When the fetus is engaged, the largest diameter of the presenting part (biparietal diameter) passes through the pelvic inlet the fetal head will be at 0 station. The pelvic inlet is the upper border of the true pelvis and is determined by three anteroposterior diameters: diagonal conjugate, obstetric conjugate, and conjugate vera. A fetal station is where the top of the fetal head is in relation to the imaginary line between the ischial spines of the maternal pelvis. The fetal position is also dependent on the fetal station in relation to the pelvic outlet. When the fetus is occiput posterior, which means the fetal occiput is against the pregnant clients posterior, the client may experience a lot of back pain during labor. For example, a fetus is vertex (head down) position with the occiput (back of the head) towards the left front of the maternal pelvis, which would be documented as LOA (left occiput anterior), which is the most common position. Additionally the position of the fetal head is also described by which direction the occiput (in a vertex presentation) is in respect to the maternal pelvis. Right (R) or left (L) side of the maternal pelvis, landmarks include occiput for vertex presentation (O), scrum for breech presentations (S), scapula for shoulder presentation (Sc), and mentum for face presentations (M). Three notations are used to describe the fetal position and are used to help with maternal positioning during labor. The fetal position is the relationship of the landmark on the presenting part to the anterior, posterior, or sides of the maternal pelvis. As the head deflexs or changes in flexing or extending of the neck/body concerns arise regarding complications with brow or mentum presentations and “failure to progress” due to malpresentation of the fetal head. This fetal attitude is optimal for delivery since the fetal head is presenting within the pelvic inlet at the smallest possible diameter (9.5cm). A normal attitude is one of general flexion, where the chin of the fetus is flexed into to the fetal chest. The fetal attitude refers to the position of the fetuses head in respect to the fetal spine. The longitudinal position is optimal for vaginal delivery with singleton fetus (Kirkpatrick, Garrison, & Fairbrother, 2021). The lie can be longitudinal with vertex or breech presentation, transverse with a shoulder presentation or oblique. The fetal lie refers to the longitudinal lie of the fetus in comparison to the longitudinal axis of the uterus, in other words the relationship of the spinal column of the fetus to the spinal column of the pregnant client. With breech presentation, whether complete, footling, or frank, delivery typically occurs via C-section. Most other positions may cause cephalopelvic disproportion and cause labor to become irregular and lead to surgical intervention via cesarean section (C-section). Vertex (occiput) is the optimal presentation for a vaginal delivery. A fetus descending into the pelvis and birth canal can be in a multitude of presentations and would be documented as such as the pregnant client is progressing. The possible presenting parts of the fetus are: vertex (occiput), breech (sacrum), shoulder (scapula), brow, face, or chin (mentum). The fetal presentation is the part of the fetus entering the maternal pelvic inlet first. These suture lines and fontanels can be utilized for assess for the fetal position with in the pelvic inlet during labor. As seen in the in Figure 1 the fetal head is comprised of several unfused suture lines, and fontanels allowing the fetal head to “mold” as it passes through the birth canal. The biparietal diameter measurement is the transverse distance between the the parietal bone protuberance. The biparietal diameter of a term 40 weeks gestation fetus is approximately 9.5 cm. The fetal head is the largest part of the baby. Passenger (The Fetus) – Fetal Head, Fetal Presentation, Fetal Lie, Fetal Attitude, Fetal Position Fetal Head The ability of the fetus to successfully negotiate the pelvis during labor and delivery depends on the complex interactions of three variables: uterine activity, the fetus, and the maternal pelvis” (Kirkpatrick, Garrison, & Fairbrother, 2021). “Labor and delivery are not passive processes in which uterine contractions push a rigid object through a fixed aperture. Discuss the rationale for common elective and operative intrapartum procedures.Compare the types of pharmacological pain relief used during labor and delivery.Identify non-pharmacological strategies to enhance relaxation and decrease labor discomforts.Examine the influence of culture on childbirth and discuss the nurse’s role in supporting women through this process.Identify the characteristics and behaviors associated with the stages and phases of labor.Explain the 5 factors affecting the labor process.
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