NLE Antepartum, Intrapartum & Postpartum Care — Normal Labor & DeliveryConcept Map

Concept

Components of Labor (Five Ps)

Sub Concepts

• Passenger (fetus): lie, presentation, position, attitude, size
• Passage (pelvis): bony pelvis type, soft tissues
• Powers: uterine contractions (primary), maternal pushing (secondary)
• Position (maternal): upright, left-lateral positions optimize descent
• Psyche: emotional state, fear, tension affects pain perception and labor progress

Relationship To Central

Foundation - essential factors that determine labor progression and outcomes

Concept

Signs of Impending and True Labor

Sub Concepts

• Premonitory signs: lightening, Braxton Hicks, nesting, bloody show, cervical ripening
• True labor indicators: regular, intensifying contractions; cervical change (dilation/effacement)
• Differentiation from false labor: cervical change is definitive sign
• Maternal response patterns: inward focus, serious demeanor during active labor

Relationship To Central

Assessment framework for determining labor onset and progression

Concept

Four Stages of Labor

Sub Concepts

• First Stage (0-10 cm dilation): Latent, Active, Transition phases
• Second Stage (full dilation to birth): Cardinal movements, pushing, delivery
• Third Stage (birth to placental delivery): 5-30 minutes, placental separation signs
• Fourth Stage (first 1-2 hours post-delivery): Peak PPH risk period, recovery phase

Relationship To Central

Chronologic framework for labor assessment, monitoring, and intervention

Concept

Fetal and Maternal Monitoring

Sub Concepts

• Fetal Heart Rate: baseline 110-160 bpm, variability, accelerations, decelerations
• Deceleration Types: early (benign), variable (cord compression), late (uteroplacental insufficiency)
• Contraction Assessment: frequency, duration, intensity, rest period
• Hyperstimulation Recognition: contractions <2 min apart, >90 seconds, no rest - high risk

Relationship To Central

Critical surveillance for ensuring fetal well-being and maternal safety

Concept

Pharmacologic Management in Labor

Sub Concepts

• Oxytocin (Pitocin): dilute IV infusion, titrated to effect, high-alert drug
• Epidural Analgesia: most common, prevents maternal hypotension with IV bolus
• Opioids: systemic analgesia, avoid close to delivery (neonatal respiratory depression)
• Non-pharmacologic: breathing, position changes, ambulation, continuous support, hydrotherapy

Relationship To Central

Medications to induce/augment labor and manage pain while monitoring safety

Concept

Nursing Care by Stage

Sub Concepts

• Admission/First Stage: confirm true labor, Leopold's maneuvers, sterile exams, monitor FHR
• Rupture of Membranes: note time/color/odour/amount, check FHR immediately (cord prolapse risk)
• Second Stage: assist pushing at full dilation, prepare delivery field, check nuchal cord
• Third Stage: await placental separation signs, controlled cord traction, inspect placenta
• Fourth Stage: assess fundus/lochia/vitals/bladder every 15 minutes (PPH risk)

Relationship To Central

Stage-specific interventions aligned with labor physiology and safety

Concept

Complications Recognition and Response

Sub Concepts

• Fetal Distress: abnormal FHR patterns requiring intrauterine resuscitation bundle
• Cord Prolapse: knee-chest position, lift presenting part, emergency delivery
• Uterine Hyperstimulation/Rupture: stop oxytocin, assess for rupture signs
• Dystocia (Prolonged Labor): evaluate the Five Ps systematically
• Postpartum Hemorrhage: boggy uterus is first sign of atony - massage fundus first

Relationship To Central

Early detection and management of deviations from normal labor progression

Concept

Unang Yakap (EINC - Essential Intrapartum & Newborn Care)

Sub Concepts

• Immediate drying: within seconds to stimulate breathing and prevent hypothermia
• Early skin-to-skin contact: prone on mother's abdomen/chest for thermoregulation
• Delayed cord clamping: after pulsations stop (1-3 minutes) improves iron stores
• Non-separation and early breastfeeding: within first hour, avoid unnecessary suctioning

Relationship To Central

DOH protocol for evidence-based immediate newborn care aligned with Filipino healthcare policy

Concept

Cardinal Movements (Mechanisms) of Labor

Sub Concepts

• Engagement: largest diameter of fetal head enters pelvic inlet
• Descent: gradual downward movement through pelvis
• Flexion: chin flexes toward chest, presents smallest diameter
• Internal Rotation: head rotates to align with pelvic outlet
• Extension: head extends under symphysis pubis during crowning
• External Rotation (Restitution): head externally rotates to align with body
• Expulsion: delivery of entire fetus

Relationship To Central

Anatomic description of how fetus navigates pelvis during second stage

To

Cardinal Movements

From

Passenger (fetus)

Strength

strong

Relationship

The fetus undergoes these seven sequential mechanisms to navigate through the pelvis

To

Cardinal Movements

From

Passage (pelvis)

Strength

strong

Relationship

The pelvic shape and dimensions guide and determine the cardinal movements

To

Labor Progression

From

Powers (contractions)

Strength

strong

Relationship

Adequate, regular, progressively stronger contractions drive the labor forward

To

Powers

From

Position (maternal)

Strength

strong

Relationship

Upright and left-lateral positions enhance contraction strength and effectiveness

To

Powers

From

Psyche (emotions)

Strength

moderate

Relationship

Maternal fear and tension increase pain perception and may slow labor progression

To

Nursing Care by Stage

From

First Stage Phases

Strength

strong

Relationship

Different phases require different assessment frequencies and interventions

To

Urge to Push

From

Transition Phase

Strength

strong

Relationship

The 8-10 cm dilation phase is when the involuntary urge to push begins

To

Cardinal Movements

From

Second Stage

Strength

strong

Relationship

The cardinal movements occur during the second stage from full dilation to birth

To

Late Decelerations

From

Fetal Distress

Strength

strong

Relationship

Late decelerations are a sign of uteroplacental insufficiency causing fetal distress

To

Cord Prolapse

From

Variable Decelerations

Strength

moderate

Relationship

Variable decelerations may indicate cord compression or potential cord prolapse

To

Fetal Distress

From

Intrauterine Resuscitation Bundle

Strength

strong

Relationship

The bundle is the priority intervention for variable and late decelerations

To

Uterine Hyperstimulation

From

Oxytocin

Strength

strong

Relationship

Excessive oxytocin dosing causes hyperstimulation with risk of fetal hypoxia

To

High-Alert Drug Protocol

From

Oxytocin

Strength

strong

Relationship

Oxytocin requires IV infusion titration only; never IV push

To

Maternal Hypotension

From

Epidural Analgesia

Strength

strong

Relationship

Epidural's main risk is maternal hypotension reducing placental perfusion

To

IV Fluid Bolus

From

Epidural Analgesia

Strength

strong

Relationship

IV fluid bolus before epidural prevents maternal hypotension

To

Cord Prolapse

From

Rupture of Membranes

Strength

strong

Relationship

ROM is a risk factor for cord prolapse, especially if presenting part unengaged

To

Fetal Distress

From

Meconium-Stained Fluid

Strength

moderate

Relationship

Green-stained fluid suggests fetal distress and requires investigation

To

Placental Separation Signs

From

Third Stage

Strength

strong

Relationship

Specific signs indicate placental separation before delivery

To

Postpartum Hemorrhage Risk

From

Fourth Stage

Strength

strong

Relationship

Fourth stage is the peak risk period for PPH due to uterine atony

To

Uterine Atony

From

Boggy Uterus

Strength

strong

Relationship

A soft, boggy uterus is the first clinical sign of uterine atony

To

Postpartum Hemorrhage

From

Uterine Atony

Strength

strong

Relationship

Uterine atony is the most common cause of postpartum hemorrhage

To

Uterine Atony Management

From

Fundus Massage

Strength

strong

Relationship

Fundus massage is the first intervention for a boggy uterus

To

Newborn Thermoregulation

From

Unang Yakap EINC

Strength

strong

Relationship

Immediate drying and skin-to-skin contact prevent neonatal hypothermia

To

Neonatal Iron Stores

From

Delayed Cord Clamping

Strength

strong

Relationship

Clamping after 1-3 minutes allows transfusion of placental blood improving iron

To

Unang Yakap EINC

From

Early Breastfeeding

Strength

strong

Relationship

Initiation within first hour is part of non-separation policy

To

Labor Hyperstimulation

From

Contraction Assessment

Strength

strong

Relationship

Contractions <2 min apart, >90 sec, or no rest indicate hyperstimulation

To

Cervical Change

From

True Labor Signs

Strength

strong

Relationship

Progressive cervical dilation and effacement are definitive signs of true labor

To

Passenger Assessment

From

Leopold Maneuvers

Strength

strong

Relationship

Maneuvers determine lie, presentation, position, and engagement of fetus

To

Engagement

From

Station Assessment

Strength

strong

Relationship

Station at 0 or below indicates engagement of the presenting part

To

Transition Phase

From

Do Not Push Until Fully Dilated

Strength

strong

Relationship

Although urge to push occurs at transition, pushing must wait for 10 cm dilation

To

Ambulation and Hydration

From

Latent Phase

Strength

moderate

Relationship

Latent phase allows continued activity; encourage walking and fluid intake

To

Frequent FHR Monitoring

From

Active Phase

Strength

strong

Relationship

Active phase requires more frequent FHR assessment every 15-30 minutes

To

Perineal Trauma Prevention

From

Controlled Delivery of Head

Strength

strong

Relationship

Controlled descent and extension minimize perineal tearing

To

Second Stage

From

Nuchal Cord Assessment

Strength

moderate

Relationship

Check for cord around neck before full delivery of head

To

Newborn Status

From

Apgar Score

Strength

strong

Relationship

Assessed at 1 and 5 minutes to evaluate newborn adaptation