Chapter 13: Nursing Care During Labor And Birth Flashcards
What is the priorities for a focused assessment?
- Determine condition of mother & fetus
- If birth is imminent
Focused assessment includes
- FHR
- Maternal VS
- Impending Birht
Focused Assessment: FHR
- Intermittent auscultation for termed fetus.
- Normal rate and rhythm
- Note presence of acceleration and absconded of decelerations.
Focused Assessment: Maternal VS
-Assessed to identify HTN or infection: BP and temperature
HTN or preeclampsia in pregnancy
140/90 or higher
Maternal temperature of 38 C (100.4 F) or higher suggests
Infection
Impending Birth sings include
- Grunting sounds
- Bearing down
- Sitting on one buttock
- “Baby is coming”
Comfort measures during labor and birth include **
- Lighting
- Temperature
- Cleanliness
- Mouth care
- Bladder
- Positioning
- Water
Comfort measures during labor & birth: Lighting
Soft, indirect lighting is soothing.
Bright overhead light is irritating.
Comfort measures during labor & birth: Temeprature
- Mom is usually hot and perspiring. Cool, damp washcloths on her face and neck promote comfort.
- Electrical fan
- Socks if feet get cold
Comfort measures during labor & birth: Cleanliness
Bloody show and amniotic fluid leak from the vagina during labor.
- Change sheets and gown as need, keep her dry and comfortable.
- Change the underpad regularly to reduce microorganisms that may ascend into vagina. (Folded towel or bath blanket absorbs larger quantities of amniotic fluid than the pad alone)
Comfort measures during labor & birth: Mouth care
- Ice chips, frozen juice bars, and hard candy on a stick reduce discomfort from dry mouth.
- Brushing teeth and simply rinsing mouth.
- Lip balm
Comfort measures during labor & birth: Bladder
Get her to empty her bladder and check her suprapubic area at least every 2 hours.
How can a full bladder affect labor and birth?
- Intensifies pain during labor
- Delay fetal descent
- Cause pain that remains after epidural is started
Comfort measures during labor & birth: Positoning
-Movement and frequent position changes
Movement and frequent position changes in labor promotes:
- Decrease in pain, improve maternal-fetal circulation
- Improves the strength and effectiveness of contractions
- Decrease length of labor
- Facilitate fetal descent
- Decrease perineal trauma and episiotomies.
Six physiologic principles related to maternal positioning in labor
- ) promote spinal flexion
- ) promote an increase in the uteru-spinal drive angle
- ) facilitate stronger expulsive forces
- ) promote a good fit
- ) increase pelvic diameters
- ) facilitate occiput posterior rotation. “C” shape
Back labor
Common when the back of the fetal head puts pressure on the woman’s sacral promontory. (Occiput posterior position)
Positions that encourage the fetus to move away from the sacral promontory are:
- Hands-and-knees position
- Lean forward over a birthing ball (sturdy beach ball)
These two reduce back pain and enhance the internal rotation mechanism of labor.
Women with epidural needs assisting with
Position changes q30-45 minutes
Comfort measures during labor & birth: Water
- Can slow labor if used in latent labor.
- Breast stimulation by a shower or whirlpool often provokes contractions by secretion of natural oxytocin.
Water should be used in
Active labor or if persistent
Nonpharmacologic ???***
….
While the nurse cares for the mother, minimal information can be quickly gathered if birth is imminent:
- Name of her physician or nurse-midwife if she had prenatal care
- Names of mother and support person(s)
- Number of pregnancies and prior births, including whether the birth was vaginal or cesarean
- Status of membranes
- Expected date of delivery
- Problems during this or other pregnancies
- Allergies to medications, foods, or other substances
- Time and type of last oral intake
- Maternal vital signs and FHR
Women usually feel the urge to push when
· the cervix is fully dilated and effaced
· fetus descends to about +1 station or lower and internal rotation.
Pushing against a cervix does not easily yield to pressure therefore
It can lead to cervical edema -> blocks labor progress or cervical laceration.
What should be taught during the first stage?
Teach woman to exhale in short breaths if pushing is likely to injure their cervix or cause cervical edema.
Second Stage: Laboring down
Technique of delaying pushing until reflux urge occurs.
Laboring down allows for
- Uterine contractions to cause most fetal internal rotation and descent after full dilation naturally.
- Rest before actively pushing baby out.
Pushing vigorously sooner before onset of the reflux urge can cause
Birth canal injury.
If fetal descent has not occurred after 2 hours,
Open glottis pushing (w/o holding breath)
Laboring down results in
- Less maternal fatigue
- Decreased: pushing time, risk of instrument-assisted and cesarean births
- APGAR sores equivalent to those of women who pushed immediately on fully cervical dilation.
Vertical maternal position enhances
Fetal descent
Squatting
- Ideal position for pushing because it enlarges the pelvic outlet slightly and adds the force of gravity to the mother’s efforts
- Good if she has small pelvis or fetus to large
What are other positions that have gravitational advantage?
o Pushing while sitting on birthing ball
o Pulling against squatting bar
o Tug of war game
What should you teach a patient while she is pushing in a sitting or semi-sitting position?
- Teach them to curve their body around her uterus like a “C” shape rather than arching their back.
- Most effective, woman should pull on her knees, handholds, or a squat bar while pushing.
- Also hold the “C” shape, in her upper body, if she is pushing on her side.
What methods and breathing patterns should you teach your patient?
·Push w/ abdominal muscle while relaxing perineum area; begin by taking a breath and exhaling. Take another breath and exhale while pushing for 4-6 seconds at a time.
·Modest/woman that fear loosing control may inhibit their pushing efforts if you say “push like your taking a dump” instead tell them to push down and out under her symphysis, following the pelvic curve.
· Showing them a pic or diagram will help them to visualize the curve.
Methods that reduce BF to placenta & is fatiguing include
- Sustained pushing while holding a breath (valsualva maneuver or purple pushing)
- Pushing more than 4x per contraction
Encouragement during labor and delivery
▪Tell the woman when her labor is progressing; if she can see her efforts are effective, she has more courage to continue.
· Help her touch/ see the baby’s head with a mirror as crowing occurs.
· Praises the woman, reinforces her actions, which gives her a sense of control, respect and support.
· If one effort doesn’t work after 3-5 contraction, encourage them to try other techniques.
Giving to self
▪ Do not overlook, even independent woman may become dependent during labor and need human contact.
▪ Although mom and support person may be prepared they often welcome suggestion and affirmation from the nurse. Gentle coaching and encouragement.
Offering pharmacological measures
▪Be informative but neutral when explaining about available pain medication
▪She may feel disappointed and guilty because she took medication despite her planned unmediated birth
▪This should be done as early in the labor as possible while the woman is still in control and can think critically
When offering pharmacological measures, include
· Include the option for the woman to change her mind and how that will be communicated
· Although the event may not be what she wanted, encouraging the woman to express her feeling helps her put it into perspective.
