care concepts withdrawal.
into the labor and delivery • The placenta reaches a set
experience age, which triggers
contractions.
• Rising fetal cortisol levels
FACTORS AFFECTING THE reduce progesterone formation
INTRAPARTUM EXPERIENCE and increase prostaglandin
• Previous experience with formation.
pregnancy. • The fetal membrane begins to
• Cultural and personal produce prostaglandins,
expectations.
• Prepregnant health and
biophysical preparedness for PREMONITORY/ PRODROMAL SIGNS OF
childbearing LABOR
•Motivation for childbearing
• Socioeconomic readiness •Lightening/ engagement
•Age of mother •Increase level of activity
• Partnered versus unpartnered •Decrease of wt. 3-4lbs; 1-2
status days before labor begins
• extent of prenatal care •Exaggerated Braxton Hicks
• Extent of childbirth education contraction
•Show
Labor - series of events by
which uterine contractions and
abdominal pressure expel a fetus
and placenta from the uterus.
Theories of why labor begins

• The uterine muscle stretches

from the increasing size of the
fetus, which results in release THE COMPONENTS OF LABOR
of prostaglandins.
• The fetus presses on the POWER
cervix, which stimulates the
release of oxytocin from the
posterior pituitary.
• Oxytocin stimulation works
together with prostaglandins to
initiate contractions.

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Uterine Contractions Cervical Changes
- Assessed according to
frequency, duration and • Effacement – shortening and
strength. thinning of the cervical canal.

•BRAXTON HICKS Contractions •Dilatation – refers to the

- false labor enlargement or widening of the
- mild (but can be strong) cervical canal from an opening
- irregular and can also be a few millimeters wide to one
painful but DO NOT cause large enough (approx. 10 cm) to
cervical dilation permit passage of the fetus.

TRUE AND FALSE LABOR

CONTRACTIONS
FALSE TRUE

1. Begin and 1. Begin

remain irregularly
irregular but become
regular and
predictable

2. Felt first 2. Felt first

abdominally in lower back
and remain and sweep
confined to around to the
the abdomen abdomen in a
and groin wave

3. Often 3. Continue no
disappear with matter what
ambulation or the woman’s
sleep level of
activity PASSAGE of Labor

4. Do not 4. Increase in
increase in duration,
duration, frequency, and
frequency, or intensity
intensity

5. Do not 5. Achieve
achieve cervical
cervical dilatation
*Cervix
dilatation

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- dilates and effaces to allow PASSENGER: Fetal Head
for easier passage of the fetal
head.
- mechanism

Pelvis- shape can influence how

easily FETUS can PASS THROUGH PASSENGER: Fetal Lie

PASSENGER: Fetal attitude

- describes the degree of
flexion a fetus assumes during
labor or the relation of the
fetal parts to each other.

PASSENGER PASSENGER: Fetal presentation

and position
•FETUS, FETAL MEMBRANE & *Fetal presentation the body
PLACENTA part that will first contact
- Fetal head the cervix or be born first
- Fetal lie determined by the combination
- Fetal attitude of fetal lie and attitude
- Fetal presentation and Typically CEPHALIC
position

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 that vaginal birth may not be
possible.

BREECH PRESENTATION BREECH -

Buttocks or feet first

Variation of CEPHALIC
PRESENTATION
*Vertex
- The head is sharply flexed,
making the parietal bones of TYPES of BREECH
the space between the
fontanelles (vertex) the
presenting part.
- Longitudinal (lie)
- Good/full flexion (attitude)

*Brow
- Longitudinal lie
- Moderate flexion (military)
- Because the head is only TRANSVERSE PRESENTATION
moderately flexed, the brow or *Transverse or shoulder
sinciput becomes the presenting presentation
part

*Face
- Longitudinal PASSENGER: Fetal position
- Poor flexion *Fetal position
- fetus has extended the head to • Location of the FETAL
make the face the presenting REFERENCE POINT in relation to
part. 4 quadrants of MATERNAL PELVIS
- From this position, extreme •Cited with 3 LETTERS
edema and distortion of the face
may occur.
*Mentum/chin
- Longitudinal
- Very poor flexion
- fetus has completely
hyperextended the head to
present the chin, causing the
presenting diameter (the
occipitomental) to be so wide

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 rior

Presentat Point of LETTER LOP, left LSaP, LAP, left

ion reference occipito left scapulo
posterior sacropost posterior
Vertex Occiput O erior

Chin Mentum M LOT, left LSaT, RAA, right

occipito left scapuloant
Breech Sacrum Sa transvers sacro erior
e transvers
shoulder Scapula A e
(Acromion)
ROA, RSaA, RAP, right
right right scapulo
occipit sacroante posterior
oanterior rior

ROP, RSaP,
right right
occipito sacropost
posterior erior

ROT, RSaT,
right right
occipito sacro
transvers transvers
e e

Vertex Breech Shoulder

Presentati Presentati Presentati
on on on
(Occiput) (Sacrum) (Acromion
Process)
PASSENGER: Fetal STATION &
LOA, left LSaA, LAA, left ENGAGEMENT
occipito left scapulo
anterior sacroante anterior
FETAL STATION

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- describes how far down your − AVAILABLE SUPPORT during
baby’s head has descended into CHILDBIRTH
your pelvis
- Measured in cm COMPONENTS OF THE BIRTH PROCESS
- Ischial spine = 0
- ABOVE the ischial spine is *POWER
(-) - Uterine contractions
- BELOW the ischial spine is - maternal pushing efforts
(+)
- Documented as: - 5, - 4, - 3, *PASSAGE
-2, -1, 0, +1, +2, +3, +4, +5 - maternal pelvis

*PASSENGER
ENGAGEMENT: - fetus, membranes & placenta
- fetal station 0 = “engaged” head, lie, attitude,
- Presenting part have entered presentation & position.
down into the pelvis & inlet is
at the ischial spine line (0). *PSYCHE -client’s psychological
- When does it happen? response to labor and birth
- First time moms: 38 weeks
- Already had babies: can happen LABOR
when labor starts
-ALSO CALLED PARTURITION
-THE HARD WORK OF DELIVERING A
BABY.

Starts ENDS

Uterine DELIVERY Delivery

contracti Of Fetus Of
ons PLACENTA

PYSCHE of Labor

•Client’s PSYCHOLOGICAL RESPONSE

to LABOR & BIRTH

− ANXIETY
− CULTURE
− EXPECTATIONS
− EXPERIENCE w/ CURRENT
PREGNANCY
− LIFE EXPERIENCE
− PREVIOUS BIRTH EXPERIENCES

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 Cervix dilates: 6 – 10 cm on
average of 1cm/hr

Intensity: stronger & longer

Contractions: (45 to 60 seconds)

every 3 to 5 minutes 4 to 8
hours

INTERVENTIONS
STAGES OF LABOR
• Time to go to hosp.
STAGE 1:
• Water may break (if it hasn’t
LATENT (EARLY) - longest phase
already)
• Important to monitor for
Goal: Cervical dilation
meconium -stained fluid which is
(opening) 0-10 cm & 100%
greenish brown
effacement (thinning) due to
• Mother will be serious,
contractions
anxious, and in pain.

Cervix dilates: 0-6cm

• Provide comfort
Intensity: less intense/mild
•changing positions,
Contractions: 5 to 30 minutes
•warm shower or bath,
and 30-45 seconds in length
•massages between
Pinkish discharge (Mucus plug)
contractions,
•breathing techniques,
• 14 - 20 hrs
•ice or fluids for dry
• monitor contraction duration
mouth.
and intensity…
• Encourage frequent urination
• try to stay comfortable at
to keep bladder empty (full
home until water breaks or
bladder prevents uterus from
enters active phase of labor.
contracting properly and can
• Woman will be talking,
slow down labor),
excited, and nervous.
• monitor vitals of mother and
• Go for a walk
fetal heart rate.
• Take a shower or bath
• Listen to relaxing music
• Try breathing or relaxation
TRANSITION (ACTIVE)
techniques taught in childbirth
• Cervix dilates: 6 – 10 cm and
class
thins
• Change positions
• Intensity: very intense and
long (back2back)

• Contractions: 60 – 90 secs
every 2- 3 minutes or less
ACTIVE:

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• 30 min to 2 hours /more transition period…. 60-90
(Shortest phase but most seconds length every 2-3
intense/painful) minutes).
• Pain on lower back & rectum • For first-time mothers this
(bowel movement) stage lasts approximately 1 hour
(may last 3 hours) and 20
INTERVENTIONS minutes for multipara.
• Mother will be concentrating, Watch for changes in perineum
irritated, pain, nauseous, that represents birth of baby
shivering is approaching:
• Tell your health care provider • Bulging perineum and
if you feel the urge to push. rectum
• If you want to push but •Parts of baby present
you're not fully dilated, hold • Increasein bloodys
back.
• Pant or blow your way through
the contractions. INTERVENTIONS
• provide support & • Monitor mother’s vital and
encouragement, baby heart during, after, and
• monitor mother’s v/s and FHR before contractions with
(esp. during contractions, and continuous fetal monitoring
before, and after. N heart rate (assessing for signs of
110 to 160), distress)
• mother’s contractions • Teach mom how to push: exhale
(length, frequency) when pushing
• monitoring status of cervix Positioning: High-fowler and
(dilation and effacement), lithotomy, squatting, side-lying
assessing fetal position and , maintain comfort measures,
station (station 0 baby head is encouragement and praise,
engaged and at ischial spine) • At some point, you might be
asked to push more gently — or
STAGE 2: IT’S TIME not at all (PREVENTS laceration
• Starts when cervix has fully ---- episiotomy:episiorraphy)
dilated and ends when baby is • After your baby's head is
fully delivered. delivered, the rest of the
• Cervix is fully dilated so baby's body will follow shortly.
baby can start descending into • The baby's airway will be
the birth canal - intense cleared if necessary.
pressure in rectum as baby • If you've had an
descending uncomplicated delivery, your
• watch fetal station +1 to 5+ health care provider may wait a
(5+ is head crowning). few seconds to a few minutes
before the umbilical cord is
• Contractions will be strong cut.
and intense like in the Delaying may:

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 • increases the flow of • Feel for the nape
nutrient-rich blood from • Expulsion – once the
the cord and the placenta shoulders are born, the rest of
to the baby. the baby is born easily and
•increases the baby's iron smoothly because of its smaller
stores and reduces the size.
risk of anemia
STAGE 3
SECOND STAGE: CARDINAL MOVEMENTS
of LABOR Delivery Mechanism of PLACENTA:
- SCHULTZE - “Shiny Schultz”
MECHANISM OF LABOR - BABY’S SIDE
• Descent – the downward - Comes out 1st
movement of the biparietal
diameter of the fetal head to - DUNCAN - “Dull/Dirty Duncan”
within the pelvic inlet. - “dull”, red, and rough and is
• Flexion – as descent occurs the side from the mother
and the fetal head reaches the
pelvic floor, the head bends INTERVENTIONS
forward onto chest, making the • monitor BP before and after
smallest anteroposterior delivery of placenta,
diameter the one presented to • administer oxytocin “Pitocin”
the birth canal. as ordered by the physician
• Internal rotation – during AFTER delivery of the placenta,
descent, the head enters the helps uterus contract after
pelvis with the fetal delivery of placenta and
anteroposterior head diameter in prevents hemorrhage,
a diagonal or transverse • assess placenta to make sure
position. it is COMPLETE (cord should
• Extension – as the occiput is have two arteries and one
born, the back of the neck stops vein),
beneath the pubic arch and acts • make mother comfortable and
as a pivot for the rest of the encourage bonding with baby
head. (breastfeeding),
• Crowning – fetal scalp appears • change linen
at the opening of the vagina • pericare
• External rotation
(restitution) – the head STAGE 4: (recovery and bonding)
rotates (from the • This stage lasts from 1 to 4
anteroposterior position it hours after birth
assumed to enter the outlet) • The mother and newborn
back to the diagonal or recover from the physical
transverse position of the process of birth.
early part of labor.
• Neonate’s airway

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• The maternal organs undergo
initial readjustment to the
nonpregnant state
• The newborn body systems begin
to adjust to extrauterine life
and stabilize.
• The uterus contracts in the
midline of the abdomen with the
fundus midway between the
umbilicus and symphysis pubis.

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