NURSING RESPONSIBILITIES IN DELIVERY ROOM

MONITORING AND EVALUATION OF UTERINE CONTRACTION

Uterine contractions may be monitored intermittently by hand or continuously by an internal or external system.

Continuing to monitor the duration, strength, and interval between contractions can aid in tracking the progress of labor.

LENGTH OF CONTRACTIONS

To determine the beginning of a contraction without a monitor, rest a hand on the woman’s abdomen at the fundus of the uterus very gently to sense the gradual tensing and upward rising of the fundus that accompanies a contraction.

The duration of a contraction is timed from the moment the uterus first tenses until it has relaxed again.

INTENSITY OF CONTRACTION

Contractions are rated as: MILD

The uterus is contracting but does not become more than minimally tense

MODERATE The uterus feels firm

STONG The contraction is so intense the uterus

feels as hard as a wooden board at the peak of the contraction.

FREQUENCY OF CONTRACTION

The frequency is timed from the beginning of one contraction to the beginning of the next.

Use as light a touch as possible on the woman’s abdomen while timing contractions or estimating their strength.

The fetus moves into position as your body prepares for delivery. In the weeks before your due date, the fetus may drop lower in the uterus. Some positions can cause problems for both mother and baby.

FETAL POSITIONS

Most Common Position

Ideally for labor, the baby presents head-down, facing the mother's back, with its chin tucked to its chest and the back of the head ready to enter the pelvis.

Occiput or Cephalic Posterior

Sometimes the baby is presenting head down as it should be, but it is facing the mother's abdomen. This increases the chance of painful "back labor" and prolonged delivery.

Occiput or Cephalic Posterior

Frank Breech

In a frank breech, the baby's buttocks lead the way into the birth canal. The hips are flexed, the knees extended. This increases the chance of forming an umbilical cord loop that could precede the head through the cervix and cause injury to the baby if it is delivered vaginally.

Frank Breech

Complete Breech

This baby presents with the buttocks first; both the hips and the knees are flexed. Like other breech presentations, this increases the risk of forming an umbilical cord loop that could precede the head through the cervix and cause injury to the baby if it is delivered vaginally.

Complete Breech

Transverse Lie

The baby lies crosswise in the uterus, making it likely that the shoulder will enter the pelvis first. Most such babies are delivered by cesarean.

Transverse Lie

Footling Breech

Sometimes, one or both of the baby's feet are pointed down toward the birth canal. This increases the chances of the umbilical cord slithering down into the mouth of the womb, cutting off blood supply to the baby.

Footling Breech

Principles of Newborn Care

When a baby is born to a mother being treated for complications, the management of the newborn will depend on:

whether the baby has a condition or problem requiring rapid treatment;

whether the mother’s condition permits her to care for her newborn completely, partially or not at all.

APGAR SCORE

Five factors are used to evaluate the baby's condition and each factor is scored on a scale of 0 to 2, with 2 being the best score:

Activity and muscle tone Pulse (heart rate) Grimace response (medically known as

"reflex irritability") Appearance (skin coloration) Respiration (breathing rate and effort)

APGAR SCORING

Apgar Sign 2 1 0

Heart Rate(pulse)

Normal (above 100 beats per minute)

Below 100 beats per minuteAbsent(no pulse)

Breathing(rate and effort)

Normal rate and effort, good cry

Slow or irregular breathing, weak cry

Absent (no breathing)

Grimace (responsiveness or "reflex irritability")

Pulls away, sneezes, or coughs with stimulation

Facial movement only (grimace) with stimulation

Absent (no response to stimulation)

Activity(muscle tone)

Active, spontaneous movement

Arms and legs flexed with little movement

No movement, "floppy" tone

Appearance(skin coloration)

Normal color all over (hands and feet are pink)

Normal color (but hands and feet are bluish)

Bluish-gray or pale all over

What Apgar Scores Mean

A baby who scores a 7 or above on the test at 1 minute after birth is generally considered in good health. However, a lower score doesn't necessarily mean that your baby is unhealthy or abnormal. But it may mean that your baby simply needs some special immediate care, such as suctioning of the airways or oxygen to help him or her breathe, after which your baby may improve.

At 5 minutes after birth, the Apgar score is recalculated, and if your baby's score hasn't improved to 7 or greater, or there are other concerns, the doctors and nurses may continue any necessary medical care and will closely monitor your baby. Some babies are born with heart or lung conditions or other problems that require extra medical care; others just take a little longer than usual to adjust to life outside the womb. Most newborns with initial Apgar scores of less than 7 will eventually do just fine