Maternal child healthModule 5

Discuss labor and the admission process

Objectives

The birth process

Changes in birthing Home-like environment … and home

environment Planned birthing process Cultural considerations and birthing

traditions

Introduction

Theories ◦Mechanical Uterine stretching

◦Hormonal Release or decrease in hormones Oxytocin stimulation Progesterone withdrawal Estrogen stimulation Fetal cortisol

Onset of labor

Lightening Braxton-Hicks contractions Cervical changes

◦Softening, dilation, effacement Bloody show Rupture of membranes Sudden energy burst

Signs of impending labor

Contractions: increase in frequency, duration, strength

Cervix: dilating to about 10 cm Fetus: descending through birth way Teaching:

◦ Notify provider when bag of waters (amniotic sac) breaks: time, color, amount, odor

◦ Call or go to delivery setting when contractions: every 5 minutes 60 seconds each For at least an hour

Labor

Passage◦Pelvis◦Uterus◦Cervix◦Vagina◦Perineum

Variables affecting labor

Passenger◦Size and skull◦Fetal attitude◦fetal position◦Fetal presentation: cephalic, breech, shoulder

◦Fetal lie

Variables affecting labor

Fetal attitudes

Fetal positions (see FON p 814 Fig 26-5)

Fetal presentation

Fetal lie:

Powers◦Uterine contractions (primary)◦Maternal pushing (secondary)

Psyche◦Attitude (experiences, expectations, values)

◦Anxiety/fear◦Cultural beliefs

Variables affecting labor

First stage◦ Dilation and

effacement Early/latent:

0-3 cm 5-8 min/apart 20-35 sec/each

Active 4-7 cm 3-5 min/apart 40-60 sec/each

Transition 7-10 cm 2-3 min/apart Up to 80 sec/each

Stages of labor

Second stage:◦ Delivery of newborn

Mechanisms of labor

Engagement Descent Flexion Internal rotation Extension Restitution External rotation expulsion

Stages of labor

Third stage◦ Delivery of placenta

Oxytocin Breastfeeding Fundal massage

Pitocin IV IM

Stages of labor

Fourth stage◦Recovery/stabilization2-4 hoursVital signs/assessment1st hour: Q15 minutes2nd hour: Q 30 minutes

Stages of labor

Cardiovascular◦ Higher blood pressure indicates pain or problem

Respiratory◦ Should remain as deep and relaxed as possible.

Avoid hyperventilation Renal

◦ Normal or decreased◦ Encourage voiding every 2 hours so baby can

move down

Maternal systemic labor responses

Gastrointestinal◦ Decreased motility◦ Eating/drinking not contraindicated for labors at

low risk of general anesthesia Fluid/electrolyte balances

◦ Not eating/drinking can dehydrate◦ IV may increase edema◦ IV pitocin additive may increase edema

Immunity◦ Temperature rise normal – may also be infection◦ IV antibiotics will be used if Strep B infection

present

Maternal systemic labor responses

Integumentary◦ Cervix softens◦ Perineum stretches – may be massaged with

lubricant ◦ lacerations, episiotomy may complicate

Musculoskeletal◦ Fetal head may press against mom’s bony places,

causing pressure/pain◦ Back labor

Neurological◦ May have heightened responses

Maternal systemic labor responses

Initial assessment◦ History◦ Determining stage of labor◦ Physical exam◦ FHR◦ Station, dilation, effacement◦ Contractions◦ Nursing management

Admission of client in labor

Subjective data ◦Histories Medical, obstetric, current pregnancy, psychosocial

Objective data◦Assessments: V/S, general, pelvic, fetal, FHR tracing, contraction patterns, amniotic fluid

Assessment: Labor

FON p 836 nursing care plan◦Pain and anxiety

◦Fatigue◦Risk for infection

Planning and outcome identification

Assisting client and support person◦ Breathing

techniques Avoid holding

breath!◦ Assessing best

means of relaxation◦ Birth plans

Nursing interventions

Systemic medications should not be given until phase of labor

estimated◦ Demerol (meperidine): narcotic

Monitor mom/fetus for CNS depression, decreased heart rate

◦ Stadol (butorphanol tartrate): opioid agonist/antagonist Monitor mom/baby for CNS depression,

decreased heart rate; mom may report weird dreams

◦ fentanyl (Sublimaze): usually given at/after surgery

Comfort measures

Regional blocks◦Paracervical block

◦Pudendal block

◦Epidural◦Saddle block low spinal

Comfort measures

General anesthesia◦ Nitrous oxide

(inhaled)◦ Pentothal (IV)◦ Should be monitored

post-op in PACU◦ Will be transferred to

postpartum room when stable

◦ Additional pain control should be used

Comfort measures

Non-pharmacological◦Movement◦Warmth/cold◦Counterpressure◦Psychosocial/spiritual support◦Empowerment◦Prepared childbirth methods Patterned and non-patterned breathing

Comfort measures

Awwwww…..