CARE OF MOTHER 3-10 Flashcards
3-10
Although a number of theories have been proposed
to explain why labor begins, it is believed that labor is
influenced by a combination of factors originating
from the mother and the fetus (____).
Katz, 2003
Possible Causes of the Onset of Labor
Maternal Factor Theories
Pressure on the cervix stimulates nerve plexus,
causing release of oxytocin by maternal posterior
pituitary gland. This is known as
Ferguson reflex
Possible Causes of the Onset of Labor
Maternal Factor Theories
Uterine muscles stretch, causing release of
prostaglandin.
Ferguson reflex.
Oxytocin and
prostaglandin work together to inhibit calcium
binding in muscles cells, raising intracellular calcium
and thus activating contractions.
Estrogen/progesterone ratio shift
Possible Causes of the Onset of Labor
Fetal Factor Theories
Placental aging and deterioration triggers initiation of
contractions
Fetal cortisol, produced by the fetal adrenal glands,
rises and acts on the placenta to reduce
progesterone formation and increase prostaglandin
Prostaglandin produced by fetal membrane s
(amnion and chorion) and the decidua stimulates
contractions. When arachidonic acid stored in fetal
membranes is released at term, it is converted to
prostaglandin
Factors Affecting Labor
Passageway
Type of pelvis (e.g. gynecoid, android, anthropoid,
or platypelloid)
Structure of pelvis (e.g. true versus false pelvis)
Pelvic inlet diameters
Pelvic outlet diameters
Ability of the uterine segment to distend, the cervix
to dilate, and the vaginal canal and introitus to
distend
Factors Affecting Labor
Passenger
Size of the fetal head and capability of the head
to mold to the passageway
Fetal presentation
Fetal attitude
Fetal position
Factors Affecting Labor
Power
frequency, duration, and strength (intensity)
of uterine contractions to cause complete cervical
effacement and dilation
Factors Affecting Labor
Placental factors
site of placental insertion.
Factors Affecting Labor
Psyche
refers to the client’s psychological state;
available support systems, preparation for child birth,
experiences , and coping strategies.
Signs and symptoms of impending labor
(Premonitory
Signs)
are irregular, intermittent
contractions that have occurred throughout the
pregnancy, become uncomfortable, and produce a
drawing pain in the abdomen and groin
Braxton Hicks contractions
Signs and symptoms of impending labor (Premonitory
Signs)
Lightening
Braxton Hicks
Cervical changes include softening , “ripening” and
effacement of the cervix
Rupture of amniotic membranes
Burst of energy or increased tension and fatigue may
occur right before the onset of labor
Cervical changes include
softening , “ripening” and
effacement of the cervix that will cause expulsion of
the mucous plug (bloody show).
Characteristics of True Labor
Contractions occur at regular intervals
Contractions e back and sweep around to the abdomen , increase in intensity and duration , shortened intervals.
Walking intensifies contractions.
Bloody show”
Cervix becomes effaced and dilated
Sedation does not stop contractions
Characteristics of False Labor
Contractions occur at irregular intervals.
Contractions are located chiefly in the abdomen, the
intensity remains the same or is variable, and the
intervals remain long.
Walking does not intensify contractions and often
gives relief.
Bloody show usually not is not present. If present, it is
usually brownish rather than bright red and may be
due to a recent pelvic examination or intercourse.
There are no cervical changes.
Sedation tetends to decrease the number of
contractions.
primiparas
(longer)
multiparas
shorter),
“ occurs when the newborn’s head or
presenting part appears at the vaginal opening.
“Crowning“
(surgical incision in perineum)
Episiotomy
Second Stage
begins with complete dilation of the cervix and ends
with delivery of the newborn
Contractions are severe at <2- to 3-minute intervals, with a duration of 50 to 90 seconds
birth canal with help from the
following cardinal movements, or mechanisms, of
labor.
“Crowning“
Episiotomy
second stage
The newborn exits the birth canal with help from the
following cardinal movements, or mechanisms, of
labor.
Descent
Flexion
Internal rotation
Extension
External rotation (restitution)
Expulsion
“Crowning
what is called the Third stage
(Placental stage)
Third stage (Placental stage)
It occurs in two phases
placental separation and placental expulsion
Third stage (Placental stage)
Signs of placental separation include the
uterus
becoming globular,
the fundus rising in the abdomen,
lengthening of the cord, and
increased bleeding
(trickle or gush).
Third stage (Placental stage)
Generally, ____ are administered to help
the uterus contract
oxytocic drugs
Third stage (Placental stage)
This stage begins with delivery of newborn, and ends
with delivery of the placenta.
placental separation
Contractions of the uterus controls uterine bleeding
and aids with placental separation and expulsion
oxytocic drugs a
Fourth stage (recovery and bonding)
This stage lasts from 1 to 4 hours after birth.
The mother and newborn recover from the physical
process of birth.
The maternal organs undergo initial readjustment to
the nonpregnant stage
The newborn body system begin to adjust to
extrauterine life and stabilize.
The uterus contracts in the midline of the abdomen
with the fundus midway between the umbilicus and
symphysis pubis.
4 Core Steps of ENC
Immediate Drying
Skin-to-skin contact
Proper cord clamping and cutting
Non-separation of newborn and mother
EENC transfers___ from the mother to the
newborn
life-saving warmth, placental blood
and protective bacteria
Early Essential Newborn Care (EENC)
Prolonged skin-to-skin contact is recommended for
no less than ____ minutes.
90
Kangaroo Mother Care or KMC is care for ____ through prolonged and continuous ____
preterm
infants
skin-toskin contact.
_____ can also provide skin-to-skin contact through
KMC
Fathers
Exclusive breastfeeding is where the infant only
receives ____
breast milk without any additional food or
drink, not even water, for the first 6 months
Exclusive breastfeeding protects your baby from
common childhood illnesses such as _______, and helps with a quicker recovery if the
infant falls ill.
diarrhea and
pneumonia
Exclusive breastfeeding also contributes to health
and well-being of mothers:
helps to space children,
reduces the risk of ovarian and breast cancer, and is
a secure and low-cost way of feeding.
Can Early Essential Newborn Care apply to all types of
deliveries?
yes includinng pre term
How do I know my baby is getting enough milk from
breastfeeding?
At birth, a newborn’s stomach is only the size of your
thumbnail and requires a very small amount of milk
per feed
closing her or his mouth and taking no
more breast milk
Try breastfeeding 8 to 12 times over the day and night,
when the baby shows early feeding cues
How do I know when my baby is ready to breastfeed?
drooling, then mouth opening, licking and biting of
their fingers or hand.
I don’t have enough breast milk. Should I add infant
formula?
The more you breastfeed, the more milk you produce.
My nipples hurt when I breast feed. What can I do?
Adjust the baby’s position and attachment to resolve
nipple pain while breastfeeding.
Signs of good attachment:
More areola is visible above the baby’s mouth than
below
Mouth is wide open with the lower lip turned outward
Baby’s chin is touching the breast
Baby’s sucking is slow and deep with occasional
pauses
one newborn dies
every 4 minutes – largely due to inappropriate clinical
practices at the time of birth.
Western Pacific Region,
from the first
breastfeeding, essential nutrients, antibodies and
immune cells are transferred from mothers to their
babies to protect them from infection
colostrum or “first milk”
4 Time-Bound Interventions in ENC
Immediate and thorough drying
prevents hypothermia which is extremely important to
newborn survival
4 Time-Bound Interventions in ENC
Early skin-to-skin contact
prevents hypothermia, hypoglycemia and sepsis,
increases colonization with protective bacterial flora
and improved breastfeeding initiation and exclusivity
4 Time-Bound Interventions in ENC
Properly-timed clamping and cutting of the cord
properly-timed clamping and cutting of the cord after
1 to 3 minutes until the umbilical cord pulsation stops
decreases anemia in one out of every seven term
babies and one out of every three preterm babies.
It also prevents brain (intraventricular) hemorrhage in
one of two preterm babies.
4 Time-Bound Interventions in ENC
Non-separation of the newborn from the mother
for early breastfeeding initiation
Breastfeeding initiation within the first hour of life
prevents an estimated 19.1% of all neonatal deaths.
What has the government done to ensure
implementation of the Essential Newborn Care Protocol?
The signing of the Administrative Order 2009-0025 l last
Dec. 1, 2009
Newborn Care Practices in the Delivery Room
that should no longer be continued
routine suctioning of secretions
if the baby is crying and breathing normally
e newborn on a cold or wet surface.
Wiping or removal of vernix caseosa
Foot printing
Bathing earlier than 6 hours of life
Unnecessary separation
neonatal intensive care unit without any indication
