INTRAPARTUM period

• period during labor and

delivery
INTRAPARTUM • starting before
PERIOD labor admission through
the immediate postpartum
period.

• care of women and their

INTRAPARTUM
CARE
babies, during labor and
immediately after birth.
 LABOR AND DELIVERY

• physiologic and mechanical series

of processes where all the
LABOR products of conception (fetus,
(PARTURITION) placenta & fetal membranes) are
expelled from the birth canal.

DELIVERY • actual event of birth

THEORIES of LABOR
 THEORIES OF LABOR
2. Oxytocin 3. Progesterone
1. Uterine Stretch Theory
Stimulation theory Deprivation theory
• Labor begins • Pressure of the fetal • When
when uterus head on the cervix in progesterone (a
distends the late pregnancy uterine
& muscles stretch stimulates the muscle relaxant)
far beyond its posterior pituitary decreases in late
volume gland to secrete pregnancy,
oxytocin causing the uterine
uterine contractions. muscle contracts
 THEORIES OF LABOR

4. Prostaglandin Theory 5. Theory of aging placenta

• Increase prostaglandin • Advance placental age

synthesis results to uterine decreases blood supply to
contraction the uterus that triggers
• Fetal membrane production uterine contractions,
of prostaglandin, which thereby, starting the labor.
stimulates contractions
BEGINNING SIGNS OF LABOR
PREMONITORY/BEGINNING SIGNS
OF LABOR
1. Lightening 2. Braxton Hick’s Contractions
• descent of the fetal presenting • false labor contractions
part into the true pelvis • Painless, irregular, abdominal
• Onset: contractions
• Primigravida: 10-14 days
(2- 3 weeks) before labor
• Multigravida: 1 day before
or during labor
 Coronal section

false pelvis

(c)Anteriorviewoffalse elvis(inK) (a)Anteriorviewoftrue elvis(olue)

 PREMONITORY/BEGINNING SIGNS OF LABOR

3. A sudden burst 4. Slight decrease 5. Softening/ripening

of maternal in maternal weight of the cervix
energy/activity
• Due to release of • 2-3 lbs • cervix becomes
epinephrine • decrease in “butter soft”
secondary to progesterone
decrease in level promotes
progesterone easy excretion of
level in placenta body fluid thus
increase urine
production
SIGNS OF TRUE LABOR
 SIGNS OF TRUE LABOR

1. Rupture of
• Sudden gush or as scanty,
the membrane slow seeping of clear fluid
of bag of from the vagina
waters (BOW)
• blood-tinged mucus
discharged from the vagina
• Causes:
2. Bloody
• 1. expulsion of the mucus
Show
plug from cervical canal
• 2. pressure of fetus on the
cervical capillaries
 AMNIOTIC FLUID
Polyhydramnios (Hydramnios) : (> 2000 ml)

Oligohydramnios : (< 500 ml); indicates disturbance in

kidney function

ABNORMAL AMNIOTIC COLORS

• GREENISH (meconium staining; fetal distress in a non-

breech presentation)
• GOLD OR YELLOW (signifies hemolytic disease such as RH or
ABO incompatibility)
• CLOUDY, GRAY (Foul smelling; indicates infection)
• PINKISH/REDDISH (signifies bleeding)
 SIGNS OF TRUE LABOR

• initiation of effective,
3. Painful, productive, involuntary
Regular uterine contractions
Uterine
Contractions • surest sign of true
labor
 Comparison of
True vs. False Labor
 COMPARISON OF TRUE VS. FALSE
FACTOR FALSE LABOR TRUE LABOR
LABOR• Irregular
• Contractions
• regular and predictable.
• Duration frequency &
• Increase in duration,
intensity does not
frequency, and intensity.
increase
• Bloody Show • Present
• Not present.

• Becomes effaced
• Usually uneffaced and
• Cervix • Dilates and effaced
cervix is closed
progressively
 COMPARISON OF TRUE VS.
FALSE
FACTOR
• Discomfort
LABOR FALSE LABOR TRUE LABOR
• Generally confined to the • Starts in lower back
abdomen and groin and radiates around
abdomen
• Intensity • Often disappear when • Increased by walking
woman walks or sleep • Walking intensifies
contractions.

• Station • No change • Presenting part

descends
 FETAL
STATION
❖ relationship of fetal presenting part to
the ischial spines of the maternal pelvis
❖ Measured in CENTIMETERS above or
below the ischial spines
ISCHIAL SPINE
❖ Most important landmark of the pelvis
❖ Measures the degree of descent
COMPONENTs OF LABOR
A number of forces affect the progress of
labor and help to bring about childbirth.

A successful labor depends on four integrated

factors. These factors are often referred to as
the components or “P’s” of labor
 P’S IN LABOR & DELIVERY
PASSAGE • pelvis, birth canal and soft tissues

PASSENGER • fetus, membranes and placenta

• force of uterine contractions and

POWERS
maternal pushing effort

PSYCHE/PSYCHOLOGIC • attitude and behavior

RESPONSE of the mother towards labor and delivery
powers OF LABOR
 POWERS OF LABOR

The force supplied by the fundus of the uterus, implemented

by uterine contractions, a natural process that causes cervical
dilatation and then expulsion of the fetus from the uterus.

After full dilatation of the cervix, the primary power is

supplemented by use of the abdominal muscles.
 POWERS OF LABOR
Uterine • initiation of effective, productive,
regular, involuntary, uterine
Contractions contractions.

Primary • involuntary uterine contractions

Power
Secondary • voluntary pushing efforts/
Power bearing down of the mother
 • tightening of the uterine muscles during labor
Contraction • exhibits a wavelike pattern that begins slowly
climbing (increment) to a peak (acme), and
decreases (decrement)
PHASES OF UTERINE CONTRACTIONS:
1.Increment/Crescendo 2. Apex/Acme 3. Decrement/Decrescendo

• Phase of increasing up • the height or • intensity of the

or “building up” contraction
peak of the
• intensity of the decreases
contraction increases contraction
• Last; end phase
• First phase; longest • Contraction is at
• Onset of a contraction its strongest
 As labor contractions progress and become regular and strong, the
uterus gradually differentiates itself into two distinct functioning areas

Upper portion becomes

thicker and active

Lower portion becomes

thin walled, supple, and
passive

PHYSIOLOGIC • boundary or demarcation between the

RETRACTION RING two portions becomes marked by a
ridge on the inner uterine surface
The contour of the overall uterus also changes from a round,
ovoid structure to an elongated one whose vertical diameter is
markedly greater than its horizontal diameter
CHARACTERISTICS OF CONTRACTIONS

1. FREQUENCY
2. DURATION
3. INTERVAL
4. INTENSITY
 DURATION
From the beginning of contraction to the end of the same contraction

Expressed in “ seconds”

Maximum duration= 90 seconds

 FREQUENCY
From the beginning of the first contraction to the beginning of the next
contraction.

Expressed in “every minutes”

 INTERVAL
From the end of the first contraction to the beginning of the next contraction.

Best time for checking maternal BP, FHT

Interval
Interval
 INTENSITY
the strength of uterine contractions during Acme

PALPATION
• placing the hand lightly on the fundus with the fingers spread judging the degree of indentability of the
uterine wall during Acme.
 INTENSITY
MILD MODERATE STRONG

• fundus is slightly • fundus is firm & • fundus is

tense & easy to difficult to indent hard,firm & rigid
indent with with fingertips • almost impossible
fingertips • Feels like touching to indent with
• Feels like touching chin fingertips
tip of nose • Boardlike fundus
• Feels like touching
finger to forehead
 CERVICAL CHANGES DURING LABOR
Effacement

Dilatation
 DILATATION
Progressive , opening/widening of the cervical canal

Expressed in centimeters (cms)

10 cm = fully dilated cervix

 EFFACEMENT
shortening and thinning of the cervical canal

Expressed in percentage(%)
EFFACEMENT
 100% • fully effaced cervix
effaced • cervical canal become paper-thin

75% • cervix become ¼ of its original

effaced length

50 % • cervix become ½ of its original

effaced length

25 %
• cervix is ¾ of its original length
effaced
Effacement
•primipara, effacement before dilatation
•multipara, dilatation before effacement
PASSENGER OF LABOR
 PASSENGER (THE FETUS)

• largest part of the body

Fetal • most frequent
presenting part
Head • least compressible of
all parts
CRANIAL • 2 FRONTAL
BONES • 2 PARIETAL
OF
• 2 TEMPORAL
FETAL
HEAD • 1 OCCIPITAL
 SUTURES

•thin spaces in
between bones
•Aid in molding of
fetal skull
 Frontal • Anterior suture
between 2 frontal
Suture bones

Coronal • Anterior suture

between frontal and
Suture parietal bones

Sagittal • Longitudinal, midline

suture joining 2 parietal
Suture bones

Lambdoid • Posterior suture

between parietal and
Suture occipital bones
 FONTANELS

• Points of intersection of
cranial bones
• Membrane-filled spaces
between cranial bones
• Referred to as “soft
spot”
 • Formed by 2 frontal bones and 2
parietal bones
ANTERIOR • Lies at the junction of sagittal,
FONTANELLE coronal and frontal sutures
(BREGMA) • Diamond shaped
• Closes when infant is 12 to 18
months old

• Formed by union of 2 parietal

POSTERIOR and 1 occipital bones
FONTANELLE • Triangular shaped
(LAMBDA) • Closes in infant 6 to 8 weeks or
2-3 months old
 MOLDING
• Slight overlapping of the
cranial bones due to the force
of uterine contractions
pressing the head against the
cervix
• Skull becomes elongated
shape
• permits passage to the
maternal pelvis
AREAS OF THE FETAL SKULL

• Occiput : area behind the

posterior fontanel
• Vertex: lies between the
2 fontanels and extends
to the parietal bones
• Sinciput : Located in front
of the anterior fontanel
 DIAMETERS
OF THE
FETAL SKULL
 DIAMETERS OF THE FETAL SKULL

ANTEROPOSTERIOR
DIAMETERS (AP)

TRANSVERSE
DIAMETERS
ANTEROPOSTERIOR (AP) DIAMETERS
 SUBOCCIPITOBREGMATIC

• Smallest; narrowest AP diameter of

the head
• 9.5 cms
• From below the occiput to the anterior
fontanel
• Presenting part if head is in full flexion
 OCCIPITOFRONTAL

• from occiput to the bridge of

the nose
• Approximately 12 cms
• Presenting part if head is in
moderate flexion
 OCCIPITOMENTAL

• from occiput to the chin

• 13.5 cms
• widest AP diameter
• Presenting part if head is
hyperextended
 TRANSVERSE DIAMETERS
BIPARIETAL DIAMETER

• 9.25-9.5 cms
• “widest/largest“ transverse diameter
• Measured between 2 parietal bones
• In a well flexed cephalic presentation, the
biparietal dameter will be the widest part
of the head entering the pelvic inlet
Fetal Presentation
and
Position
 FETAL LIE

the relationship between

the long axis of the
mother’s body to the long
axis of the fetal body

•Longitudinal Lie
Types:
•Transverse Lie
 LONGITUDINAL /VERTICAL LIE TRANSVERSE / HORIZONTAL LIE

• long axis of the fetus • long axis of the fetus is

is parallel to the long axis of perpendicular to the long axis
the uterus of the mother. of the mother’s uterus
• Head (cephalic) • presenting part either
or breech (buttocks) shoulders a hand, an elbow,
presents first in the cervix or an iliac crest.
• Occurs in 99% of pregnancies • Vaginal birth is impossible
 FETAL ATTITUDE
the relationship of the
fetal parts to each other

the degree of flexion a fetus

assumes during labor

• Complete Flexion
• Moderate Flexion
Types: • Partial Extension
• Complete Extension
 COMPLETE FLEXION

• Normal fetal Attitude

• Spinal column is bowed forward
• Head flexed; chin on the chest
• Arms flexed & folded against chest
• Thighs flexed over abdomen; legs bent at the
knee
• umbilical cord lies between arms and legs
 MODERATE FLEXION

• “military position”
• chin not touching the chest
• occipito -frontal diameter or
sinciput presents to the birth canal.
 PARTIAL EXTENSION

• “brow” presents to the

birth canal
• Head moderately
extended
 COMPLETE EXTENSION

• back is arched; neck is extended

• head is completely extended
• occipitomental diameter of the head presents
to the birth canal
• a face presentation
 FETAL PRESENTATION
the part of the fetus that
enters the pelvic inlet first
and leads through the birth
canal
• Cephalic(Vertex) /Head
- 96%
Types: • Breech/buttocks or
feet - 3%
• Shoulders-1%
Footling breech
 CEPHALIC PRESENTATION
most common presentation

fetal head is the body part that

will first contact the cervix

• Occiput/vertex
• Sinciput
Types • Brow
• Face
• Mentum/Chin
 OCCIPUT / VERTEX
PRESENTATION
• most common; ideal
• head fully flexed on
chest
 SINCIPUT PRESENTATION

• Moderate flexion
• occipito frontal diameter or the
sinciput becomes the presenting
part.
 BROW
PRESENTATION
• Head
moderately
extended
• Presenting part
is the forehead
FACE PRESENTATION

• head is completely
extended
• presenting part:
face
 MENTUM/CHIN
PRESENTATION
• head is hyperextended
• Presenting part : widest AP
diameter the occipitomental
• a fetus cannot enter the
pelvis in this presentation
 BREECH PRESENTATION
either buttocks or
feet are the first to
come in contact with
the cervix.

• Complete (Full) Breech

Types • Frank Breech
• Footling Breech
 COMPLETE BREECH

• thighs flexed on the

abdomen & feet and
legs are tightly flexed on
thighs
• Presenting part:
buttocks & tightly flexed
feet
 FRANK BREECH

•hips are flexed;

legs & knees
extended on the
chest.
•Presenting part:
buttocks alone
 INCOMPLETE
• foot present at the
FOOTLING cervix.

• one leg is extended at

SINGLE the hip & knee & the
FOOTLING other leg presents in the
cervix

DOUBLE • both legs are unflexed &

both feet are the
FOOTLING presenting part.
 SHOULDER PRESENTATION

• transverse lie
• Fetus lie crosswise in the
uterus
• Presenting part: shoulder,
iliac crest, a hand, or an
elbow
 FETAL STATION
relationship of fetal presenting
part to the ischial spines of the
maternal pelvis

Measured in CENTIMETERS above

or below the ischial spines

• Most important landmark

ISCHIAL of the pelvis
SPINE • Measures the degree of
descent
 Station Plus (+) Station
Minus (-) 0/Engaged
Station
• Presenting part • Presenting • Presenting
ABOVE level of part at the part BELOW
the ischial level of the level of the
spines ischial spines ischial spines
• Expressed in • Expressed in
NEGATIVE POSITIVE
numbers (-1, -2, numbers
-3)
(+1,+2,+3)
• +4 : bulging at
the perineum/
crowning
FLOATING (HIGH)
▪ Unengaged presenting part
STATION -3
▪ presenting part is 3cm above the ischial spines
STATION -2
▪ presenting part is 2cm above the ischial spines
STATION -1
▪ presenting part is 1cm above the ischial spines
STATION 0/ENGAGEMENT
▪ presenting part is at the level of the ischial spines
STATION +1
▪ presenting part is 1cm below the ischial spines
STATION +2
▪ presenting part is 2cm below the ischial spines
STATION +3 OR +4
▪ the presenting part is at the perineum & can be seen if
the vulva is separated
STATION +4
▪ “crowning”
 Engagement

• the largest transverse diameter

(biparietal diameter) has entered
the true pelvis or reached STATION
O
• Occurs weeks before labor in
nullipara
• Occur a day before or during labor
in multipara
• Determined by vaginal examination
 FETAL POSITION

relationship of the denominator

or landmark of the fetal
presenting part to the imaginary
quadrants of the maternal pelvis
IMAGINARY QUADRANTS
OF THE MATERNAL PELVIS:
• RIGHT ANTERIOR
• LEFT ANTERIOR
• RIGHT POSTERIOR
• LEFT POSTERIOR
• TRANSVERSE
 Position is denoted by a three-letter abbreviation
First • location of presenting part to the
right (R) or left (L) side of maternal
letter pelvis

• specific landmarks of the fetal

presenting part
Middle
• (O) for occiput, (M) for mentum
letter /chin, (Sa) for sacrum, (A) for
acromion process or Sc for Scapula

Third • location of the presenting part in relation to

the anterior (A), posterior (P) or transverse
letter (T) portion of the maternal pelvis
DENOMINATOR - part
of the presentation
used to indicate the
position

• OCCIPUT (O) – cephalic/vertex presentation

PARTS OF THE
• MENTUM/CHIN (M) – face presentation
FETUS CHOSEN AS • SACRUM (Sa)(S)– breech presentation
DENOMINATORS: • SCAPULA (Sc)– shoulder presentation
 Example: ROA Example: LOA

• Occiput is located at • Occiput is located at

the right anterior left anterior quadrant of
quadrant of the the maternal pelvis
maternal pelvis
 Example: ROP Example: LOP

• Occiput is located at • Occiput is located at

the right posterior left posterior quadrant
quadrant of the of the maternal pelvis
maternal pelvis
 • Sacrum is located in
Example the right posterior
RSP quadrant of the
maternal pelvis

• Sacrum is located in
Example the left anterior
LSA quadrant of the
maternal pelvis
 FETAL POSITIONS
Cephalic/Vertex Presentation

• LOA : Left Occipitoanterior (MOST COMMON)

• LOP : Left Occipitoposterior
• LOT : Left Occipitotransverse
• ROA : Right Occipitoanterior (2nd Most Common)
• ROP : Right Occipitoposterior
• ROT : Right Occipitotransverse
 Face Presentation
• LMA : Left Mentoanterior
• LMT : Left Mentotransverse
• LMP : Left Mentoposterior
• RMA : Right Mentoanterior
• RMT : Right Mentotransverse
• RMP : Right Mentoposterior
 Breech Presentation

• LSaA : Left Sacroanterior

• LSaT : Left Sacrotransverse
• LSaP : Left Sacroposterior
• RSaA : Right Sacroanterior
• RSaT : Right Sacrotransverse
• RSaP : Right Sacroposterior
 Shoulder Presentation

• LScA : Left Scapuloanterior

• LScP : Left Scapuloposterior
• RScA : Right Scapuloanterior
• RScP : Right Scapuloposterior
PASSAGEWAY OF LABOR
(THE PELVIS)
 PASSAGE
PASSAGE SOFT PASSAGES BONY PASSAGE

• route a fetus • Cervix, vagina, • Pelvis

must travel perineum
from the
uterus through
the cervix and
vagina to the
external
perineum
 PELVIS
• A bony ring or canal
PELVIS through which the fetus
passed during birth

• Transmits the body

weight to lower
extremities
FUNCTIONS
• Support and protects
the reproductive and
other pelvic organs
FOUR PELVIC BONES

•2 innominate (hip
bones)
•1 sacrum
•1 coccyx
 INNOMINATE / HIP BONES
ILIUM ISCHIUM PUBIS

• the upper • thick lower part. • the anterior or

flattened part of • Ischium front part of the
the hip bone Tuberosity - a hip bone
large prominence • Symphysis Pubis
on which the - where the two
body rests when pubic bones
sitting. meet
• Ischial Spine - an
inward projection
behind and a
little above the
tuberosity
 1 SACRUM

• a wedge -shaped bone

consisting of five fused
vertebrae
• Sacral Promontory
❖the center of the upper border
of the first sacral vertebra
 1 COCCYX

• a vestigial tail.
• A small bone consists of four
fused vertebra forming a
small triangular bone.
• NODDING.- the backward
movement of the coccyx
during labor providing more
space for the delivery of the
fetus
DIVISIONS OF THE PELVIS
• superior half; upper
• larger but shallow division
FALSE • supports the uterus in the abdominal
PELVIS cavity during pregnancy
• the portion above the pelvic brim

• inferior half; lower

TRUE
• curved, smaller portion
PELVIS
• bony passage /canal
 LINEA TERMINALIS

•imaginary line that

separates the upper
or false pelvis from
the lower or true
pelvis
PLANES OF THE PELVIS
 PELVIC INLET
(PELVIC BRIM)
• Upper portion
• entrance to the true
pelvis
• Bounded by the upper
border of the symphysis
pubis,sacral promontory
and linea terminalis
 MIDPELVIS(PELVIC CAVITY)

• Between the boundaries for

the pelvic inlet and outlet
❖TRANSVERSE OR
INTERSPINOUS DIAMETER
• between the 2 ischial
spines
• smallest diameter of the
midpelvis or midplane
 PELVIC OUTLET

• lies at the level of the

ischial tuberosities, the
lower border of the
symphysis pubis and coccyx
 IMPORTANT
PELVIC MEASUREMENTS
PELVIC MEASUREMENTS
❖ANTEROPOSTERIOR DIAMETER
❖TRANSVERSE DIAMETER
IMPORTANT MEASUREMENTS IN THE
PELVIC INLET OR PELVIC BRIM
 DIAGONAL CONJUGATE (DC)
• most important measurement of the pelvic inlet
• Widest anteroposterior diameter
• distance from the lower/ inferior margin of the
symphysis pubis to sacral promontory
• measured by internal examination
• ADEQUATE SIZE = 12.5 - 13 cm or more
 OBSTETRICAL CONJUGATE

• Smallest/shortest anteroposterior diameter of

the pelvic inlet
• distance from inner surface/ midpoint of the
symphysis pubis to sacral promontory
• To estimate: subtract 1.5 to 2 cm from the
diagonal conjugate(DC)
• > 10.5 cm
 IMPORTANT MEASUREMENT
IN THE MIDPELVIS

INTERSPINOUS DIAMETER

• smallest transverse
diameter of the pelvis
• > 10.5 cm
• Distance between the 2
ischial spines
INTERSPINOUS DIAMETER
 IMPORTANT MEASUREMENT
IN THE PELVIC OUTLET
INTERTUBEROUS DIAMETER
(BIISCHIAL TUBEROSITY)

• distance between the 2 ischial tuberosities

• narrowest transverse diameter of the pelvic outlet
through which the widest diameter of the fetal
head(biparietal diameter) must pass through
• Atleast 11 cm
• Measured with a clenched fist
• Measured using the knuckles of a fist hand placed
across the perineum
• knuckles do not touch both tuberosities on the
sides
 ANGLE OF THE
SUPRAPUBIC ARCH
• Normal: 80-90 degrees
• Provides adequate
room for the upward
extension of fetal head
at delivery time.
 A PELVIS IS ADEQUATE IF:

• The promontory of the sacrum

is not accessible
• The pelvic sidewalls are parallel
• The ischial spines are not
prominent
• The sacrum is not flat
• The pubic arch is wide (>90º)
TYPES OF PELVIS
 GYNECOID PELVIS

• Normal and classic female

pelvis type
• Found in approximately in
50% of women.
• Inlet well rounded / circular
• MOST IDEAL FOR CHILDBIRTH
 Characteristics of Gynecoid Pelvis

• Round inlet, with the widest

transverse diameter only slightly
greater than the AnteroPosterior
diameter
• Side walls straight
• Ischial spines of average
prominence .
• Well-rounded sacrosciatic notch
• Well-curved sacrum
• Spacious subpubic arch, with an
angle of approximately 90 degrees
 ANDROID PELVIS

• Found in less than 30% of women

• resembles a male pelvis
• Narrow and heart-shaped
• Fetus will have difficulty exiting from this
type of pelvis
• Associated with worse pregnancy/labor
outcome
• Usually requires cesarean section or
difficult forceps delivery (20% of
women)
 Characteristics of Android Pelvis

• Triangular inlet with a flat

posterior segment & the widest
transverse diameter closer to the
sacrum than in the gynecoid type .
• Convergent side walls with
prominent spines
• Shallow sacral curve
• Long and narrow sacrosciatic
notch
• Narrow subpubic arch
 ANTHROPOID PELVIS

• Ape-like
• Found in approximately 20% of
women
• oval-shaped; long & deep/narrow
• The narrow transverse & wide
AnteroPosterior does not conform
to the head of the baby
• Mode of Birth: spontaneous,
vaginal, forceps
 Characteristics of Anthropoid Pelvis

• A much larger AnteroPosterior than

transverse diameter, creating a long
narrow oval at the inlet
• Side walls that do not converge
• Ischial spines that are not prominent
but are close, owing to the overall
shape
• Variable, but usually posterior,
inclination of the sacrum
• Large sacrosciatic notch
• Narrow, outwardly shaped subpubic
arch
 PLATYPELLOID PELVIS

• Flattened broad pelvis

• short Anteroposterior diameter
• wide transverse diameter.
• Found in only 3% of women
• rarest type of pelvis
• Fetal head might not be able to
rotate to match the curves of the
pelvic cavity
 Characteristics of
Platypelloid Pelvis
• A short AP & wide transverse
diameter creating an oval-
shaped inlet
• Straight or divergent side walls
• Posterior inclination of a flat
sacrum
• A wide bispinous diameter
• A wide subpubic arch
PSYCHOLOGICal RESPONSE
OF THE MOTHER
 PSYCHOLOGICAL OUTLOOK

•Refers to the psychological state or

feelings that a woman bring into labor.
•Feeling of apprehension or fright
•Includes a sense of excitement
 CULTURAL VALUES

• affect the family’s expectations of birth and

satisfaction with it.
• influence who the woman wants to support her
during labor, how she expresses pain
• Influence specific practices that are important
to her and her family
 FACTOR THAT AFFECTS PSYCHOLOGIC
RESPONSE TO LABOR PROGRESS
• Expectations and goals for the labor process
• Feedback from other people participating in the
birthing process
• Childbirth preparation process
• Support system
 SPECIAL CONSIDERATIONS

• Fear and anxiety affect labor progress

• Anticipation of pain can increase emotional
tension thus increased pain perception
• A woman who is relaxed, aware of and
participating in the birth process usually has a
shorter, less intense labor
Catecholamines-stress hormone that can inhibit uterine
contractions and placental blood flow

Excess muscle tension means that each contraction or

maternal bearing-down effort must work against more
resistance than if the tension is less.

Excess anxiety and fear consume maternal energy that she

could otherwise use to cope with the demands of labor
References

Printed Textbooks:

618.20231 Si327 2018 v.1. Silbert-Flagg, J. (2018). Maternal & child health nursing: care of
the childbearing & childrearing family. Philadelphia, PA Wolters Kluwer Health.
618.20231 Si327 2018 v.2. Silbert-Flagg, J. (2018). Maternal & child health nursing: care of
the childbearing & childrearing family. Philadelphia, PA Wolters Kluwer Health.
Electronic Books :
eBooks (Ebschohost). Clair, B. (2022). Carrying on: another school of thought on
pregnancy and health. New Brunswick Rutgers University Press.
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