Pregnancy, Labour & Delivery

Question 1

The birth process

Answer 1

• rhythmic contractions of the uterus and the dilation of the cervix
• baby is a neonate for the first 28 days after birth

Question 2

Assessing Labour

Answer 2

• determine early in your assessment whether they are in labour. Q to ask
  1. first pregnancy? (takes longer)
  2. Are they in a physician care for high risk factors
  3. how the amniotic sac ruptured? (water broke?)
  4. how far apart are the contractions? Strong?
  5. is there bloody discharge?
  6. Do they have an urge to push?
  7. Is the baby crowning?

Question 3

Stages of Labour

Answer 3

Stage one - preparation
Stage two - delivery of baby
stage three - delivery of placenta
Stage four - stabilization

Question 4

Preparation stage

Answer 4

1st contraction til cervix fully dilated (10 cm)
when contractions are <3 mins apart - delivery is near
- Prepare yourself
- only bleeding that cannot be controlled after birth is issue
- The mother: commonly concerned about complications. Reassure, tell to breath, explain what to expect, focus on one oject in the room, remain calm, slow, deep breaths

• establish clean environment (under her buttocks, drape over her legs, keep a clean, warm towel for neonate
• suction for baby’s mouth and nose
• supplemental o2

Question 5

Delivery of baby

Answer 5

contraction are > 3 mins apart
1. position of comfort
2. as crowning occurs apply gentle, light counterpressure
3. mother should be directed to stop pushing
4. baby will turn to one side to let shoulders pass
5. support baby’s head
6. guide the shoulders, DO NOT pull the baby!
7. place neonate on its side, between mother and you
8. clamp or tie the cord at 2 locations (4 and 6 inches away from neonate)

Question 6

Delivery of the placenta

Answer 6

Normally within 20 min. after birth
Placenta separates from uterine wall & exits through vagina
RTD?

Question 7

Stabilization

Answer 7

Remember 2 patients now!
Priorities: baby’s airway and body temp.
- open and clear airway
- no spontaneous cries: flick the soles of the feet or dry vigorously for 30 sec
- if baby does not breath A/R
- Wrap baby up

Question 8

Postpartum bleeding

Answer 8

> 500 ml of blood loss
RTD
Do NOT attempt packing to control bleeding
care for external bleeding from tears

Question 9

Caring for Neonate

Answer 9

APGAR at minute 1 and 5
- Skin colour (blue and pale = 0, pink body blue extremities = 1, 2 completely pink = 2)
- pulse (absent = 0, <100 = 1, >100 = 2)
- irritability (no response = 0, Grimace = 1, cough, sneeze, cry = 2)
- muscle tone (limp = 0, some flex of extremities = 1, Active movement = 2)
- respiration (absent = 0, Slow & irregular = 1, Strong, crying = 2)
7-10 normal
4-5 is low
0-3 is critically lower
score of 10 is uncommon