Obstetrics for Nurses

by Charles B. Reed

The resistances are the bony pelvis and its relatively soft coverings of muscle and fascia.

The problem is to get the awkwardly shaped passenger through the curiously shaped passage.

In the first, and a part of the second stage, the uterine contractions do not act directly upon the body of the child, for the latter is surrounded by a wall of liquor amnii.

Pressure is transmitted by a fluid medium in all directions, hence, the weak part of the wall, which is the cervix, must give way. While the membranes remain intact, or when sufficient fluid is retained, no amount of pressure can injure the fœtus. When the membranes rupture, the force of the pains is exerted directly upon the child to drive it forward, and prolonged pressure may produce injurious effects through compression of fœtus, placenta, or cord.

The progress of labor is registered usually by watching the advance of the fœtal head.

The relation of the head to the pelvic brim is of great importance, as it travels much faster and easier in certain positions than in others. The term “presentation” is used to designate that part of the child which enters or tends to enter the pelvic inlet.

The presentation is named from the part of the child which comes into apposition with the brim. Thus, one speaks of a vertex presentation, or a breech presentation, or a shoulder presentation. The presentation is determined externally by palpation.

The vertex presents in 96 per cent of all labors. With the vertex presenting, the head may occupy any one of four positions. The term “position” is used to explain the relation which the most distinctive feature of the presenting part bears to the quadrants of the pelvic inlet. Thus, the most distinctive feature or landmark of the vertex is the occiput, which is the point of direction, and so again, the position is the relation of the point of direction to the brim of the pelvis. The point of direction is the part that takes precedence in the process of delivery. Thus, in all cases where the occiput is in advance, the occiput is the point of direction and the position is called occipital. Where the chin is in advance, it is mental (mentum is Latin for chin.) In breech cases, the sacrum is the point of direction.

The pelvis is divided by the transverse and anteroposterior diameters into four quadrants named respectively the left anterior, the right anterior, and the right and left posterior. (See Fig. 1.) Thus, in a vertex presentation the back of the child may be (and in 53 per cent is) to the front and to the left.

The occiput is the point of direction, and lies in relation to the left anterior quadrant of the pelvis, and is spoken of as a left-occipito-anterior position. Similarly a right-occipito-anterior position is named, and right- and left-occipito-posterior positions. These occur respectively in about 21 per cent, 14 per cent and 11 per cent of the cases. (Eden.)