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Normal Labor and Delivery PowerPoint
Week 3 PowerPoint used for community exam 2. Recall the def. of labor, the stages of labor, the phases of stage 1, the def. of effacement and how contractions are timed
Terms in this set (78)
Series of processes by which the fetus, placenta, and membranes are expelled from the uterus and through the birth canal
Theories of Onset of Labor
Etiology Unknown ! Estrogen increased, Progesterone decreased, Fetal fibronectin found in plasma and cervicovaginal secretions prior to onset of labor, Prostaglandins increased, Oxytocin
Mechanical factors (Progressive uterine distention increasing IUP: Infant size,
Uterine size), Aging placenta
Premonitory Signs of Labor
Uterus more irritable, Braxton Hick's Contractions stronger and more frequent, Bloody show, Increased vaginal secretions, Membranes may rupture
Cervix ripens (Mucous plug and bloody show), Sudden burst of energy (nesting instinct), Backache, Lightening
Labor starts at
with the first true labor contraction and ends with complete dilatation of the cervix. Forces involved in bringing about cervical changes
Nurses Role during labor:
Assessment of FHR and contractions, Facilitate comfort and progress, Emotional assessment and support, Promote safe and satisfying birth experience
Begins in lower back and extends from back to abdomen, Increases in intensity, frequency and duration. Change in cervix (softening, effacement, dilatation, more anterior position
Confined to lower abdomen, Does not increase in intensity, frequency, or duration. No change in cervix, Walking may relieve discomfort, Presenting part may not be engaged
Powers (nature), Passenger (mother), Passageway (determines if C-section or vaginal), Position, Psyche, People
Powers : Primary
Forces generated by uterine musculature
Frequency, amplitude and duration of contractions, Observation, manual palpation, tocodynamometry, Intrauterine pressure catheter (IUPC), Measured in Montevideo units :(Average strength of contractions (mmHg) x # of ctxs in 10 minutes, Adequate 200-250 MVUs)
Phases of contractions:
Increment, Acme, Decrement
Bearing-down efforts to aid in expulsion of the fetus
Abdominal palpation or Ultrasound, Macrosomia (>4500g) associated with failure to progress
Longitudinal axis of fetus relative to longitudinal axis of uterus > Longitudinal, transverse or oblique
Passageway, Bony Pelvis
Bones and cartilage
Passageway, Soft Tissue
Vagina - rugae, Cervix- dilation, Pelvic floor - stretches
Maternal positions can
promote comfort and enhance labor progress
Psyche during labor
Fight or Flight' response: Catecholamines
Blood flow to uterus
Blood flow to placenta
Stages of Labor: First Stage
Three phases: Early (latent) 0-3 cm, active 4-7 cm and transition 8 - 10 cm.
Lasts from onset of contractions to full dilation of cervix = 10 cm. Longest stages for Primips. Maternal-Fetal Assessment
Stages of Labor: Second Stage
Full dilatation of the cervix to birth of the baby
Stages of Labor: Third Stage
Birth to delivery of placenta and membranes. Approximately within 30 minutes. Signs of placental separation:
Lengthening of the umbilical cord
Gush of blood from vagina
Change in shape of fundus
More globular shape
Stages of Labor: Fourth Stage
Immediate postpartum period (1-2 hours. One to two hours following birth. Continued close assessments for normal recovery from birth: mom and baby.
Physiology Of the First (Latent) Stage of Labor
Cervix moves anterior, softens, ripens, thins < All are signs of progress, even in the absence of cervical dilation
Woman's experience of the First (Latent) Stage of Labor
Cramping, pressure, pain. A range of emotions, including anxiety, confidence, excitement, dread, fear of unknown
Nursing care of Early (Latent) labor in regards to the history
The story of her pregnancy; what's happening now?
Nursing care of Early (Latent) labor in regards to the Emotional Assessment
Understanding her plans: What is most important?
Nursing care of Early (Latent) labor in regards to Assessing Coping
Subjective and Objective,Providing education, reassurance and support >
(Early assessment and intervention with anxiety has great impact on progress)
Nursing care of Early (Latent) labor in regards to Physical Care:
Hygiene, Nutrition and fluids, Elimination, Ambulation and positioning. Make a 'connection' and Offer support
Second Phase:Active Labor
Cervical dilation 4 - 7 cm, Contractions: length, intensity and frequency. Options for pain management
Non-pharmacological comfort measures:
Relaxation, breathing, focus, music, counterpressure, hot/cold, TENS, water therapy, positioning, mobilization, touch, massage, effleurage, personal hygiene, voiding, supporting partner/family
Cervix: 8 - 10 cm, Contractions increase in length, strength and frequency.
Signs of progress: Increased pressure, Sudden nausea, Loss of control, Bloody show.
Transition Phase Nursing Care
Maternal-fetal assessment, Assist with breathing and positioning.
'Take charge routine':Voice tone and touch, Stay close, Acknowledge the sensations, Maintain belief
Urge: Ferguson's Reflex, Bloody show increased, Bulging perineum, Labial separation, Visible caput, obvious descent
Nursing Care during Second Stage
Encourage bearing down efforts, position
Optimal Conditionsfor Descent
Spontaneous urge, Position (Rotating to OA), Quality of contractions, Station ≥ +1 (ideally would be +3)
PUSH, PUSH, PUSH!!!!!!!!!!!!!!!!!!!!!!!!
Physiological and emotional effects: Decrease oxygen to fetus. Exhaustion to mother.Holding breathe. Counting. Judgmental
Effort +++ but..... Ineffective. Eyes clenched shut, vocalizations, back arched, moving towards the head of the bed. Holding back > may be the result of fear and overwhelming sensations.
Take Charge Routine ... !
Physiologic Second Stage Associated with:
Shorter 'active pushing phase', Less maternal fatigue, Fewer operative births
Less fetal acidosis, Fewer pelvic floor complications. Increased maternal satisfaction
Fully dilated with no urge to push. Passive descent. Physiologic 'lull'. Station 0 to + 2
Instinctive grunting - open glottis. Women push several times during contractions. 'Synchrony' between the woman's respiratory and uterine function. Efforts vary in intensity and frequency
Second Stage: Nursing Care
Facilitating descent. Fluids, frequent voiding, presence, education, reassurance. Watch for holding back. DIRECTED PUSHING ONLY AS INDICATED.
Descent and thinning (stretching) of perineal muscles. (Exercise of contracting muscles, relaxation). 'Sigh out' breathing. Initial skin to skin - right to abdomen!
Active Management during the third stage has been shown to ...
Reduce total blood loss.> Abdominal hand secures the uterine fundus to prevent uterine inversion while the other hand exerts sustained downward traction on umbilical cord.
Nursing Responsibilities during the Third Stage
APGAR, Skin-to-skin with Mom
Newborn and Maternal WELLBEING!
Assess fundus and bleeding (Fundus firm @ umbilicus). Vital Signs, including the fifth! Newborn assessments (NEWBORN THERMOREGULATION), Breastfeeding
Comfort, Physiological assessments - for BOTH
Assessments at Time of Admissionto Labor Unit - Focus Assessment
Fetal heart rate, Maternal vital signs, Impending birth
Assessments at Time of Admissionto Labor Unit - Database Assessment
Obtain essential information from the client: last ate? Obstetrical history, Prenatal History, GBS status, Past medical history
Assessments at Time of Admission to Labor Unit
Focus Assessment, Database assessment and physical examination
Shortening of the uterine cervix and thinning of its walls as it is dilated during labor
A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding.
Newborn suck releases OXYTOCIN to stimulate letdown reflex, Lobules in breast produce milk, placenta hormones stimulate the lobules, after birth mother produces prolactin to maintain breast size and milk production levels
Nonpharmacologic pain and stress management strategies alone or in combination with pharmacologic methods manage discomfort
Narcotic IV push (Stadol, Nubain). Maternal and Fetal Effects ~ Have Narcan available.
Spontaneous Rupture of Membranes
Natural rupture of the amniotic sac, which usually occurs at the height of an intense contraction with a gush of fluid out of the vagina.
turns blue with alkaline amniotic fluid. turns pink with other fluids
Microscopic appearance of amniotic fluid resembling fern leaves when the fluid is allowed to dry on a microscope slide; also called fern test.
Artificial Rupture of Membranes
... aka AROM, Facilitates monitoring, while also Increasing the force of uterine contractions. But increased risk of cord prolapse if head is not "engaged." Is something the OB might do
Risks of membrane rupture nursing care
Always assess FHR immediately after, Note time, amount, color, odor (TACO). Increase risk for infection
Increase risk of infection nursing care during membrane rupture
Vital Signs, Palpate uterus for tenderness, FHR pattern, Cleanliness/Hygiene, Odor, Avoid invasive procedures as much as possible, CBC
During labor the fetus can be deprived of oxygen. How the infant tolerates this must be monitored
Electronic Fetal Monitoring (EFM)external
Ultrasound transducer, Tocotransduce
Electronic Fetal Monitoring (EFM)Internal
Spiral electrode, Uterine catheter
fetal heart rate, Controlled by Autonomic Nervous System. Sympathetic increases FHR. Parasympathetic decreases FHR. Baseline fetal heart rate. 110 - 160 beats per minute
Relationship of a nominated site of presenting part to denominating location on internal pelvis
Fetal Heart rate Tachycardia
> 160 , early sign of fetal hypoxia, increase maternal temperature, PPROM, drugs
Fetal Heart Rate Bradycardia
< 110, later sign of fetal hypoxia, decreased maternal blood pressure, prolonged umbilical cord compression, terminal
Variability of FHR ~ increased
early, mild sign of hypoxia and fetal stimulation
Variability of FHR ~ decreased
sleep state, hypoxia, acidosis, CNS depressant medications ( ominous if caused by hypoxia or associated with late decelerations)
Characteristics of reassuring fetal heart rate (FHR) pattern
Between 110-160, normal baseline variability, absence of non-reassuring changes (decelerations), accelerations of FHR with fetal movement
Characteristics of Normal Uterine Activity
Contractions every 2 to 5 minutes, duration of contractions less than 90 seconds, intensity of contractions less than 100 mm hg pressures, 60 seconds or more from end of one contraction to beginning of another, intrauterine pressure of 15 mm hg or less between contractions
Factors associated with reeducation of fetal oxygen supply
reduction of blood flow through maternal vessels, reduction of oxygen contract in maternal blood, alteration in fetal circulation, reduction of blood flow to intervillous space in placenta
Non-reassuring fetal heart rate patterns
tachycardia, decrease in baseline variability, loss of variability, severe variable decelerations, late decelerations, prolonged decelerations and severe bradycardia
Nursing actions when non-reassuring FHR pattern occurs
Change mom's position, correct maternal hypotension, elevate hips, increase rate of IV, discontinue oxytocin, if infusing. Administer oxygen at 10 liters minute via face mask
If a non-reassuring FHR prepare for
emergency delivery if pattern cannot be corrected
is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labor.
With this delivery, the head of the baby is not coming down & this device is like a cup, it fits on the head and uses negative pressure to assist in the birth of the head.
applying forceps to fetal head; low or midforceps delivery according to the degree of engagement of the fetal head and high when engagement has not occured
Cesarean Section Indications
fetal compromise, maternal compromise, macrosomina, failure to progress, CPD, Malpresentation, Previous C-section, Active Herpes, Placenta Previa, Placenta Abruption and multiple Gestation
general anesthesia is rarely used for vaginal birth but may be used for cesarean birth or when rapid anesthesia is needed in an emergency situation
Risks of Cesarean Section:
Aspiration, Pneumonia, Immobility, Elimination, Pain
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