Labor and Delivery

AntePartum and labor &

DeliveryThe period prior to and giving birth.

• Antepartum-Building up to delivery, pre-contractions . (stages of pregnancy)

• Labor & Delivery- Process of Labor -Three Stages of Labor

Stages of Labor• Stage 1- Early LaborContractions begin and “Water”

might break: Dilation and effacing of cervix occur

• Stage 2- Active LaborMom pushes and baby is moved

down birth canal, up to “crowning”. During this stage Baby is delivered

• Stage 3- Delivery of Placenta and contraction of Uterus back down

Pain ManagementEpidural – regional pain control

IV Pain medications – has some effects on baby, can be sedative for mom and make it hard to push

Natural – no medication General Anesthetics (surgical)

– has effects on baby, usually done with emergency procedure

Equipment• IV pumps and poles• BP and Heart monitor

for mom• TOCO monitor for baby

and mom contractions• Can sense fetal HR and

contractions• Labor and Delivery bed

Contractions of Uterus

• Assessed by evaluating the height and consistency of the fundus (the part of the uterus that can be palpated abdominally). – Mild - end of nose– Moderate - chin– Strong - forehead

• Oxytocin is the hormone produced in the pituitary gland that induces contractions

• Manufactured oxytocin in Pitocin and is used to either induce or augment labor

Signs of True Labor• When did your contractions start?• How far apart are the contractions?• How long so they last?• How strong are they?

• Once at the hospital staff will check for dilation and effacing

True Labor Cont.

• Contractions should be Regular and 5-10 minutes apart

• Become progressively longer contraction• Become progressively stronger contraction• Length of time between contractions shortens• Changing position or activity does not change

contraction pattern• May have bloody show, loss of mucous plug or rupture

of membranes (only 1 in 10 women have spontaneous rupture of membranes)

Prepaired for Delivery

Fully effaced – thickness of cervix has thined

Dilated to a 10 + Diameter of the cervix in greater than 10 cm

Lid comparison – 20 oz coke bottle top to a wide mouth pickle jar

Babies head has moved down into birth canal

Team members for Delivery• OB/GYN physician

• L&D nurse• CNA • Anesthesiologist• Nursery nurses• Pediatrician • Lactation consultant

Focus On BABYNormal Pregnancy- 9 months

(3 trimesters)1st Trimester- develops heart

beat, brain and spinal cord form, forming arms, legs, fingers toes

2nd Trimester- mom feels movement. Baby can move extremities

3rd Trimester- Optimal growth and Development

Focus on Baby

• Full term is considered anything over 38 weeks

• Premature is anything less than 37 weeks• After 40 weeks is considered over due

Other things to consider…

Nursery nurses and Labor and Delivery nurses work to gether to take care of 2 or more patients.

When might it be more?

Now Practice

• Based on the following assessments, what stage of labor would you place each expectant mother in? Why?

• Would you send her home to wait, or would you admit her to Labor and Delivery? Why?