T3: Nursing Care of the Family During Labor and Birth Flashcards
labor and birth begins with…
first uterine contraction, continues with hard work during cervical dilation and birth, and ends as woman and family begin attachment process with infant
diagnostics for labor
o Testing of amniotic fluid will reflect FERN PATTERN
true labor
o Contractions are REGULAR
o Pain is felt in BACK RADIATING TO FRONT
o Cervical changes (DILATION!)
o Fetus engages (moves to inlet of the pelvis)
o Change of position DOES NOT MATTER/HELP
o Bloody show (cervix bleeds as it dilates)
cervical changes are found through
a sterile vaginal exam
false labor
o Contractions irregular
o Lie down or move may make labor stop
o No changes in cervical dilation, effacement, or bloody show
o Fetus not engaged often posterior
dilation
enlargement of cervical os and cervical canal during the first stage of labor
effacement
thinning of the cervix during labor
station
Relation of the presenting part of the fetus in an imaginary line drawn between the maternal ishcial spines; measured in degree of descent of the presenting part of the fetus through the birth canal
o -2,-1,0,+1,+2
position
relationship of assigned area of the presenting part or landmark to the maternal pelvis
first stage of labor consists of
early/latent and active phase
first stage: early/latent dilation
1-5 cm
first stage: early/latent effacement
100%
first stage: early/latent station
0 to -2
first stage: early/latent contractions
every 5-30 minutes
first stage: early/latent lasts about
6-8 hours
First Stage: Active Phase dilation
6-10 cm
First Stage: Active Phase contractions
every 2-3 minutes
First Stage: Active Phase lasts
3-6 hours
First Stage: Active Phase interventions
- Change positions frequently
- Empty bladder frequently
- Use hydrotherapy
- Needs encouragement
- Don’t distract her
- “Feel like you’re losing it”
at 8-10 dilation…
· Length, 20-40 minutes
· Contractions 2-3 minutes
· Trembling, nausea, perspiration, snap at coach
· Don’t leave alone
· Patterned breathing
second stage of labor
o 10 cm-delivery
o Latent Phase - Resting (“laboring down”)
o Active Phase - Pushing (spontaneous and “directed”-Few minutes to several hours
third stage of labor
delivery of placenta
3 signs that placenta is detached and ready to deliver
· Lengthening of the umbilical cord
· Gush of blood
· Stomach changes shape
oxytocin
given after delivery so uterus contracts
fourth stage of labor
o 1-2 hours after delivery
o Post Delivery Care
o Recovery
o Care of the family
o Family newborn relationships
newborn care and assessment
-Skin to skin/warmth
-APGAR SCORING
APGAR scoring tells us
during the first minute how the baby did during labor; it is then repeated 5 minutes after to tell us how the baby is adapting to extra uterine life
APGAR
activity, pulse, grimace, appearance, respiration
APGAR highest score
10/10
first degree laceration
extend through skin and structures superficial to muscles
episiotomy
surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth
second degree laceration
extend through muscles to the perineal body
third degree laceration
extend through the anal sphincter muscle
fourth degree laceration
laceration that also involves the anterior rectal wall
5 P’s of labor
Passenger
passageway
powers
position
psychological response
passenger
fetus and placenta
passageway
birth canal
4 basic types of shapes to pelvis
-Gynecoid- classic female type
-Android- resembling
- Anthropoid-resembling the pelvis of anthropoid apes
- Platypelloid-flat pelvis
powers
contractions and maternal voluntary pushing effort
primary power
Involuntary contractions causing dilation and effacement
secondary power
voluntary urge to push
Position of Mother
standing, walking, side lying, squatting, on hands and knees
fetal presentation
portion of the fetus that enters the pelvic inlet first
o Vertex (96%) breech (3%) & shoulder 1(%)
fetal lie
Relation of long axis of fetus to long axis of mother
fetal attitiude
Relation of fetal body parts to each other e.g. flexion of chin
Fetal presenting part: O
occiput (head)
Fetal presenting part: S
sacrum
Fetal presenting part: M
mentum or chin
Fetal presenting part: SC
scapula or shoulder
Location of presenting part in relation to a portion of maternal pelvis: A
anterior
Location of presenting part in relation to a portion of maternal pelvis: P
posterior
Location of presenting part in relation to a portion of maternal pelvis: T
transverse
engagement
mechanism where fetus nestles into the pelvis; occurs when presenting part reaches the level of the ischial spines
descent
process that the fetal head undergoes as it begins its journey through the pelvis
how is descent assessed
through station
flexion
process of nodding of fetal head forward toward the fetal chest
internal rotation
occurs most commonly from occipitotransverse position, assumed at engagement into the pelvis, to the occipitoanterior position while continuously descending
extension
enables the head to emerge when the fetus is in a cephalic position; begins after the head crowns; extension is complete when the head passes under the symphysis pubis and occiput, and the anterior fontanel, brow, face, and chin pass over the sacrum and coccyx and are over the perineum
restitution
realignment of the fetal head with the body after the head emerges
external rotation
shoulders externally rotate after the head emerges and restitution occurs, so that the shoulders are in the anteroposterior diameter of the pelvis
expulsion
birth of the entire body
FETAL ADAPTATIONS TO LABOR
- Fetal lung fluid is cleared from the air passages during labor and vaginal birth;
- Fetal oxygen pressure (PO2) decreases;
- Fetal arterial carbon dioxide pressure increases (PCO2);
- Fetal arterial pH decreases;
- Fetal bicarbonate levels decrease;
- Fetal respiratory movements decrease during labor.
Amniotomy
Artificial ROM with an amnihook
