Stages of Labor
Summary
TLDRThis educational video script delves into the stages of labor, guiding viewers through early to late term with a focus on identifying labor onset signs like bloody show or water breaking. It outlines the progression from uterine contractions to cervical changes, emphasizing the importance of continuous assessment. The script breaks down labor into four stages, detailing each phase's characteristics, from latent and active labor to delivery and postpartum care. It also addresses the significance of maternal and fetal monitoring, the role of oxytocin, and the necessity of placenta delivery to prevent complications, providing a comprehensive guide for expectant parents and healthcare professionals.
Takeaways
- π The video discusses the stages of labor, focusing on the transition from early to late term for expectant mothers.
- π Signs of labor include the bloody show, rupture of membranes, and the onset of contractions, which can be distinguished from false labor by their frequency, duration, and pattern.
- π€° The beginning of labor is marked by uterine contractions and cervical changes, which are characterized by the frequency, duration, and regularity of contractions, as well as the thinning and dilation of the cervix.
- π©ββοΈ Nursing assessment during labor involves continuous monitoring of the patient, with early labor being the optimal time for education and orientation.
- π The importance of reviewing the birth plan, monitoring maternal and fetal vital signs, and assessing the status of amniotic membranes is highlighted.
- πΆ The process of labor is initiated by the baby's pressure on the cervix, which triggers the release of oxytocin and prostaglandins, leading to uterine contractions.
- π Stage one of labor has three phases: latent, active, and transition, each with distinct characteristics regarding contractions, effacement, and dilation.
- π€ The latent phase is marked by irregular contractions, while the active phase sees regular contractions every three to five minutes, and the transition phase involves strong, overlapping contractions.
- π€± Stage two of labor involves the delivery of the fetus, with complete cervical dilation, and the coaching of the patient to push during contractions.
- π Stage three is the delivery of the placenta, which is crucial for preventing postpartum hemorrhage and ensuring the uterus contracts back to its original size.
- π Stage four focuses on postpartum care, including monitoring for hemorrhage, assessing the uterus and lochia, and facilitating family bonding and maternal recovery.
Q & A
What are the main indicators that a mother is in labor?
-The main indicators that a mother is in labor include the bloody show, which is the loss of the mucus plug, the rupture of membranes or water breaking, and the onset of contractions. These contractions can be distinguished from false labor by their frequency, duration, and regularity.
What is the role of the uterine contractions and cervical changes in the onset of labor?
-Uterine contractions and cervical changes are crucial in the onset of labor. Contractions increase in frequency, duration, and become regular, while the cervix undergoes effacement (thinning) and dilation (opening) to facilitate the baby's passage.
How does the baby's position affect the onset of labor?
-The baby's position pressing on the cervix can cause it to stretch or pull, leading to the release of oxytocin from the hypothalamus and posterior pituitary gland. This hormone causes the uterus to contract, pushing the baby further into the birth canal.
What are the three phases of stage one of labor?
-The three phases of stage one of labor are the latent phase, the active phase, and the transition phase. Each phase is characterized by different levels of cervical dilation, effacement, and the mother's experience of contractions.
What is the significance of the latent phase in stage one of labor?
-The latent phase is significant as it is the longest phase where contractions are irregular, and the mother can still engage in normal activities. It is also the optimal time for initial assessments, teaching, and preparing for the labor process.
What are the characteristics of contractions during the active phase of stage one labor?
-During the active phase, contractions become regular, occurring every three to five minutes, lasting about one minute. This phase is when the mother starts to feel more moderate pain and may require comfort and coaching.
Why is it important not to push before reaching full cervical dilation?
-Pushing before full cervical dilation (10 centimeters) can cause trauma to the cervix, leading to swelling that may prevent the baby from passing through easily, potentially complicating the delivery.
What is the primary goal of stage two of labor?
-The primary goal of stage two of labor is to deliver the fetus. This stage begins with complete cervical dilation and involves coaching the mother to push during contractions and rest in between to facilitate the baby's birth.
How does the placenta's separation from the uterus indicate the onset of stage three labor?
-The separation of the placenta from the uterus is indicated by the lengthening of the umbilical cord, a gush of blood, and increased uterine contractions. These signs precede the delivery of the placenta, which is stage three of labor.
What are the key assessments and care practices during stage four of labor?
-Stage four of labor involves monitoring the mother for two hours postpartum, focusing on preventing hemorrhage, assessing vital signs, lochia (bleeding), and the condition of the uterus (fundus). It also includes aftercare such as perineal cleansing, ice pack application, and encouraging rest and nutrition.
Outlines
π€° Introduction to Labor Stages
The video script begins by introducing the topic of labor stages, specifically focusing on the transition from early to late term for expectant mothers. The speaker outlines the signs of labor, such as the bloody show, rupture of membranes, and the onset of contractions. The video aims to educate viewers on the process of labor, from the start signaled by uterine contractions and cervical changes, to the delivery of the fetus and placenta. The importance of assessing the frequency, duration, and regularity of contractions, as well as the cervical thinning and dilation, is emphasized. The speaker also highlights the significance of early labor for patient assessment and education, setting the stage for a comprehensive understanding of labor management.
π Stage One of Labor: Latent, Active, and Transition Phases
The second paragraph delves into the first stage of labor, which is further divided into three phases: latent, active, and transition. The latent phase is characterized by irregular contractions, minimal cervical effacement and dilation, and is the period where the mother feels relatively comfortable, allowing for conversation and movement. This phase is crucial for initial assessments, such as Leopold maneuvers and blood work. As labor progresses to the active phase, contractions become more regular and intense, necessitating comfort measures and coaching for the mother. The transition phase is marked by strong contractions, pelvic pressure, and the urge to push, indicating the mother is nearing full cervical dilation. The paragraph emphasizes the importance of patient support and the assessment of contraction patterns throughout these phases.
πΆ Stage Two of Labor: Delivery of the Fetus
The third paragraph discusses stage two of labor, which involves the actual delivery of the fetus. With complete cervical dilation, the focus shifts to coaching the mother to push during contractions and rest in between, especially if an epidural has been administered. The importance of comfort measures, such as cold and warm compresses, and the potential need for an episiotomy to facilitate delivery without causing trauma, are highlighted. The paragraph also touches on the significance of the mother's position during delivery and the involvement of the birth partner to enhance the bonding experience. The ultimate goal of this stage is the safe delivery of the baby, after which the focus shifts to the next stage of labor.
π©Έ Stage Three of Labor: Placenta Delivery and Postpartum Care
The fourth paragraph addresses stage three of labor, which is the delivery of the placenta. After the baby is born, the placenta must also be delivered to prevent complications such as hemorrhage. The speaker describes the signs of placental separation, including the lengthening of the umbilical cord, a gush of blood, and increased uterine contractions. Once the placenta is delivered, attention turns to postpartum care, including the assessment of the umbilical cord, perineal area cleansing, and the potential need for pitocin to aid uterine contraction. The importance of monitoring the mother's vital signs, lochia, and fundal height to prevent postpartum hemorrhage is emphasized, concluding with the final stage of labor.
π Stage Four of Labor: Postpartum Observation and Care
The final paragraph discusses stage four of labor, which is the postpartum period where the mother is closely observed for two hours after delivery. The focus is on preventing postpartum hemorrhage by monitoring vital signs, assessing lochia to ensure bleeding is decreasing, and ensuring the uterus is firm and contracted. The speaker also mentions the importance of urinary output, family bonding, and the mother's recovery, including eating, sleeping, and urination. The paragraph concludes by summarizing the four stages of labor and encourages viewers to engage with the content through likes and comments, signaling the end of the video script.
Mindmap
Keywords
π‘Stages of Labor
π‘Bloody Show
π‘Rupture of Membranes
π‘Contractions
π‘Effacement
π‘Dilation
π‘Latent Phase
π‘Active Phase
π‘Transition Phase
π‘Cervical OS
Highlights
Introduction to the stages of labor, focusing on the transition from early to late term.
Discussion on the signs indicating the onset of labor, such as the bloody show or rupture of membranes.
Explanation of the difference between true labor contractions and false labor contractions.
Description of the physiological process that starts labor, including uterine contractions and cervical changes.
Importance of continuous assessment during labor and the significance of early labor for patient education.
Details on the nursing assessment process upon the patient's arrival in the facility.
The role of oxytocin and prostaglandins in the progression of labor.
Explanation of the three phases within stage one of labor: latent, active, and transition.
Characteristics of the latent phase, including irregular contractions and minimal cervical changes.
The active phase's focus on increased comfort and coaching for the patient as contractions become more regular.
Description of the transition phase, marked by strong contractions and the urge to push.
Stage two of labor, focusing on the delivery of the fetus and the importance of coaching during pushing.
The significance of stage three, which involves the delivery of the placenta and the prevention of postpartum hemorrhage.
Highlighting the importance of postpartum care in stage four, including monitoring for hemorrhage and assessing the uterus.
Advice on facilitating family bonding and the importance of rest and nutrition for the mother post-delivery.
Conclusion and call to action for viewers to like, comment, and subscribe for more informative content.
Transcripts
foreign
engineers in this video we're going to
be talking about the stages of labor if
you like this video make sure to give it
a thumbs up comment down below and don't
forget to subscribe check out nature.org
where we have all of our illustration
notes and drawings for you guys to check
out as well so let's get into it with
the stages of labor we're going to
specifically be talking about when Mom
is in her early term to late term so we
are talking about a client here who is
in the full-on stages of labor and how
do they start what's going to indicate
to us that our patient is in labor
so typically there is either the bloody
show where we lose our mucus plug or we
have our water breaking which is our
rupture of membranes or mom has the
indication of her contraction starting
and whether or not those are true labor
contractions or false labor contractions
we will talk about that in a minute
but I wanted to go over really quickly
what really starts the delivery of our
stages of labor how do we go from our
delivery of the fetus to the placenta to
being out of Labor so the beginning or
our start of Labor is our uterine
contractions and our cervical changes
and do you remember what those
indications are of the uterine
contractions which is our true labor
it's usually those three things the
increase in our frequency
so they're occurring more often increase
in
duration
which they are lasting longer and
they're becoming regular so our
contractions are going to increase in
their frequency happening more often
increase in the duration lasting a
longer time and they're going to be
happening more often in a regular
pattern and then what are our cervical
changes do you remember what we talked
about in our previous videos about the
changes that happen to the cervix that
indicate that we are in deed in true
labor
there is a basement
which is our thinning of our cervix so
our cervix eventually becomes
thinner it starts to thin out here
and then we also have our dilation
which is then the opening right so now
our cervical OS is maybe going from one
centimeter
all the way to 10 or right there's maybe
about three centimeters but you get the
point that it's increasing in dilation
so throughout this entire process of the
stages of labor with our client and with
our patient we're going to want to
continuously assess them and this is
what we're going to be doing kind of the
whole time so with our nursing
assessment when our patient comes in
they're in hopefully the earliest stage
of Labor that you're going to be seeing
them in and then from there advancing
through those stages so this time is
usually the easiest time to orient our
client and talk to them about what's
going on tell them what the unit looks
like what the process is going to be
like through here and do our teaching
and our talking here because this is the
most coherent or most at education that
our patient's going to be they're going
to be more likely to understand what
you're talking about and teaching them
in this process
when we do get them into our facility we
want to maybe review the birth plan for
them so you want to talk to them about
what their plans are for their birth are
they going to want an epidural do they
not want an epidural who do they want in
the room who they don't want in the room
and then also what kind of care they've
had through their anti-partum
we also want to start getting them on
the monitor monitoring maternal and
Fetal Vital Signs and then also try to
lay down what their contraction pattern
is at that time and the status of their
amniotic membranes did they have a
rupture of membranes if they did we're
going to document and talk about that
with them or if they didn't and then
we're going to continually assess them
through this entire labor
and you're probably wondering well how
does like how labor starts just all of a
sudden but what is that process and
there's a little process here that I
drew out for you guys to kind of
understand in a nutshell what is going
on so baby is going to be pressing on
the cervix and causing the cervix to
either stretch or pull or a face and
dilate because of that head being
engaged or maybe it's a foot maybe it's
a shoulder maybe it's a butt but they're
all pushing on these cervix
when that cervix stretches it sends a
signal to the hypothalamus and the
posterior pituitary gland saying hey
there's some stretching in the cervix
because of that process it releases
oxytocin oxytocin is then released it
causes the uterus to contract and when
we have that Contracting we're making
baby push down down into our further
down to our stations and because of that
baby's head is then continually
Contracting on this cervix and we have
this positive feedback right here
also when all this is occurring placenta
is also releasing some prostaglandins
and those prostaglandins are also
telling the uterus to contract as well
which is again pushing I'm telling baby
to go down and this baby pushes down
into the cervix cervix stretches and we
keep having this release of oxytocin
so this is the starting portion if we
are in true labor to start our stages of
labor so let's go in and talk about the
first stage stage one of labor now our
patient is in stage one and we're going
to be talking about all the stages of
labor stage one two three and four but
you're going to notice that right behind
me there are multiple phases to stage
one so stage one if you didn't know has
three phases there's latent active in
transition and if you're like me and
you're like oh great there's not only
stages but there's phases and now I have
to remember more stuff I always remember
that latent just starts with lat which
gives me the orientation of these three
latent active in transition
so the goal of stage one is to complete
the dilation and phasement of the cervix
what we're trying to do is open up that
cervix and thin it out so that we have a
nice big opening for baby to come on out
So within the latent phase which is the
first phase of stage one
we're going to be focusing on what's
going on with Mom and how mom is feeling
so we have the longest phase and this is
usually the phase where we can still
talk and breathe normally carry
conversations walk around these are the
ones the contractions and the dilation
facement that is going to be simplest or
the most mild so what we're looking at
here is Mom's probably coming into the
hospital we're going to do some Leopold
Maneuvers so we can get our external
fetal monitor on so we're going to check
where baby's back is feel where baby's
head is we're going to place our IV if
Mom is okay with that and get some blood
work drawn we want to be checking you
know hematocrine hemoglobins check those
Baseline levels see what their typing
screen is of their blood case we have to
administer some blood later we also want
to get some baseline Labs or anything
else that we might need for them we want
to get our paperwork out of the way so
this is the phase where if we're going
to be doing any type of teaching any
type of paperwork that needs to get done
for any type of procedures we might have
we want to fill those out now
do our complete head to toe and then get
our status on our membranes did we have
rupture membranes if we did we're going
to check with our paper if Mom's not
sure we'll check with our nitrozine
paper if not or we're not sure then we
can also validate with the nitrogene
paper and if it did and Mom did notice
it we're going to ask what was the color
what was was there an odor what was the
amount just so we can get an idea and
document all of that
but the biggest indicator of our latent
phase is where we are with our
contractions and our effacement and
dilation
within our contractions and this is the
big NCLEX thing right here is the latent
phase has The Irregular contractions
this is the beginning of labor so Mom
really might not notice that she's in
labor she might think oh I don't that
was just you know a random contraction
that I'm having it wasn't really true
labor so they're going to be a regular
of these contractions they're going to
last any or they're going to be in
anywhere from five to thirty minutes so
they might be as often as five minutes
or there might be a span of 30 minutes
in between each contraction and they're
going to last around 30 seconds
the effacement is going to be from zero
to thirty percent so we're thinning at
that zero to thirty percent and our
dilation is going to be from zero to
Thirty so remember our cervix is trying
to thin so you can see here as we
progress from latent all the way down
through active into transition we're
going to be trying to thin and dilate so
you can see the difference here now
we're going to move into active phase
and this is where our patient is going
to need some more comfort and coaching
this is where we're going to realize oh
I think I'm actually having contractions
now I can feel them they're a lot more
moderate in pain we can feel them so the
comfort and coaching of how we're going
to be breathing through these
contractions how we're going to maybe
reposition dim the lights play some
calming music and encourage our patient
to avoid every two hours in order to
keep that bladder nice and empty we want
to make sure that we are also talking to
our patient if they're feeling a lot of
pain that if they would like an epidural
this is kind of the phase or the area
that we would put that epidural in
because we're still still able to
control our contraction contraction
control our body and our breathing
because once we get past active into
transition they're a lot stronger and
it's kind of hard to sit still for an
epidural to go in so our contractions in
the active phase are going to be regular
they're going to be roughly
occurring every three to five minutes
now and they're going to have a duration
of about one minute and this is where
our Faceman is going to be 30 to 80
percent and our dilation is four to
seven so we're getting ready to have
baby but we're not quite there and as we
transition into transition phase
this is where we're going to start
feeling that pelvic and rectum pressure
this is where we're going to feel the
urge to push or Bear Down sometimes this
is where we may think we have to take a
bowel movement we got to go to the
bathroom but that may or may not happen
but we also may be pushing for a baby
and we don't want to push until we're at
10 centimeters because if we push before
10 centimeters we are going to maybe
cause some trauma to that area the
cervix is going to get angry because
we're going to be pushing really hard
and it might swell and when that
swelling occurs baby's not going to pass
through as easily as we would like to
because of this the client's going to be
restless sweating hiccuping nausea and
vomiting in a lot of pain so we want to
encourage them to stay calm support them
through the breathing through the
contractions because these contractions
are going to be strong they're going to
be super super strong they're going to
be super super painful because we are
moving now in through our labor they're
going to be occurring every 30 seconds
to two minutes and they're going to be
lasting around 60 to 90 seconds if
you're looking at this you're like wait
a minute how can they be occurring every
30 to 2 minutes but a lasting almost a
minute to a minute and a half or 60 to
90 seconds they will overlap as one
contraction is starting to fall off
another one might start right back up
and that's how we know we're getting
really close to baby
80 to 100 of our effacement and then
eight to ten centimeters on our dilation
and once we have reached our 100
effacement and our 10 centimeters
dilated we are now ready to push and to
get baby out so let's move into stage
two and now we're on to stage two so now
we are getting ready to have baby so we
have complete cervical dilation or if
you assess mom you may see crowning or
the baby's head right there and we are
ready to deliver the fetus so again this
is where it's really important to coach
the client and encourage them you want
to make sure that they are pushing when
they feel contractions and resting when
there isn't a contraction and if our
patient did have an epidural they may
not be able to feel the contraction so
this is when we want to really coach
them through okay a contraction is
coming I'm going to need you to push and
push and then time to rest we got to
breathe and get our rest in because
labor sometimes can take a long time and
we don't want mom getting tired so with
this we also want to try to get that
Comfort going for Mom so we want to
either use a cold compress for the head
or the back of the neck and warm
compresses down the perineum to allow
everything to relax down there we want
to assist in positioning so be able to
get them in whatever delivery position
they would prefer and then also get the
partner involved that is there because
we want to make sure that we are getting
Mom comfortable and also building that
bonding if we can and then we also are
going to have to ask Mom if there is an
option for an episiotomy or if you know
what this is this is when we maybe
aren't able to get baby out quite it's a
lot of stretching going on and in order
to prevent a tear we may do a small
incision in the perineum so we'll do an
incision
thank you
in the perineum
and that's going to allow just a little
bit a little small incision to allow
baby's head to pass through and be able
to have babies and then baby is
delivered baby is out and now we're
going to move into stage three now that
baby has been delivered we are going to
move into stage three babies out and
it's now time to deliver the placenta so
don't get confused that baby is out and
labor is over we still have to have the
placenta come out as well because
remember if we retain placental
fragments or the placenta what can
happen is we are never going to have our
uterus contract back down to its
original size so that will keep that
exposure of hemorrhage or bleeding out
so we need to deliver the placenta baby
is born and we want to perform our
apgars of one in five minutes and we
want to promote that skin to skin dry
baby off get baby comfortable get baby
warm put them on our mom and then be
able to move forward with focusing on
mom getting that placenta out so we are
going to be looking for certain signs
that are telling us that our placenta is
separating from from the uterus because
remember it is adhered onto the uterine
wall and it's going to have to separate
in order to come out
so some signs of separation from the
uterus are a couple things you want to
imagine right this uterus here and the
placenta are going to start to separate
right and as they separate it's a
tearing I kind of picture it as like a
scab when you pick a scab off you're
like breaking all those little vessels
in there so as you pull off the placenta
you're going to have some separation so
the first thing that's going to happen
is that umbilical cord also is going to
lengthen right it's going to separate
from the uterus it's going to lengthen
you're going to see it all of a sudden
lengthen from them because of that
separation and that pulling off we're
going to have a gush of blood so we have
that long eating of the umbilical cord a
gush of blood and then we're going to
have the fun to start Contracting you're
going to feel a little bit more
contractions as we're trying to push
that placenta out
when this all is happening we're going
to say yay the placenta is delivered but
there is something we need to do before
the placenta is delivered when baby is
out once baby is out
baby is out
we want to think about clamping
after one minute right we're going to
place two clamps on our umbilical cord
so baby is out we're clamping the
umbilical cord we're trying to get
placenta delivered placenta comes out
and now we are focusing more on the
Aftercare of Labor so we already have
our placenta out we are going to cleanse
the perineal area Place some ice packs
if there was an episiotomy uh performed
you want to make sure that we are
getting the suture or if there were some
tears we were getting that all sutured
up nice and clean we also maybe want to
think about starting pitocin so that we
can have our uterus contract back down
and then decrease our chances of
hemorrhage postpartum hemorrhage we also
want to assess our umbilical cord
remember when we are looking at the
opening of our umbilical cord where we
cut it we're looking to make sure
there's two umbilical arteries and one
umbilical vein making sure that we have
the appropriate vessels in there we also
want to make sure that we are assessing
our placenta our placenta has two sides
remember we have dirty Duncan which is
the underside that ripped away from the
uterus which is the maternal side and
then we have the shiny Schultz which is
the part that is where the umbilical
cord comes and it's on the baby because
the baby's new and happy and shiny so
once we do all this assessing and we're
documenting through all this we are now
going to move into stage four which is
the Care at the end of Labor we're not
quite done with labor we still got to
keep an eye on mom for the next two
hours so let's talk about stage four
baby is out placenta is out and now we
need to take care of stage four so stage
four is now once a placenta is out we
have about two hours after to keep an
eye on Mom and the biggest things that
we're going to be focusing on is that
postpartum Hemorrhage what's going on
with Mom so the maternal Vital Signs we
want to make sure that we are keeping an
eye on on our Vital Signs and
particularly blood loss so we're going
to be focusing on our blood pressure and
our pulse and we want to make sure
there's two things we're basically
looking for are they hypovolemic
or if they had any other
problems we might be thinking are they
having preeclampsia right if they had
some eclampsia prior preeclampsia prior
to labor they could still be in that
range for the preeclampsia so we're
keeping an eye on their blood pressure
and their pulse and we're also going to
be keeping an eye on their lochia which
is every 15 minutes we're going to be
assessing that bleeding and what we're
looking at is we're going to be looking
at that pad
and seeing if that pad is going from a
heavy to moderate all the way down to
hopefully a light okay as we progress
from labor from placenta being out and
on from labor so what we're looking at
here is it should be decreasing over
time our bleeding should be decreasing
over time our Vital Signs Should Be
steady and when we are assessing our
fundus it should feel nice and firm if
it feels boggy
we're going to think a couple things I
can do big end question here you assess
your postpartum patient and all of a
sudden you're feeling a boggy fund it's
what are you going to do you're going to
massage the fundus right we're going to
be using our hands to place here and
here on either side of our uterus and
we're going to try to massage the fundus
right try to make it shrink back down
because what we want to do is have this
contract all the way back down into its
small
pre-baby shape right if it's not or if
the fungus still feels a little boggy or
mushy to you you know maybe you want to
think about some medications like
oxytosis or oxytocin those medications
that are going to increase that uterine
contraction so help that uterus to
shrink back down we also want to be
looking at the urinary output of our
patient making sure that we are
preventing distension of the bladder we
don't want the bladder to be distended
because it may cause some other issues
within our abdomen we want to facilitate
the family bonding to the baby so we
want to make sure we're doing skin to
skin we'll make sure that we are
increasing with the feeding and getting
that bonding experience whether it's
breastfeeding or bottle feeding so that
we are building that bonding moment with
baby
if mom had an episiotomy or had some
tearing and there was a laceration you
want to make sure you're assessing that
area and making sure you're providing
care so there's no infection rate there
going on and then we also want to
encourage that we have our client eat
sleep and urinate the eating and
sleeping is a big part sleep when baby
sleeps and try to eat as well because
there might have been a really long
labor labor might have been over 20
hours in total so we want to make sure
that we're keeping an eye on our client
and making sure that they are getting
that rest and that energy back that they
had
and that is it that is the four stages
of labor I hope it made sense I hope you
got something from this video if you did
and you liked it make sure to hit that
like comment down below and subscribe
and as always until next time
[Music]
Browse More Related Video
Patient Education Animation: Labor and Vaginal Birth
development of the placenta-labor and delivery - birth-embryology-placental maternal side formation
Reproductive System, Part 4 - Pregnancy & Development: Crash Course Anatomy & Physiology #43
CapiΜtulo 7 Process Analysis at Arnold Palmer Hospital
Professional Menu Planning & Purchasing Strategies for Chefs
Human Anatomy and Physiology: Homeostasis
5.0 / 5 (0 votes)