Process of Labor

Give everyone a few more seconds to join and then we'll get started. Oh, jasmine in the middle of your ob course too. Do you guys talk about stes just out of curiosity in your ob class or do you guys cover that in a different section? Got It. You've covered, it'd be a little bit perfect. I'm thinking about doing a tutoring session with um, all the different stes and just the different treatments and what to watch for and things like that because we cover that here, um, at the colleges. But it seems like a lot of places have it at separate, not in very depth, so a little bit. Okay. Um, all right, well maybe we'll add that as just something, so we are going to talk about process of labor tonight. Um, so this is just kind of what the mom has going on to get through labor, things about baby positioning.
Um, and then we'll really dive into that with the baby positioning because I think that's a little confusing when they're talking on tests, giving questions and they're talking about is the baby roa loa, just the different positions. I'm going to go through just some terms with stuff that might be kind of like what, why, but then I'm going to show you guys images and these images are going to make a thousand times more difference and you'll understand it hopefully a whole lot better. And then I'm going to give you the links to those, um, to these websites. I have these images on this that you'll have them to go to, um, that you can look back when you're setting. All right, let's get started. And of course at the end we'll have time for all the questions and answers. All right, I'm gonna share my screen.
Can you guys see that? Okay. All right. So first, just these basic definitions that, um, a lot of the schools have ya learn and make sure you know, so the process of labor is gonna include a few different things. The four piece, which have to do with the mom, and then what we call out pneumonic, which this has to do with the baby's positioning. All right? So first are four P's. Um, the first one is going to be powers. So powers upset at me to make that underline. Um, so powers are going to be two different things. We have voluntary and we have involuntary. So our involuntary are going to be contractions, right? The mom has no control over that, but that is going to give her power. So contractions give like a force to that uterus to help push the baby out. Okay? So that's part of the power.
If we have good contractions, then we can deliver a baby easier than if we have poor contractions. So that's our involuntary and voluntary. So what she has control over is gonna be how well she pushes, right? So that's her power. Those are our both of our powers. Um, the next P is passageway. So passageway is gonna refer to obviously the pelvis, right? The way the baby's got to pass through, how it's getting through. So the shape of that pelvis. Um, how much room there is for that baby to get through it. So easy enough passenger, well we have two, but our main one is going to be the baby. Obviously if there's more than one. So the baby and then the placenta, those are our passengers that are gonna get their way through the passageway. And then our last P, which is always super confusing because it doesn't sound like if he is site.
So this is going to be just how mom feels. Um, you know, her emotional state, she has that support person, all that. So when you have patients that don't have that super, like don't think they can do it, they don't have that competence to do it. Their psych isn't good. I can tell you they do not deliver a baby or push as well. They just don't. Um, they need all of these things to be working together to deliver this baby. So those are four ps. Our next little pneumonic here that out is referring to attitude, lie presentation, presenting part and the positions. And we'll go through them. Student doesn't memorize all that right there. Um, so the first one is attitude. So attitude is just referring to how the baby is like is it ab flex or extended? So IX flex means that ace flex down in that fetal position, that chin is to the chest, chin to chest, um, or their extended.
And that would be where their head is super extended back. And I don't know why I always am like acting out these positions and you all cannot see me. Um, so I can show you after if, if we're confused about anything. So flex is chin to chest or extend it. If we are extended than that baby's not gonna deliver very well because we need that chin to the chest. It kind of helps pave the way. I mean the baby can deliver easier. So that's our attitude. The next is going to be the lie. So the line is going to be referring to are we um, vertex? Are we transverse? So transfers is going to be where we are. Um, oops, sideways. So here's mom's spine is going up and down and then we have the baby's spine crossing that. So it's like making a t a sigma that trans versus going across vertex is just straight up and down.
Um, this could be, we want them to be vertex with their head down, just gonna be 'em. If they're not, then they're in breach position. So they have like their foot down or their bucked down. Um, and the head is up in the ribs. So that's going to be our lie for different lies presentation. So presentation, they are either some phallic or it's there, but whatever is the presentation of the baby, hopefully Suffolk, right? Which that's head. That's what we want to see our presenting part. So that is what are we seeing coming through? So these kind of overlap. So hopefully it's our head, right. Um, which that's going to be labeled as, oh, when we get through this. And that'll make sense in a minute. Um, shoulder could be a presenting part, hopefully not, but it could be. So that would be sc for Scapula when we're labeling it.
Um, or do we have the chin coming first, which is an am because of men. Tom Is the job, owns that chin bone. Um, so you never want to see this. This is so bad. The Chin's coming through, the chins being delivered first, that head is going to snap. So they have to, the doctor has to literally push that baby's head back up and go to the or. Um, I've seen that happen a couple times. So what we want to see is the head down as the presenting part. And I'm going to go through this and these o s c m is all gonna make more sense in a minute, I promise. Um, and then our last little piece here, our last p is our position and position is just going to be, are we um, anterior or posterior? If I could spell still can't. Here we go.
Okay. So anterior, posterior, this means, are we towards the front or tor is the presenting part towards the front or towards the back. So anterior means we are well towards the front and posterior means we're towards the back. So that just means the presenting part is either facing the front of the pelvis and his anterior or it's facing the back of the pelvis and his post here. And again, when I show you these images, this will make sense. Our last one here is station. And we'll get to this. I'm actually gonna come back to this when I can draw it out on my little board and um, it'll be easier. So I'm going to take you guys over to, um, these websites just show you these images. Hold on one second. Okay.
Okay.
Cheers.
Maybe
sorry guys, hold on.
Okay.
Why is it
there? Go.
Alright. I know it looks really weird now. Can you guys see my screen?
Okay,
let me know if you can see my screen so I can click. I don't want to lose you guys. Yeah. Okay, perfect. Sorry. All right, so I'm going to click into these couple of websites and I'll give you guys the links. So this first one is called, um, this spinning babies. That's not the one I want to. And that was my second one I was going to show you. Awesome. Well, let's go here first. Okay. So this little spinning babies, this show. So we have the mom, when we are talking about different positionings, we're gonna label them Roa, loa. And I'll tell you what all that means. The first letter, let's take, um, this one for example, this baby's being born and coming. We say right that the presenting part, which is the OSC, the put the heads of the asa puts that bone on the back of the head here.
Okay? So that little bone there, so that's the asa put, the asa put is facing the right side. So this is going to be the mother's pelvis, the mother's right side. So not what we are looking at or what the doctor's looking at. So it's the Moms, right? Okay. So right off the put, and it's, and here ear. So if you remember, the anterior versus posterior, anterior means it's towards the front. Okay? So let's look at this one. For example, this baby was coming through. We have the asa put is facing the mother's and left sides with Elo and it's p, it's posts here years, it's more towards the front. So Roa is going to be our most common, and that's what we want to see for, for delivery. You will hear in clinicals, people saying, oh, their OCI. So that means they're directed p asa put posts here.
So they're just, we call them sunny side up. Literally the asa put is facing straight to the back, the posterior of the mom. That's a very hard position to deliver it because that Chin is that flex to the chest, right? A baby is keeping its head straight in line and not cooperating. Um, so that is our p. So these, I just think it shows you all the different things. Our t is transverse, so just how it's turned. Um, our p posterior or a anterior. And then all of these are our o for our presenting part, our [inaudible]. Um, cause obviously if we start to see the chin coming out, we're not delivering that this way. If you have a scapula hanging out down here, that's not happening either. So while we're having a vaginal delivery, really the o is the presenting parts. So if you get this on a test, I want you guys to write out or kind of draw out whatever's written.
Um, so it'll explain, you know, it's facing the right, whatever it may be. Um, and I just think drawing it is a really, really helpful. Okay. I'm going to get, I'll start other links here. Uh, this is the one and this link or this image. I just think this website called spinning babies, it shows just so many different little positions, but I love the, um, the artwork. I think it makes it just such a visual here. So this baby you see as an LOI. So we're at the left mom's pelvis, right, the left side, the occiput, and we're anterior that headspace or the [inaudible] put here space more towards the front instead of towards the back. So hopefully that makes sense and help you guys. And then I'm gonna take you in here and we'll get this link. So this is our process of labor, right inside of interest in g, you guys can go to and watch the video and look at the different images and little helpful guides. What questions do you guys have about that? And I'm gonna stop sharing screen. I'll put these links in for you guys. Oh No, you guys can see me. I'm so sorry. I was over there talking about all these things or I'm gonna put these links in. I don't know why it does that. When I click out. Could you all not hear me or could some of you hear me
okay?
Oh good. Some people heard. Okay. Um,
okay,
you guys, could you see all the images? Arlene, you still can't hear? Um, I don't know if you refresh your screen.
Okay,
good. I'm glad I didn't lose all of you. I'm putting in here these different links of the images that I showed you all and took you to. So for those that couldn't see it or hear it, um, these have really good positions that are pictures of all the different positions that show you the positioning of our we left, right? Also put facing which way anterior posts here. So I hope you guys like those images. I think they're really helpful. Um, so before I mentioned the station that last s on the outs, that marker, um, that I would go to. So I don't want to forget. So I'll tell you guys about this, um, s and what it stands for into me. This is just way easier for me to draw. So I'm gonna do that and hopefully this will be really clear. Alright, so s is our station.
So this has to do with where the baby is in terms of delivering. What station are we? So guys, I'm a really bad artist. This is a pelvis. Okay, so here is where like the baby's coming down the birth canal. Okay, here's spine. Oh, maybe that doesn't look so bad. Um, okay. So wherever that baby is, if we are at the issue signs, this is known as zero station, okay? We're at the issue response zero. So this is obviously felt when they're doing a cervical exam and they'll figure out where the baby is. The closer the baby is to delivery, it's going to be positive numbers. So it's like centimeters. So we're plus one plus two plus three is like the head is crowning. Okay. If the baby's up, we say if they're up high, they're floating up there kind of terms, you'll hear it's going to be minus.
So minus one minus two minus three is typically as high as you get. Um, so that just means that the baby's not well engaged in the pelvis. So we're not close to delivering that baby needs to get its way down there to make its way out. So positive numbers, just think of it like this. It's a positive thing, but the babies close to delivery. So these numbers are going to be positive. Um, people get this confused when you're in your ob class, when you're talking about your fundal assessments, they get it confused with that because the funding has the top of that uterus as you're measuring it going down after having a baby, it's minus numbers. Um, so it's going to be one more time I'll station. It's a positive. Their positive numbers mean more closer to delivering. So we're moving further down. Does that make sense? You guys have any questions on the station stuff or on Fundus or any of that?
[inaudible]
or any questions at all? I'm happy to answer for you now.
Yeah,
you guys have no questions.
Oh, I'm surprised, but I'm glad. I hope it made sense. Um, I know this is about labor. I was curious about how to differentiate. Oh yeah, you are welcome to ask any questions that does not have to be just about this labor stuff. Any Ob questions I'm happy to help with. Um, I knew you were going to say that I was waiting for it. Yes. Pre-Vis and abruption. These things are always, um, always, always, always mixed up. It's one of the things I talk about when I do our five misunderstood ob concept tutoring session. Okay, so a Previa. Your key things here are painless bleeding. That is your big, big symptom there. Painless bleeding. Okay. Abruption. It's going to be painful. All right, so let's talk about why and what this all means. So previa just has to do with the location that the placenta has been implanted. Hold on, let me get my uterus pillow.
[inaudible]
because this is so helpful. Okay, so I know y'all crazy. I'm crazy. Okay. So when our placenta attaches, we want it to be, you know, up here in the uterus, right? So in a Previa, the placenta is attaching in the wrong place. So typically if we have a complete Previa, that means it's covering the entire cervix. It is not supposed to implant down at the bottom. It's supposed to be up here. So this, um, the Previa, the placenta attaches down here, so it's going to cause bleeding throughout the pregnancy. Not always. Some people with a lot, some people it's a little, but they will have painless bleeding noted. Um, oh good Arlene, I'm glad you got sound. Um, so you have painless bleeding happening, um, with that. So that's our premium. There's different ways that can implant, but typically it's going to be over the cervical Os.
Um, it could also be marginal where it's not completely covering the cervix, but will still cause pain leading your abruption. So an abruption is where you have the placenta attached to the uterus. OK. And An abruption means a comes detached before it should. You never want the placenta to come detached before the baby has delivered by an abruption. That's what happens. So you might have a little bit of an abruption where it comes separated and blood fills up behind. It's painful. Think about you have an organ attached and it's coming detached. It hurts. Okay. So the abruption, it could be a full abruption where it comes completely detached. The abdomen fills with blood. So another big symptom with our abruption is gonna be painful bleeding and a board like rigid hard abdomen, um, because it's filling with blood. So it's getting rock hard, if that makes sense.
Um, so anyways, so the abruptions it can be several different levels. So those are your big differences. Um, typically on questions you would probably see something where it's either saying it's painful bleeding or it's painless bleeding, um, like hematoma. So yes, kind of, but the or the, so the big problem with it is that with a placenta coming detach or placenta is the babies by heart kind of, right? It's their lifeline. Um, like without our heart, we're not gonna work without that placenta. That baby's not going to get the blood, the oxygen and nutrients it needs. It's not gonna work. If you have a full abruption, that baby's not gonna make it. Um, unless they get that baby out so fast. But it's rare that that would happen. Typically they're on a monitor strip and you start to see on the strip that that fetal heart rates not looking good as it's coming detached and we take care of it, we do action right away. Um, so those are those big differences. Jasmine did that help? Okay, you're welcome. I'm glad I asked to pull out my uterus. The love for you all. What other questions do you guys have? Anything ob related, maybe something you've seen in clinical that you don't get or your teacher isn't clear on anything. I'm happy to help you.
Okay.
Okay. PREECLAMPSIA versus help. So
sure.
Pre E we call it for sure. So pre what this is, is it, um, going to be hypertension? That happens in pregnancy, but there's a few key so they have to be over 20 weeks gestation. Okay. So that's number one. Number two, they have to have protein in their urine. This is a must. If they don't have protein in her urine, they do not have preeclampsia. So P and p k pre has protein and we have hypertension. So we're going to have an elevated or elevated blood pressure. So our number is typically one 40 over 90. Now, this is not just like one check. We're done. You have preeclampsia because you were one 40 over 90. They're going to give you a little break, recheck it. So you need to have this time to four hours apart. Typically, that's really detailed. So one 40 over 90 your big things here are just that they're over 20 weeks in protein in the urine.
Now, real quick, before we get to help, so [inaudible] can mean, um, can develop into Eclampsia. So just think about it. This is pre work before the acclaim. See I happened, this just means that the preeclampsia patient has ceased. So our patient, that's pre e, but the way to solve this is to have a baby that's the only cure. Um, but we can give her mag sulfate prophylactically and what that is for, it's to prevent seizures. But the MAG sulfate has this awesome side effect of lowering blood pressure. So it really is helpful. Um, so she'll get mag sulfate and be delivered eventually. Um, but we're gonna keep watching her because she could see, okay. So our help syndrome, um, any of these blood pressure problems can develop into help. Help is scary. Help is a very sick mom, very sick. And the only way to help her to cure her is going to be delivery. Um, and they don't care how many weeks your baby is. If your baby is term awesome. If your baby's 20 weeks and not viable, too bad, um, because you are so sick that the mom is at risk to die if we don't get this baby out because it's the only way to help her. All right, so this is, uh, pneumonic. So it's known as HELLP Syndrome, but it has a few different things that go with it. So our h is homolysis,
so homolysis of blood cells. So this patient might look Jaundice, r, e, l, R, elevated [inaudible],
no
liver enzymes.
And then miss LP is low platelets, so they don't have to have all of these. Okay. So remember that. Sorry that because, um, you're going to get tripped up on that. They don't have to have all of these. They just have to have one of them and it could build, watch it so they could have low platelets and that's all they have. And they'll watch it. And if the platelets keep trending down, you know, they're not going to immediately deliver just because she has low platelets, but they're going to watch it. And if she's worsening or any of this starts to happen, it's done. You have to have a baby. Um, so those are things with help. So typically this patient has hypertension of some type happening in pregnancy, um, and they go into help syndrome. Um, but these are the sickest of sick moms that you'll see.
Our secretary actually, um, that help syndrome. She was at work and look awful. I'm very puffy and swollen. And um, the next day or two days later, I think we all got a message that she was at a different hospital that has a NICU that takes lower gestation babies, um, and her baby defined, but she had to have her baby, I think at 25 weeks because she had helped syndrome. So super scary. But those are your things that happen with that. So are elevated liver enzymes, low platelets. So these patients might have some, um, little like bleeding, like bruising from their low platelets and be jaundice will be some things. Could you explain about how the funnest in station number confusing? Yes. Erase that. Oh, she, I did. Okay. So let me dry that again and then do the funnest thing. Okay. So let's start with fun. This so fun. This has to do, okay. Fundus is the top of the year, right? Okay. So after the baby's born, we are going to be checking to see where that fund is. Is we want to check to see that it's moving back down because right. It's got to go back down to the pelvis and sacral live up here in our abdomen forever. Okay? So we measure this at all right? Let me draw a little lady here.
Okay. That's her belly button. that.in the middle. Okay. So when we are checking where her, um, find it says after delivery, typically it's going to be at you. And that means at the unbelief. That's all that means. So it's at you at the umbilicus. That's where we want to see it. Every day. It should move down one to two, what we call finger breaths or centimeters is really all that it is. But you measure it with your fingers. So I'll put my hands on and measure how many fingers below you it is. So for day one, postpartum day one, we should be at you. Minus one. Keep going, you minus two. And it keeps on going down until we can't feel it anymore. So that is the fundus. So this is after delivery.
Okay. Um, now during pregnancy, while they're pregnant, we are, the doctors will be measuring from the pubic symphysis up to see how many weeks the baby's measuring. So from the pubic synthesis up to the top of the fundus. So if in centimeters that measured 28, then she's probably about 28 weeks pregnant. That's how the baby's measuring. Okay, so that's during pregnancy. Now let's talk about the station thing. So the station, that's fine. Okay. Here's the baby's head. Our issial spine is zero station. So when we're saying, okay, that baby is at zero station, we made it right, they're engaged. But at the issue of spines, as the baby gets closer to delivering, we are plus one plus two and plus three is going to be about the head crowning. So it's opposite of this. When the Fundus is moving down, we're measuring minus one minus two minus three. When we're measuring the baby coming out, it's the Plus one plus two plus three. If the baby's high and floating up there and nowhere close to delivering, then we're at the minus. Did I make that clear or is that much more confusing now I hopefully I didn't make it more confusing
so they're opposite. Okay, good. Cause then I threw in measuring when they're pregnant and I didn't want to throw you off. What other questions do you guys have anything?
Hmm
guys go to those websites and um, look at the different pictures. That just makes it so much more clear. At least for people like me, that might be a visual learner help. So those are in there and then use NRS in g. So I put that process of labor link in there. And if you go to that and then over to the side, you'll see all the other ob lessons. If there's anything else that you're not clear on.
Okay.
All right, well if you guys don't have any other questions, then hopefully I'll see you at the next session. Oh, postpartum hemorrhage. What do you want to know, Christina? They bleed a lot. You got to measure the blood. You want to know meds? I'll tell you anything you want. Okay? So someone's having a postpartum hemorrhage. It's your biggest nightmare. So they can bleed really, really fast and you got to fix it really, really fast. So the first thing, you're never going to leave your patient, okay? So you're going to call for help. You are going to massage the fundus. So massaging the Spanish just means rubbing on those fibers. Okay, Robyn, make it firm. Cause hopefully that'll stop the bleeding cause a boggy. It's either a boggy uterus or affirming or uterus. Obagi means it'll bleed. So massage it to firm it up. Um, we are going to possibly give meds.
So pitocin is going to be or Oxytocin, um, will be the drug that you're going to give id or I am, uh, then there's some other meds we have methergine or the name you often I was like math, Alergan or bean. And the other one is Hemabate or carbo prose. So these medications are two other medications that we give a lot for hemorrhage. Um, they both are just gonna help firm up that those muscle fibers methergine you have to worry if they have hypertension. So star that and remember it can be not, I mean contra indicated maybe not the right word. Maybe be more cautious. Um, because the methergine causes those vessels to constrict and it can cause uh, your hypertension Dorson or blood pressure to get higher. So if they have hypertension, we want to make sure the doctor's aware, the carbon pros or Hemabate we want to worry about this one with asthma patients, these are always test questions it seems like. Um, so worry about that with our asthma patients cause it can cause Broncos spasms to occur. So you just want to let the doctor know if they have that. If they order, but typically just massage the fundus, gives some fluid, maybe some blood, if they've lost a lot, we want to wade the blood to see how much they've lost. Um, so one to one ratio. So one gram was one ml of blood loss. Um, and then meth origin and carbon [inaudible] are your big drugs that she'll give.
Okay.
Ah, oh gosh. Okay. Sorry. Fetal monitoring. So you're welcome. Um, OK. Decelerations and Mary bellies. So we have a few different, so r d salary options. Um, okay. We have two different types of desales. No, that's not it. Okay. Let me just draw this real quick and then I'll show you. I couldn't, it's easier to do it like this. Okay. So are two different types of decelerations. Let me, um, that's separated. Okay. So this top one here, these are called late. So at the bottom you have contractions at the top. You have late, late mean the deceleration happens after the start of the contraction. Okay? So we're de selling and then we're de selling. Again. That's not good. That means that we have placental. It means that, uh, the blood's not getting through the placenta to the baby away. It should. This is what would happen with an abruption.
Okay? So those are our late, all you really need to understand for a class I would say it would be just these basics. Okay? So late decelerations, what you're going to do, late decelerations, you're going to give them oxygen, you're going to give her a fluid Bolus and you're going to turn her profitably to her left side. Um, just to help get blood flow to the baby. Left side is best for pregnancy. Okay? So those are your lights. These are early decelerations. Down here. Earlys are good. Earliest mean we have head compression, which means a heads closer to coming out of the vagina. It needs, it's getting at squeeze. So earlys you'll notice are a image. So you'll definitely see words like that on tests and near image, um, or the deceleration and heart rates starts with the contraction and returns to baseline. So those are your early, so those are the big things to know. Um, so earliest are good, late decelerations are not. And then just know what to do for the patients who stopped the pitocin and she's getting it, give her oxygen fluid Bolus and turn her, you stopped the pitocin because the baby's not tolerating contractions. So if we're giving her something that causes contractions and we want to stop that, um, okay, so that is decelerations and variability. So variability just means that we have good, um, if we have good variability then the heart rates kind of moving up with the eraser. Um, let me just draw it.
Okay. So good variability needs to just kind of have a heart rate that's jumping all over the place. Okay. So it's moving all over. Um, looks good. Poor variability would be that baby. Like that's kind of looks like flat line. You want to have this cause it needs to, maybe he's moving around in there and the heart rates going up. So those are your things with variability. Um, usually variability just means that we have cord compression. So the baby's Kinda pulling on the cord or turning if it's not good variability. So not good variability. Is this where we have a flat line? It's just a sleepy baby. So we need to wake him up or it could look like this. Let me draw our contractions where we have just these like huge dips in heart rate happening. That's not really happening with the contraction, but the heart rate just keeps dipping versus the lates and the early decelerations.
Those were kind of happening with the contractions or right after. So variability just means we're having debts everywhere. This means the cord is being compressed so you, that little sucker is pulling on its spongy cord or it's leaning on it or something. So you want to turn the patient and tried to help dislodge the cord wherever it's being compressed. Um, and then also give oxygen. You should always give oxygen even if the mom's oxygen level is good because the extra oxygen will go to the baby, um, and help its heart rate. So oxygen is always your answer. Um, you're welcome Arlene. I hope that helped. I'm reading if you, so Kiki, I would suggest go, let me pull it up for you actually cause of all these hurry monitors, I'm going to go pull up. So hold on. If you lose my sound, um, the fetal heart monitoring because there's a awesome mnemonic and it shows you on a strip and it's really helpful.
Okay. Yeah, for you guys to have all the fetal monitoring questions and I'll probably be doing a tutoring session soon on that one. Um, so look for it. But that link will take you right in, you can watch the video, it has a full outline and it has a really awesome pictures in there that will help show you the veal chop pneumonic with fetal decelerations and just the all the heart rate monitoring. So go to that and hopefully that will help. Um, cause veal chop is going to be kind of your best way to understand it. But there's this awesome cheat sheet in there that has fetal monitoring strips and what is happening, why it's happening and then what to do if it's not good. So I really suggest using that and hopefully that will help some too. Do you guys have any other questions? You're welcome. Hopefully that will help you too. It's just, I could go on and on about fetal heart monitoring, but that will kind of sum it up and make it clear. You're welcome. All right guys. Well, I hope. Oh, you're welcome. Thank you. I hope you guys will join me. I know I'm back. I'm talking about something cool a soon, so come join me. All right guys, go out and be your best selves. Happy Nursing.