Four P\'s of Labor

1. fetus is either longitudinal or transverse
(longitudinal is the safest)
(transverse is not good, may need C/S, risk for prolapsed cord, especially if water breaks)
- high mortality rates and asphyxia w/ transverse lie

1. the fetus presenting part to the ischial spines
2. station 0 or below
3. above the spines
4. below the spines
- water can be broke at a 0 or -1 station, anything higher is a risk for Prolapsed Cord

1. part of the passenger that enters pelvis first
(vertex, breech, brow, shoulder, face)
- frank breech is butt first
2. Prolapsed cord - cord below fetus in pelvis (prescence of meconium in amniotic fluid indicates need to assess for PC, Variable Deceleration, oxygenate mother via face mask, monitor FHR & place mother in knee-chest position to relieve cord compression)
cephalopelvic disproportion (CPD) - fetus can't fit into the cervix
- Asphyxia, not enough oxygen flow
- C/S, C-section delivery

1. change or turning the fetal presentation by abdominal or intrauterine manipulation.
2. need consent, ultrasound done to locate placenta, done at 37 weeks gest. if still breeched, perform nonstress test (reactive = good), done in a hospital setting, have IV access, tocolytics help to relax uterus

1. Twins, overextends the uterus & increases risk for preterm labor & birth, C/S delivery & postpartum hemorrhage (hard for uterus to go back to regular size allowing more vaginal bleeding)

1. three letters denoting relationship of a landmark on the baby to the mother's pelvis
ex. LOA = Left Occiput Anterior (the Occiput of the baby is pointing toward the Left front of the mother's pelvis)

1. Movement of the baby thru the pelvis during labor/birth. Essential to an easy, safe passage.

Engagement/descent
Flexion (head/chin flexes down)
Internal rotation (rotates to fit thru pelvis)
Extension (occiput first out thru vagina)
External rotation/restitution (shoulders turn to fit out of vagina)
Expulsion (rest of the body follows)

- power during labor comes from the upper uterine segment (FUNDUS)
- 2nd stage - adds power of abdominal muscles

1. to move the labor along while its contracting
2. to begin labor (water broke but no contractions)
3. to soften and efface the cervix