process and stages of labor and birth sarah alkhaifi
TRANSCRIPT
Nursing management
• Second stage of labor• Provide privacy (curtain, draping, information)• Encourage woman to share her feeling. • Teach woman prenatally about benefits of upright
positions• During labor, encourage woman to change positions
frequently; suggested positions include squatting, semi-recumbent, standing, and upright kneeling
• Allow woman to rest until she feels an urge to push• Encourage spontaneous bearing down• Support, rather than direct, the woman’s involuntary
pushing efforts• Discourage prolonged maternal breath holding• Monitor fetal heart (base line, variability, aceleration,
deceleration)• Monitor the uterine contractions (intensity, duration)
instruct the woman to push in according to the uterine contraction.
Nursing management
Nursing management
• Assess the effectively of maternal pushing through comparing the bearing down with the fetal head descending.
• place one hand (non dominant) on the fetal head to avoid rapid extension.
• Support perineum during crowning with sterile pad. • Assess if there is indication for Episiotomy.
As the fetal head pushes down, the perineum bulges. This sign indicates that birth is imminent. (Copyright © Barbara Proud.)
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Nursing management
• Check if umbilical cord present around the neck of baby. (loss, tight).• Loss the umbilical cord in case the umbilical cord around the fetal neck. • Let the fetus’s head to rotate (external rotation)• Place your hand in each said of baby’s head and pull the fetal head
downward to deliver the anterior shoulder ,then apply upward traction to deliver posterior shoulder.
• Deliver the rest of the newborn body, and place the fetal on the mother’s ABD.
• Inject 5 U of oxytocin IM after delivery of anterior shoulder.• Cut and clamp umbilical cord. (technique).• Perform APGAR assessment for the newborn. • Perform immediate newborn care (see the lab) • Collect umbilical cord blood (bilirubin ,blood culture, Blood gases, carbon dioxide, and pH levels, Blood
sugar level, Blood type and Rh, CBC, Platelet count)•
What do you know about late VS early umbilical cord clamping?
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord
Third stage of labor
• From complete fetal delivery till complete separation of the placenta.
• Up to 30 minutes for placental separation
• Mechanism of separationFirm uterine contraction
Deceasing in the uterine surface area
Bleeding and hematomah
Third stage of labor
• Signs of placental separation
1.Globular shaped uterus 2. Rise of fundus3. Gush of blood4. Lengthening of cord
• Do not pull on cord !.... Why?
Placental DeliveryPlacenta Delivery• After signs of placenta separation
signs the mother may bear down.
• Controlled Cord Traction(CCT).
1
2
3
Fourth Stage of Labor
• 1- 4 hrs after delivery• Time of recovery• After pains• Hunger and thirst• At risk for atony and hemorrhage• Promote bonding and attachment