Nursing Care of the Family During Labor and Birth Flashcards
coordination contractions with cervical change
Labor -
Involuntary
Labor Begins with onset of regular uterine contractions
Longest stage of labor - extremely variable in length
Regular uterine contractions
Ends with full cervical effacement and dilation
Three phases
Care management
First stage of labor
Latent phase: Up to 3 cm of dilation
Active phase: 4 to 7 cm of dilation
Transition phase: 8 to 10 cm of dilation
Three phases - First stage of labor
Determination of true or false labor
Care management - First stage of labor
Think about muscle fibers
LOT ASSESSMENT
True
False
Focus assessment
Database assessment
Physical examination
Laboratory and diagnostic tests
Assessment: first stage of labor
Begins in lower back and extends from back to abdomen - figure 8 muscle pattern in abdomen
Increases in intensity, frequency and duration - harder to handle; contractions feel harder; closer together; evolves overtime
Contractions get harder
Change in cervix (softening, effacement, dilatation, more anterior position) - not know until assessed
Train that cannot stop
True
Contractions not go anywhere
Not get closer together
Change position and feel together
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 - not good indic
False
- Fetal heart rate - first set VS is baby - transducer on belly; tocodomoter - see contractions
Maternal vital signs
Impending birth
Focus assessment
Obtain essential information from the client: last ate/drank? - risk for C-section
Obstetrical history - GTPAL
Prenatal History - any/none; how many weeks; all labs - check all things do 9 months ago to know whole health pic
GBS status: Start abx ASAP if positive - group B strep
Past medical history - pertinent
Contingent on her and fetus
Database assessment
Checking cervix - same person checks her entire time
Efacement - how thin cervix is - % - length first knuckle; sheet of paper - completely effaced - 100%; spongy to super soft
General systems assessment
Vital signs
Leopold maneuvers - position of kid - often more providers
Assessment of fetal heart rate (FHR) and pattern
Assessment of uterine contractions
Vaginal examination - often more nurse
Physical examination
Analysis of urine specimen
Blood tests - CBC, type and screen
Other tests
Assessment of amniotic membranes and fluid - see if ruptured and check if are; check urine
Laboratory and diagnostic tests
General hygiene
Nutrient and fluid intake
Elimination
Support to patient and family - imp
Nursing interventions: first stage of labor
Oral intake - clear liquids; in labor - no food - risk for C-section
IV intake
Nutrient and fluid intake
Voiding
Catheterization - with epidural: cascade of interventions - watch for infection - help position her
Bowel elimination - often get enema - no dump on delivery table - clear colon so when push colon clean
Ambulation and positioning - without epidural can walk
Elimination
Voluntary
Start sweating and working
Infant is born
Two phases
Assessments
Perineal trauma related to childbirth
Second stage of labor
Begins with full cervical dilation (10 cm) - MUST BE 10 cm before can push
Complete effacement (100%)
Ends with baby’s birth - still attached to cord
Infant is born - Second stage of labor
Lot pushing
Latent: Relatively calm with passive descent of baby through birth canal and pelvis - station is where baby presenting part relationship to bottom of symphysis pubis - ground 0; anything beyond that +1-4
Cervical dilation, progression station, effacement - go together
Descent: Active pushing and urges to bear down
Two phases - Second stage of labor
Likely when +3
Optimal conditions for descent
Spontaneous urge
Position (OA - smallest diameter of head) - sunny side up - largest diameter of head
Quality of contractions
Station ≥ +1 (ideally would be +3)
Descent: Active pushing and urges to bear down
Bulging perineum - see things moving - not have fingers in there for an hour
Labial separation
Visible caput (top head), obvious descent
Assessments - Second stage of labor
Perineal lacerations
Vaginal and urethral lacerations
Cervical injuries
Episiotomy - not routine - often tear on own because less extensive - cut something and more pressure will do more
Perineal trauma related to childbirth - Second stage of labor
Need clamp, gloves, extra instruments in case tearing; hemastats
Preparing for birth
Optimal position - squatting - gravity - diameter pelvis changes - lay back and do lithotomy - increase diameter - easiest for provider - pushing uphill; staying upright gets baby in best position - must keep moving
Birth in delivery or birthing room or home; birth anywhere
Mechanism of birth: Vertex presentation
Care management: second stage of labor
Maternal position
Bearing-down efforts
FHR and pattern
Support of father or partner - need someone to help them
Supplies, instruments, and equipment
Preparing for birth
Valsalva - not for cardiac pts
PUSH, PUSH, PUSH!!!!!!!!!!!!
Physiological and emotional effects on mom and baby
Holding breath and pushing down
Increasing intrabdominal and intrathoracic pressure
Decrease oxygen to fetus
Some very effective pushing with this
Exhaustion to mother.
Holding breath.
Counting
Things swelling up down there if holding breath
directed/closed glottis - Care management: bearing down
Throat is open
Exhaling and giving noise - extra effort
Not holding breath
Make same noises made when got knocked up
Make noises help with effort and also breathing
Not autocratic - she is in control
Instinctive grunting
Women push several times during contractions
Efforts vary in intensity and frequency
Less maternal fatigue
Fewer operative births
Less fetal acidosis
Fewer pelvic floor complications
Distressing to hear someone screaming
spontaneous/open glottis - Care management: bearing down
Shortest stage of labor
Care management
Placental separation and expulsion
5-15 min
Third stage of labor
Still pregnant until placenta out - this is her body
Firmly contracting fundus
Change in shape of uterus - know about done
Sudden gush of dark blood from introitus - shows placenta detached; know about done
Apparent lengthening of umbilical cord - know about done
Vaginal fullness - labia nice and full - placenta huge then rub fundus
Placental separation and expulsion - Third stage of labor
Recovery - uterus is contracting - esp sev kids already; often multiple babies - post delivery post contractions strong/stronger than labor - uterus working so hard to contract
Baby out and if not in distress to abdomen - may do delayed cord clamping
Assessment
Skin-to-skin
Newborn and Maternal WELLBEING!
Assess fundus and bleeding - and rub it
Assess perineum (laceration/episiotomy)
Vital Signs, including Pain - VS q15 min
Newborn assessments.
NEWBORN THERMOREGULATION - well swaddled if not skin to skin - better if naked and on blankets; all have issue with thermoregulation
Breastfeeding - start now; often attempt
Comfort - nurse to mom: phys and somatic pain, eats, ice for bottom, peribottles; psychosocial: people around them for first 2 hours where looking at bottom and rubbing fundus; child not keeping - labor not changed
Repair to perineum - ice
Turn off epidural
Active management - risk is bleeding to death
At delivery 2 nurses - nurse for mom and nursery nurse for baby - lot people in there - OB nurse has mom then baby after released from nursery
Fourth stage of labor
Regular contractions with cervical change
What is the definition of labor?
First, second, third, fourth
What are the stages of labor?
2-3
Most seen: Epidural - 2: latent (0-5) and active (6-10)
Changed because Bigger, older; food very diff today
Latent phase: Up to 3 cm of dilation
Active phase: 4 to 7 cm of dilation
Transition phase: 8 to 10 cm of dilatio
What are the phases of Stage 1?
Latent - body do this
Active - descent - pushing
2 phases of stage 2?
Thinning of the cervix; how measure % with fingers - guess
What does effacement mean?
Start to start
How are contractions timed?
