module 5. discuss labor and the admission process
TRANSCRIPT
Maternal child healthModule 5
Discuss labor and the admission process
Objectives
The birth process
Changes in birthing Home-like environment … and home
environment Planned birthing process Cultural considerations and birthing
traditions
Introduction
Theories ◦Mechanical Uterine stretching
◦Hormonal Release or decrease in hormones Oxytocin stimulation Progesterone withdrawal Estrogen stimulation Fetal cortisol
Onset of labor
Lightening Braxton-Hicks contractions Cervical changes
◦Softening, dilation, effacement Bloody show Rupture of membranes Sudden energy burst
Signs of impending labor
Contractions: increase in frequency, duration, strength
Cervix: dilating to about 10 cm Fetus: descending through birth way Teaching:
◦ Notify provider when bag of waters (amniotic sac) breaks: time, color, amount, odor
◦ Call or go to delivery setting when contractions: every 5 minutes 60 seconds each For at least an hour
Labor
Passage◦Pelvis◦Uterus◦Cervix◦Vagina◦Perineum
Variables affecting labor
Passenger◦Size and skull◦Fetal attitude◦fetal position◦Fetal presentation: cephalic, breech, shoulder
◦Fetal lie
Variables affecting labor
Fetal attitudes
Fetal positions (see FON p 814 Fig 26-5)
Fetal presentation
Fetal lie:
Powers◦Uterine contractions (primary)◦Maternal pushing (secondary)
Psyche◦Attitude (experiences, expectations, values)
◦Anxiety/fear◦Cultural beliefs
Variables affecting labor
First stage◦ Dilation and
effacement Early/latent:
0-3 cm 5-8 min/apart 20-35 sec/each
Active 4-7 cm 3-5 min/apart 40-60 sec/each
Transition 7-10 cm 2-3 min/apart Up to 80 sec/each
Stages of labor
Second stage:◦ Delivery of newborn
Mechanisms of labor
Engagement Descent Flexion Internal rotation Extension Restitution External rotation expulsion
Stages of labor
Third stage◦ Delivery of placenta
Oxytocin Breastfeeding Fundal massage
Pitocin IV IM
Stages of labor
Fourth stage◦Recovery/stabilization2-4 hoursVital signs/assessment1st hour: Q15 minutes2nd hour: Q 30 minutes
Stages of labor
Cardiovascular◦ Higher blood pressure indicates pain or problem
Respiratory◦ Should remain as deep and relaxed as possible.
Avoid hyperventilation Renal
◦ Normal or decreased◦ Encourage voiding every 2 hours so baby can
move down
Maternal systemic labor responses
Gastrointestinal◦ Decreased motility◦ Eating/drinking not contraindicated for labors at
low risk of general anesthesia Fluid/electrolyte balances
◦ Not eating/drinking can dehydrate◦ IV may increase edema◦ IV pitocin additive may increase edema
Immunity◦ Temperature rise normal – may also be infection◦ IV antibiotics will be used if Strep B infection
present
Maternal systemic labor responses
Integumentary◦ Cervix softens◦ Perineum stretches – may be massaged with
lubricant ◦ lacerations, episiotomy may complicate
Musculoskeletal◦ Fetal head may press against mom’s bony places,
causing pressure/pain◦ Back labor
Neurological◦ May have heightened responses
Maternal systemic labor responses
Initial assessment◦ History◦ Determining stage of labor◦ Physical exam◦ FHR◦ Station, dilation, effacement◦ Contractions◦ Nursing management
Admission of client in labor
Subjective data ◦Histories Medical, obstetric, current pregnancy, psychosocial
Objective data◦Assessments: V/S, general, pelvic, fetal, FHR tracing, contraction patterns, amniotic fluid
Assessment: Labor
FON p 836 nursing care plan◦Pain and anxiety
◦Fatigue◦Risk for infection
Planning and outcome identification
Assisting client and support person◦ Breathing
techniques Avoid holding
breath!◦ Assessing best
means of relaxation◦ Birth plans
Nursing interventions
Systemic medications should not be given until phase of labor
estimated◦ Demerol (meperidine): narcotic
Monitor mom/fetus for CNS depression, decreased heart rate
◦ Stadol (butorphanol tartrate): opioid agonist/antagonist Monitor mom/baby for CNS depression,
decreased heart rate; mom may report weird dreams
◦ fentanyl (Sublimaze): usually given at/after surgery
Comfort measures
Regional blocks◦Paracervical block
◦Pudendal block
◦Epidural◦Saddle block low spinal
Comfort measures
General anesthesia◦ Nitrous oxide
(inhaled)◦ Pentothal (IV)◦ Should be monitored
post-op in PACU◦ Will be transferred to
postpartum room when stable
◦ Additional pain control should be used
Comfort measures
Non-pharmacological◦Movement◦Warmth/cold◦Counterpressure◦Psychosocial/spiritual support◦Empowerment◦Prepared childbirth methods Patterned and non-patterned breathing
Comfort measures
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