the 4 P's of effective labor

ShandyLynnRN, BSN, RN · Mar 29, 2003

I had completely forgotten about the "p's"..... Haven't heard reference to them since school! I agree though. Psyche is probably one of the main components in effective and "happy" labor process!

anitame · Mar 29, 2003

I agree with the psyche being very important. I'm sure we've all seen the woman who just would NOT push. Sometimes it's fear; sometimes it's lack of confidence. One of the hardest jobs we do is help women overcome this. It's all part of the journey of birth.

mark_LD_RN · Mar 29, 2003

glad to see you'll agree I have always felt it was a very important component:)

layna · Mar 29, 2003

I have been doing L&D for 11 years now...I have lost count of the number of times that I hear in report "oh, she's been stuck at 4 cm for two hours now...they are thinking about C-Section"...after hearing this, just a few adjustments in the environment: connect with your patient and family, make sure family feels part of the experience and not a spectator (I give them jobs to do! LOL) and get rid of people who are not a comfort to the patient, coach your patient and then her family, make them all feel confident in their ability to make it through this experience and that YOU are there for THEM to help get them through it and to keep them safe....

And voila! By some miracle force, she all of a sudden gets more active in her labor, concentrating on her birth experience and delivers lady partslly!

I really do believe that a lot of times, the fourth P is the most important and sadly overlooked more often than not.

SmilingBluEyes · Mar 30, 2003

I was witness to the 4th "p" last night with a primip who had pushed for two hours, and flat-out gave up, saying "no puedo" ( I can't do it in Spanish). She had given up and decided a csection was the only way she was gonna go. Boy, I sure hate when it comes to this and sometimes you have to get creative to get them past this mindset.

Fortunately for me, There were several generations of female relatives in the room with her. In Spanish, I asked them to come to her and convince her that her body is a marvelous creation; and to trust it to do what it was made to. These ladies did an amazing job! They encouraged her, held her, comforted her and got her thru it. With their encouragement, eventually, her confidence returned and she gave it "one more try". Having a mirror there to enable her to see the progress she was making helped a lot, also. I like when they consent to this.

Well, With this last push of effort, I watched the baby's head turn, around the pubic bone it came, and down he came!!!! I actually had to SLOW her pushing efforts to let her perineum stretch and avoid a tear from rapid decent! It was a marvelous thing to witness. She delivered with only a skid mark on her peri. After 6 years in L and D, I love watching the machinations of the fetal head as it decends! It is indeed an awesome thing to me.

Yes, I have to agree; The power of the psyche is at LEAST as important as any other aspect of labor/delivery success. I have seen it time and again. But it is not just about the PATIENT's psyche. I contend a strong belief in the very amazing and capable female body is a MUST for EVERY obstetric attendant (nurses, doctor, labor support people, and most importantly, the MOTHER HERSELF). Our minds can do amazing things along with our bodies! Good points, Mark!!!!

HazeK · Mar 30, 2003

Originally posted by mark_LD_RN
I am sure all know the 3 P's

Passage
Passenger
Power

well I've finally seen the 4th one in A text book!
Psyche

How about " Position" ?

I include this in my "P"s,.

the position of the fetus makes a difference in the labor!

Nursing interventions can make a difference here!

Ex. have the pt moving aroung, walking, turning rather than staying in one positon all the time

Ex. waiting until Vtx well engaged before AROM (ok 4 RNs to do in NV)

Ex. having pt's work with relaxation and breathing untill well into labor, instead of giving epidurals early in labor. Yes, it is nice for our patients to like us and to be able to relieve their pain....but it is even better to be a good nurse instead of a nice nurse, and decrease their risk of a c/s!

Hugs,

Haze

PS Mark, what text were you using? I graduated in '74 and knew about psyche back then! You are absolutely correct--it plays a huge part in a successful lady partsl delivery....otherwise, who would need a doula??? :-)

Vsummer1 · Mar 30, 2003

I am currently in this rotation in school, and this is what our textbook (a new, 2003 version) vs. class notes say on the "powers":

The five P's: Passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response. The first four factors are presented here as the basis of understanding the physiologic process of labor. The fifth factor is discussed in Chapter 12. Other factors such as place of birth, preparation, type of provider, and procedures implemented may be important as well (VandeVusse, 1999).

The notes supplied by my instructor include only 4:

Passage (pelvis)

Passenger

Powers

Psyche

So, I take it to mean that there are a MINIMUM of four factors with position of mother being the 5th.

OBNurseShelley · Apr 3, 2003

I am also a firm believer about psyche, i tell my patients this when i first meet them, I truly think labor and being sucessful at it, and handling it (regardless of how the mother chooses to do this, with or without medicine) is LARGELY contributed to their mental state, and/or "psyche" I also think patients need to be mentally prepared for labor and pregnancy for that matter, but of course when their admitted to the hospital that's out of our control!

SmilingBluEyes · Apr 3, 2003

The 5 P's (Powers, Passage, Passenger, Pain and Psyche) are INTRINSIC things that affect labor, according to the Labor Progress Handbook By Penny Simkin and Ruth Ancheta. But did you KNOW: there are also EXTRINSIC factors that they discuss that may be of interest to you all??? As familiar as we are with these factors, they are only part of the story. The extrinsic factors according to the authors are:

Environment (feelings of physical/emotional safety generated by the setting/people around the laboring mom)

Ethno-cultural Factors (the degree of sensitivity/respect for the woman's culture-based needs and preferences)

Hospital or Caregiver Policies (how flexible, woman/family-centered, evidence-based)

Psycho-emotional care (the priority given to NON-clinical aspects of the childbirth experience).

This Labor Progress Handbook, to me, is a must for every labor nurse or doula to read. It is compact and very portable, inexpensive and indispensible to me. It is extremely helpful in teaching us as caregivers to REALLY know what LABOR SUPPORT IS and be facilitators in a successful and joyful birth for the birthing family.

HazeK · Apr 3, 2003

Originally posted by SmilingBluEyes
The 5 P's (Powers, Passage, Passenger, Pain and Psyche) are INTRINSIC things that affect labor, according to the Labor Progress Handbook By Penny Simkin and Ruth Ancheta. But did you KNOW: there are also EXTRINSIC factors that they discuss that may be of interest to you all??? As familiar as we are with these factors, they are only part of the story. The extrinsic factors according to the authors are:

Environment (feelings of physical/emotional safety generated by the setting/people around the laboring mom)

Ethno-cultural Factors (the degree of sensitivity/respect for the woman's culture-based needs and preferences)

Hospital or Caregiver Policies (how flexible, woman/family-centered, evidence-based)

Psycho-emotional care (the priority given to NON-clinical aspects of the childbirth experience).

I do not own this book, but must strongly concur with the authors!

Oh, to have these principles taught to every OB doctor and nurse!

Haze

SmilingBluEyes · Apr 3, 2003

Yea Haze....when pigs fly. ROFL....I agree w/you!