Birth Flashcards
certain rituals and taboos by the male to signify the transition to fatherhood
couvade
The Five Stressors That Affect the Labor Process
Passenger, Passageway, Powers (contractions), Position of the Mother, Psych
Which type of fetus lie is ideal for a vaginal birth?
longitudinal lie. Cephalic is ideal for delivery as opposed to breech
What is the most common fetal position?
LOA- The occiput of the infant’s head is in the Left Anterior of the mother’s pelvis
Cephalopelvic Disproportion (CPD)
When the head is larger than the pelvic opening. C-section rationale
refers to the amount of time from the beginning of one contraction to the beginning of the next contraction
Frequency
is measured from the beginning of one contraction to the end of that same contraction.
Duration
is measured, when using a monitor, by the rise in intrauterine pressure above normal resting tone of uterus (0 to 15mmHg). It is estimate when monitor is not used, by pressing hand on the fundus and rating contraction as mild, moderate or strong.
Intensity
What is Secondary Power?
Voluntary Bearing Down - Pushing
Mother helps in expelling the infant & placenta by contracting her abdominal muscles
If she pushed before complete dilatation - cervical edema – retards dilatation & exhausts mother. Can also cause tearing and bruising of cervix
Effective pushing can cut pushing time in half
Which position of the mother causes the contractions to be stronger and more efficient?
upright position
How to tell if contractions are Braxton Hicks?
Change positions and they will go away.
Test for anmiotic fluid
alkalinity with nitrazine paper
begins with true labor and ends with complete cervical dilatation. It is divided into three phases.
1st stage of Labor
begins with complete dilatation of the
cervix and ends with delivery of the baby (pelvic phase or expulsive stage)
2nd stage
begins with the delivery of the infant and
ends with delivery of the placenta.
3rd stage
Latent Phase
0-4cm. Contractions are mild. 10-20 minutes apart lasting 15-20 seconds
Active Phase
4-8 cms. Contractions are 3-5 minutes apart lasting 30-60 seconds
Transitional Phase
8-10cms. Contractions are 1.5-2 minutets apart and lasting 50-90 seconds
Cardinal Movements of Labor
Descent Flexion Internal Rotation Extension External Rotation
During labor and delivery nursing focus is mainly on careful assessment of mother, giving care and support, and knowing what actions to take in emergency situations.
Secondary Prevention
Nursing Care during Admission
*Assess if delivery is imminent!
* Many hospitals have paper work from health care provider ahead of
admission with pregnancy history, etc.
*Anxiety of coming to hospital- orient, rapport
*Aware of cultural, age, etc
*Are they in labor? Assess signs
*Vaginal exam for effacement and dilation
*Vital signs
*Maternal weight
*Urine sample
*Lab work
Nursing Care during 1st Stage of Labor
*Assess mother’s need for information and teach necessary breathing techniques, effleurage, etc. as needed. Respect techniques learned in classes and
support them during labor.
*Monitor maternal status - TPR & BP. Assess fetal status, usually with a monitor.
*Promote elimination and hydration
*Promote comfort by changing maternal position frequently, rub back,
providing socks for cold feet, change gown, etc.
*Watch for hyperventilation
* Minimize risk of infection and injury by keeping perineum
clean & dry, change pad under mother frequently, do pelvic exams
only when necessary and use sterile gloves
*Assess for signs of second stage - desire to push or move bowels. Do not push until fully dilated.
Nursing Care during 2nd stage of Labor
- Coach pushing how to push and how to use squat bars if available
- Promote comfort, wash cloth, support legs or back during pushing.
- Prepare room for delivery
- Clean perineum and drape
- BP and FHR frequently
- Note and record, the time of delivery and type of episiotomy or laceration.
Nursing Care during the 3rd stage of Labor
*Maternal BP frequently
*Note the time the placenta is delivered
* Estimate blood loss (500 is normal)
*Assess placenta - is it all delivered?
* If ordered Give oxytocin
Pitocin 10U in IV or Methergine 0.2mg IM
BP before and after
Nursing Care during the 4th stage of Labor
- Monitor vital signs q 5 to 15 minutes. Normal blood loss at birth will result in a decrease in BP and increase in pulse
- Assess uterus q5 to 15 min. If “boggy” massage.
- Hydrate
- Assess bladder - may have to catheterize
- Promote comfort - ice to perineum. If shivering cover with a warm blanket
- Promote maternal/paternal/infant bonding. Bring infant to them to hold and if breastfeeding this is the ideal time to start.
.are used to determine the position of the infant and to locate the back, where heart sounds are best heard.
Leoppold’s Maneuvers
Are associated with head compression, usually benign
Early Decels
– Note the deceleration almost mimics the contraction. It goes down at the same time the contraction starts and returns to normal by the end of the contraction.
are associated with cord compression,. They occur at any time during labor not always with a contraction. They also vary in shap
Variable Decels
-change maternal position, knee chest position
associated with uteroplacental insufficiency,
Late Decels
- the heart rate goes down after the contraction starts and does not return to normal until after the contraction is over.
- -turn mother on left side, give 02, prepare for possible c-section.
Common Narcotics given during Labor
Meperidine Hydrochloride (Demerol) or Butorphanol tartrate (Stadol) are usually given IV. Do not give if within 2 hrs of delivery or infant may be depressed and require a narcotic antagonist.
Ataractics given during Labor
like Phenergan. vistaril or Valium are often mixed with narcotics to potentate them so less narcotic is needed. They also relieve anxiety, nausea. & apprehension.
Sedatives given during Labor
like Secobarbvital (Seconal) and Pentobarbital (Nembutal) are used for false labor or early labor
General Anesthesia given during labor
good for delivery of twin or to perform “version”
and with emergency C. Section
Epidural Anesthesia given during labor
- are the most popular used today. Numbs from the waist down.
- Nursing actions:: - IV going, take BP q 1-5 minutes X 15 min, then q10- 15 min until stable. Assess bladder frequently, may have to catheterize, Will need to assist the mother when in turning and during pushing.
- Watch closely for complications of hypotension and fetal distress.
- Turn pt. on left side, increase IV rate, give O2
- Use caution in getting patient up for the 1st time after delivery
Episiotomy
Forceps
Vacuum Extractor
Methods to Shorten the 2nd stage of Labor
- incision made into the perineum during delivery.
*Purpose is to spare muscles from over stretching resulting in
lacerations,limits pressure on infants head, allows for application of forcepts, and prevent complication like having difficulty holding urine later in life
Episiotomy
2 Types of Episiotomies
Mediolateral: 45 degrees on either side of vagina
Midline: posterior margin of vagina, directly back to anal sphincter
Types of Lacerations
3rd degree: to anal sphincter
4th degree: through anal sphincter
Nursing care of Episiotomies
- Support mother during repair
- Ice pack - 20-30 minutes on then off 20, repeat
- Assess for hematomas, healing, and infection
- Stiz bath, spray, analgesia
- Teach Kegel Exercise to promote healing
Nursing interventions if forceps are used
Assess infant for intercranial hemorrhage,
facial bruising, facial palsy
Instruct parents regarding potential complications and healing process.
Amniotomy…indcution of labor
the water bag is broken by the doctor. There is an increased chance of infection. Following there is increased pressure on infant’s head that may cause early decelerations. Increased risk for
prolapsed cord
Prostaglandin Administration
a diaphragm or suppository is inserted into the vagina. Often used with abortions.
Oxytocin Infusion…induction of labor
IV of 1000 ringers lactate with 10 U Pitocin is hung. Must have 2nd bottle with no Pitocin. Continue to increase drip rate until contractions are every 2-3 min, lasting 40-50 sec
When to worry about length of contractions?
Longer then 90 sec or more freq than 2 min, can cause depression of infant or rise in baseline.
turn off, left side, O2(6-10L/min)
Possible reasons for C-Section
- CPD
- Fetal distress - uteroplacental insufficiency
- Breech, mal positions
- Maternal disease - diabetic, toxemia, herpes
- Complications - placenta previa, abruptio, prolapsed cord
Fluid and nutrition after C-Section
IV first 24 - 48 hrs
Bowel sounds must be present before food
I & O
Ice chips to start
Symptoms to look for that may mean infection due to premature rupture of membranes
Feeling of wetness Vaginal pooling of fluid seen on pelvic examination Decreased amniotic fluid on ultrasound Positive nitrazine test Positive fern test
Nursing Interventions is suspected infection due to membranes being ruptured
-Assess VS q 4 hrs. Report temp > 100.4 F
-Monitor CBC - report elevated WBC
-Administer antibiotics as ordered
-Assess vaginal discharge, uterine tenderness and /or
irritability
-Assess for uterine contractions
-Do Not perform vaginal exams unless by PCP ordered
-Assess FHR and activity Q 4-8 hrs
-Anticipate possible cord prolapse
-Facilitate discussion of fears, concerning possible preterm delivery, cesarean birth, and unknown fetal outcome.
Possible issues with Postterm Pregnancy
*Decrease profusion of placenta
*Oligohydramnios may be present - increase risk of cord compression
*Meconium aspiration 8 x more likely
*Treat
Weekly or 2 x week NST & CST
Fetal biophysical profile
Induction or C. Section
Emergency condition, in which the umbilical cord is displaced between the presenting part and the maternal bony pelvis. Fetal hypoxia, leading to fetal death occurs.
Prolapsed cord
Etiology of Prolapsed Cord: Any condition that prevents proper engagement of
the presenting fetal part into the maternal pelvis. At risk are:
Gravida with fetal malpresentation Unengaged fetal head Contracted maternal inlet PROM Placenta previa Small singleton fetus Multiple fetuses Longer umbilical cords
S/S of possible Prolapsed Cord
Bradycardia or absence of FHT Variable decelerations ROM Cord palpable on vaginal exam Cord protrusion from vagina Sensation of cord passage – mother
Nursing Interventions for Prolapsed Cord possibility:
-Place Mother in knee–chest or trendelenburg
-Sterile vag exam to push presenting part away –
assess pulsation of the cord
-Oxygen to mother
-Do not try to reinsert cord
-Warm sterile saline solution compresses to exposed cord
-Prepare mother for C. Section
-Remain calm !!!
Most diabetic mothers have a C-section around?
37 weeks.
Why do Diabetic mothers usually not go FT?
since the placenta of a diabetic starts to deteriorate early, so infant does may not receive adequate nutrients and oxygen. This may explain why in the past there was a high rate of fetal deaths with diabetics. Prior to the C. Section tests are done to establish maturity of the fetal lungs. During delivery and recovery, the mother’s blood glucose is controlled by IV’s and insulin.
Nursing Care and Interventions for a Laboring woman with Heart Disease
-The client’s vitals must be assessed more freq, including signs of CHF like rales.
-Clients do not tolerate frequent changes of position during labor.
-They do best in side lying with their head up. Since pain has a negative effect on the heart you want to avoid pain by use of medication and/or an epidural. It is best to deliver them vaginally with an epidural and
low forcepts. Avoid a C. Section if possible. Mother should use shorter pushes, IV should be monitored carefully not to put an overload on the heart. She should have ECG, FHM & O2 during labor and delivery. Use Pitocin with caution!
Which patient should you use Pitocin cautiously with?
Heart Disease
Normal Fetal HR
110-160
