processes of labor and delivery Flashcards
signs of impending labor
- ‘Lightening’
- Cervical mucous/bloody show
- Weight loss due to ↑ in loose stools: Prostaglandins
- ‘Burst of energy’
- ‘Nesting’
- ↑ contractions, backache
- Change in sleep cycles, N/V/D
lightening
@ what week
- The fetus drops into the pelvis Easier to breathe, harder to walk - ↑ in Braxton-Hicks push the fetus down into ‘ready’ position - after 36 w - feel lighter at top
how many stages of labor
4
first stage
- Cervical Change (dilation/effacement)- Has 3 phases
- Onset of regular contractions to complete effacement & dilation:
- 0-10 centimeters dilation (opening)
- 0-100% effacement (thinning)
second stage
- Birth of the BABY
- Full dilation until delivery of the neonate
- 10 centimeters with descent of presenting part to birth
third stage
- Birth of the PLACENTA
- Delivery of neonate to delivery of placenta
fourth stage
Recovery
- Postpartum Stabilization: 1st 4 hours after delivery
- Maternal-newborn bonding & breastfeeding
true labor
- Regular contractions- becoming stronger and closer together (nothing makes them go away)
- Contractions start in the back and radiate to the front of the abdomen
- Leads to cervical change
- When to go to the hospital: “ 511” or “411”- When contractions are 4-5 minutes apart, lasting 1 minutes long, for at least 1 hour OR water breaks OR if pain is intolerable
false labor
- Irregular contractions- lasting different lengths (braxton hicks)
- They go away with movement, rest, position change, or drinking water
- Felt in the front/groin
- No cervical change: stays tight and thick
latent phase
0-3 cm
active phase
4-7
transition phase
8-10cm
babys positon (passenger)
The baby’s position (Passenger)
- Presentation
- Lie
- Attitude
- Fetal position in pelvis: ccephalic, breech, oblique, transverse
(want them cephalic/vertex)
ROA
back of head pointing front
LOA
back of head pointing towards left side
ROP
sunny side up, back of head posterior
- makes labor harder
- back pain
- lot of first time parents
LOP
back of head facing back towards left
first letter
expectants pelvis side right or left
second letter
fetus occiput
thirst letter
expectant front back or side
widding the pevis
- wide stance
- squat
- peanut ball
- **counter pressure
- hands and knees
frequency
Measured from beginning of one contraction to the beginning of the next
- 1min- 1 1/2 min
- 2-3 min apart
duration
what does it include
Measured from start of one contraction to end of the same contraction
Includes the increment, acme and decrement
intensity
iupc
Palpation
- Mild (nose)
- Moderate (chin)
- Strong (forehead)
IUPC: measures contractions more accurately can also be used as a IV and flush water in to help with variables decel
progression in labor
- Early labor – weak and irregular
- Active labor – increased intensity, duration and frequency
- “Regular” contraction pattern is contractions that last 60-90 seconds, occurring every 2 to 3 minutes
fetal station: +’s
The +’s mean the head is below the ischial spines and closer to the vaginal opening
fetal station: -‘s
The –’s means that the head is above the ischial spines and further away from the vaginal opening.
fetal station
Where the fetal head is in relation to the ischial spines of the pelvis
0 station:
completely in line with ischeal: engaged
+3
see baby head
+4
crowning
sterile vaginal exam
sterile vaginal exam, looking for a three (sometimes four things): cervical dilation (0-10 cm), cervical effacement (0-100%), and fetal station -4 to +4
Non-Pharmacological Pain Management During Labor
position changes
Expectant position changes
- Upright
- Ambulating
- Left lateral
- Semi-recumbent
- Hands and knees
- Squatting
- Sitting on a Birth ball, toilet
- Cognitive strategies
- Sensory stimulation strategies
- Cutaneous stimulation strategies (gate-control theory)
v
cognitive strategies
Education, ***patterned breathing, Lamaze, doulas, hypnosis, biofeedback
senesory strategies
Aromatherapy, breathing techniques, imagery, music, use of focal points, subdued lighting
cutaneous strategies
Therapeutic touch/ effleurage, walking, rocking, counter pressure (great for OP babies), heat or cold packs, TENS therapy, hydrotherapy, acupressure, and frequent expectant position changes
gate control therapy
distractions with nerves makes it hurt less
- confuse nerves by stimulating other areas
opioid analgesics
Butorphanol (Stadol)
Nalbuphine (Nubain)
Fentanyl
- 3 doses given
risk with opoids
can cause drowsiness- so patient is fall risk, side rails up, education not to get up without help, call bell within reach! Also if opioid given close to delivery it can cause respiratory depression in neonate- may need resuscitation!
what to check before giving opioids
check cervic within an hour of giving
- 8cm b/c of resp depression, fall risk
epidural and spinal regional analgesia
Usually a combo of
fentanyl and bupivacaine on a pump
nursing care with epidurals
they need to be on strict bedrest! All positions changes are restricted to in bed only. They are a fall risk! Safety measures in place! #1 adverse effect of an epidural is expectant hypotension (baby will have recurrent late decelerations) !!!
how to manage hypotesion from epidural
Manage with fluid bolus, lateral position change, may need pressor to fix BP.
bladder with epidural
People with epidurals will need their bladder emptied either by a straight cath q2H or indwelling Foley Cath (to be removed before birth)
what can epidurals cause in labor
Epidurals can also prolong the second stage of labor. If you can’t feel your body, you don’t know how to push effectively.. So it takes time to figure pushing out.
Nursing Responsibilities During Second Stage of Labor
- Call MD, CNM
- Monitor EFM and baby’s tolerance of pushing
- Provide comfortable environment: music, light off, talk
- Support her in different positions: upright, squating, birthing ball, bath
- Support non-pharm pain relief techniques
(cold cloth, etc.) - Keep bladder empty
- Get delivery table/warmer ready (need resuscitation gear
ready for every birth)- Tell them what you are doing! - “Police” family & other visitors she might not want in the room
-Pericare, pericare, pericare - Document birth of head, whole body, remove EFM monitors to allow skin to skin
- have pt. pant if waiting for provider
Nursing Responsibilities During a Cesarean Birth: Preprocedure
- Assess EFM, vitals, head to toe, start IV, draw CBC, T+S, start IV fluids, witness C-section consent forms/blood product consent form, administer pre- c-section meds
- Educate patient/family about c-section procedure, provide emotional support
Nursing Responsibilities During a Cesarean Birth: intraprocedure
Assist with positioning pt for spinal, spot check FHTs, apply SCDs, bovie grounding pad, insert foley cath, skin prep patient, count instrument/sponge counts, perform TIME OUT, document procedure (birth)
Nursing Responsibilities During a Cesarean Birth: postprocedure
Assist with recovery, monitor vitals, monitor for s/s of complications, check fundus, lochia, treat pain/nausea, assist with bonding/skin to skin/breastfeeding
