Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

A primipara (1–para) applies to a woman during her first labor and until the beginning of her second labor.

2–para, 3–para and 4–para apply to women in succeeding labors which correspond to the numerals used.

A multipara is a woman who has had more than one child.

There is also a terminology, with abbreviations, which is fairly generally used in this country and England to designate the position which the child, about to be born, occupies in relation to its mother’s body. A diagnosis of this position is, of course, absolutely necessary to a skilful management of labor, and the nurse should understand the meanings of the terms used, and also their distinctions and subdivisions.

Fig. 53.—Attitude of fetus in vertex presentation.

The presentation of the fetus is the term which is employed to indicate the part of the baby’s body which is at the brim of the mother’s pelvis. Thus the part of the fetus which is lowermost is designated as the presenting part and gives the presentation its name. If the breech is downward, therefore, it is a breech presentation (Fig. [52]), and if the head is the lower pole it is termed a head, or cephalic presentation. (Fig. [53].) The head presentations are divided into two main groups, which are designated, respectively, as face and vertex presentations. For example, if the baby’s neck is so arched that the chin rests upon the chest, the crown of its head, or the vertex, is the part that is lowest in the birth canal and is the part that will be seen first at the vaginal outlet. Therefore, this is called a vertex, or occipital presentation. But if the neck is bent sharply backward, the face becomes the presenting part and we have a face presentation.

The breech, face and vertex presentations are sometimes referred to as longitudinal presentations since in these instances the long axes of the bodies of mother and child are parallel. In transverse presentations, however, the child lies across the uterus, with one side or the other at the pelvic brim.

The transverse presentations are infrequent, occurring once in about 250 cases, and are regarded as abnormal because spontaneous delivery under such circumstances is extremely rare. They are more likely to be seen, when they do occur, among multiparæ and women who have contracted pelves.

The longitudinal presentations, however, constitute something over 99 per cent. of all cases and are regarded as normal, since the child occupying this relationship may be born spontaneously. In about 3 per cent. of the longitudinal presentation the breech is the presenting part and in about 97 per cent. it is the head. Of these, the vertex presentation is the one most commonly seen and is the one in which the child is most easily delivered. Face presentations are very rare, occurring in only a fraction of 1 per cent. of all cases.