WEEK 5 - Labour and Birth Care Fundamentals Flashcards
•Describe the major factors which influence labour and birth processes. •Interpret physical and behavioural findings that indicate labour progress. •Distinguish factors which influence the pain experience and their related coping and pain management strategies. •Highlight nursing implications for various pain management techniques •Describe the RN’s intrapartum role throughout the 4 stages, with a focus on supportive care.
What are the 6 P’s affecting labour?
Passenger - fetus & placenta Passageway - bony pelvis & soft tissue Powers - contractions & pushing Position - client Psychologic People
The cyclical factors involved in the psychological area of labour are…?
Fear + Tension + Pain
When client anxiety increases:
so do >catecholamine secretions and muscle tension
>magnified pain experience
But decreases occur in:
>uterine contractility
>confidence
>labour progress
Who are the PEOPLE involved in the 6th ‘P’ of labour?
Effective caregivers who are:
• Effective caregivers are: respectful, supportive, available, protective, encouraging, kind, patient, professional, calm, comforting, present
• 1:1 nursing care
• Companion of choice for labour support
The perception, interpretation and response to pain is influenced by which factors?
- Physiologic
- Psychologic
- Emotional
- Social
- Cultural
- Environmental
Childbirth satisfaction is determined not by the control of pain but according to…?
- Caregiver attitudes and behaviours
- quality of caregiver-client relationships
- client involvement in decision making
- client’s degree of control
What is supportive care?
“nonmedical care that is intended to ease a woman’s anxiety, discomfort, loneliness, or exhaustion, to help her draw on her own strengths, and to ensure that her needs and wishes are known and respected.”
Simkin, 2002
What are the interventions of supportive care?
• Continuous presence of a supportive caregiver • Includes: - Physical comfort measures - Emotional support - Information and instruction - Advocacy - Support for partner
What INCREASES as a result of increased labour support?
- Positive ratings of birth experience
- Feelings of competence, confidence • Length of breastfeeding
- Maternal assessment of baby’s personality, competence and health
What DECREASES as a result of increased labour support?
- Epidural rate/usage
- Use of forceps, vacuum • Analgesia/anesthesia use
- Length of labour
- Episiotomy rate
- Caesarean birth
- Postpartum depression
List barriers to supportive care.
- Inadequate staffing- no time
- High tech environment • Unnecessary medical interventions
- Lack of caregiver education and training
- Lack of management support
- Resistance
What is the bony landmark associated with “0” Station in the passageway?
Ischial spines of the pelvis.
1-5- is above(superior)
1-5+ is below(inferior) to the spines
Name the involuntary and voluntary POWERS of labour.
contractions & pushing
What is the most important nursing intervention related to POSITIONS?
Patient comfort & continuous variation.
What are the signifiers of PRELABOUR?
- Irregular uterine activity • Stop with walking or position change
- Felt in back, all over abdomen
- Can be stopped with comfort measures
- Cervix – may be soft, no significant change in effacement/dilation
- No bloody show
What are the indicators of LABOUR?
- Regular uterine activity • Stronger, longer, closer together
- Become more intense with walking
- Felt in lower back, lower abdomen, don’t stop with rest
- Cervix - cervical change (softening, effacement, dilation)
- bloody show
What notes should be made when assessing the amniotic membranes?
CHARACTERISTICS OF THE AMNIOTIC FLUID: C-colour O-odour A-amount T-time
ROM=rupture of membranes SROM - spontaneous PROM -premature PPROM -prolonged premature AROM(ARM)artificial
If a nitrazine strip turns from yellow to blue
OR
a ferning pattern is observed under a microscope
These are +ve tests for the presence of amniotic fluid.
Once a ROM has occured, how long should the fetal heart rate(FHR) be checked?
For one(1) full minute.
If group B streptococcus (GBS) is present, prophylactic antibiotics are given via IV to protect baby
a) in how many doses?
b) how far apart?
2 Doses
4 Hrs Apart
The RN ROLE for non-pharm pain management in 1st stage labour includes…?
- Supportive Care including Simkin’s ‘assessing and assisting’ • Review admission data • Nursing assessment: physical, emotional, psychosocial, cultural
- Fetal assessment
- Ongoing monitoring
- Perform interventions (including medications)
- Documentation
- Coordination of care
List some NON-PHARMALOGICAL pain-management options for a labouring client.
Relaxation techniques* Breathing techniques Imagery and visualization Music Touch and massage Effleurage and counterpressure Energy work Hydrotherapy Transcutaneous Electrical Nerve Stimulation (TENS) Acupressure and acupuncture Heat/cold therapy Hypnosis Biofeedback
Aromatherapy Intradermal water block Physical care measures Position changes Rapport, feedback Encouragement, validation Take Charge Routine (Simkin, 2002) Presence Anticipatory guidance Active listening And more..
The major NURSING GOAL concerning labour pain is to…
MAXIMIZE COPING
List the PHARMACOLOGIC pain management options for a labouring client.
• Sedatives • Analgesia • Anesthesia: • Local - Pudendal nerve block - Epidural block - Spinal block - Combined spinal/epidural (CSE) - Nitrous oxide - General anesthesia
The RN ROLE for pharm pain management in 1st stage labour includes…?
Assess & Monitor:
• Vital signs
• FHR
• Contractions and labour progress
• Response and pain level
• Sensory and motor function, level of block, LOC
• Return of sensory and motor function when discontinued
The SECOND STAGE of labour includes the following characteristics…?
• Full cervical dilation to the birth of the fetus • Duration: -primip 50-60 mins avg -multip 20-30 mins avg • Primary vs secondary powers • 2 phases: -passive -active • Open vs closed glottis pushing
What is the preferred method of pushing?
Open-glottis pushing
rather than purple-face pushing i.e. holding breath for 10sec
The RN ROLE in the 2nd stage of labour entails…?
- Assess signs of full dilation
- 1:1 nursing care
- Supportive care
- Hygiene, comfort measures
- Ongoing assessment and monitoring of client and fetus
- Documentation
- Coordination of care
- Assist birth attendant
Key indicators of the third stage of labour are:
- Birth of fetus to placental separation and expulsion
- Duration: few minutes to 1 hour
- Separation signs:
- Change in uterine shape (discoid to globular)
- Sudden gush of dark blood
- Lengthening of umbilical cord
- ^^^ length of 3rd stage = ^^^risk of hemorrhage
- Evidence based active management of 3rd stage
The RN ROLE in the 3rd stage of labour includes…?
1:1 nursing care • q15min monitoring • Promote and facilitate immediate/early bonding • Assist birth attendant • Explain procedures • Documentation
What are the indications for a Cesarean Section?
MCPD - LMFPO
- Malpresentations
- CPD (Cephalo-Pelvic Disproportion)
- Placental abnormalities • Labour complications
- Fetal compromise
- Medical factors
- Othe
What is the perioperative RN Role during a C/S?
- Pre-op prep
- Circulating vs scrub nurse
- Safety checks
- Assist with pain management
- Care coordination
- Documentation
- Support person
- Newborn care and monitoring
What is the post-op RN role after a C/S?
RECOVERY ROOM (PACU)
• Assessment and monitoring q15 mins until stable and/or recovered from anesthesia
• Postpartum physical assessment + O2 sat, LOC, colour, I&Os, level of block
• Newborn vitals and care
• Assist with feeding and S7S
• Facilitate bonding
• Care coordination
