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1stSTAGE OF LABOR

Nursing care during the first stage:

a. Hospital Admission. After a physician or nurse has evaluated the patient, an admission order is

written. At this point, your duties as a practical nurse are as follows:

(1) Establish a rapport with the patient and significant others.

() E!plain all procedures or routines, which will be carried out prior to performing them. "heseinclude:

(a) N#$ e!cept ice chips while in labor.

(b) Activities allowed and disallowed according to ward policies (i.e. bathroom privileges).

(c) %se of fetal monitors.

(d) #rogress reports.

(e) &isitation policies.

(f) 'here patients personal belongings will be maintained.

() $rient the patient to the surroundings (that is, room, call bell).

(*) +nitiate the patients labor chart.

() -eview the information obtained originally in the e!am room, verify and transfer the $ healthrecord to the labor chart per ward policies. /ou will review the following information:

(a) $bstetric history.

b.Perineal Preparation. 0having of pubic hair to prevent infection of perineal episiotomylacerations israrely done anymore. "here must be a physicians order to perform this tas2.

c.Cleansing Enema.

d.Evaluation of terine Contra!tions Continued."he purpose of this evaluation is to assess the abilityof the uterus to dilate the cervi!, help in determining the progress of labor, help to detect abnormalities ofuterine contractions (such as lac2 of uterine rela!ation), and help to evaluate any signs of fetal distress.

"his evaluation will help you in identifying the fre3uency (how often in minutes contractionsoccur), intensity (strength of contractions when palpitations are identified as mild, moderate, or strong4severe5), andduration (how long the contractions lasts in seconds).

'hen palpating for contractions, place your hand over the fundal area of the patients uterus.6ontractions can be felt by your fingers before the patient actually becomes aware of them. 0ee figure 7 for patient e!periencing contractions.

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"ndSTAGE OF LABOR #$EL%&ER' STAGE(

Nursing care during the second stage:

a. En!ourage t)e patient to rest *et+een !ontra!tions and to pus) +it) !ontra!tions,$nly oneperson should coach. &erbal encouragement and physical contact help reassure and encourage thepatient.

b. Position t)e patient-s legs in t)e stirrups for t)e lit)otom. position, "his is the most commonposition for delivery. 8acilities using birthing beds have the patient in an upright position. #ositioning alsodepends upon the type of anesthesia to be used and 67section delivery. Each case may be different.

c. Prep t)e patient-s perineum,A etadine9scrub and water are used with *!*s. 6lean the perineum bywashing the pubic area, down each thigh, down each side of the labia, down the perineum, and down therectal area (see fig. 7). egin cleaning at number 1 and proceed through number . $is!ard usedsponges after ea!) step. -inse area with the remaining solution.

d. /onitor t)e patient-s *lood pressure and t)e fetal )eart tones ever. 0 minutes and after ea!)

!ontra!tion,

rd STAGE OF LABOR #PLACE2TAL STAGE(

Nursing care during the third stage:

a. Continue o*servation,8ollowing delivery of the placenta, continue in your observation of the fundus.

Ensure that the fundus remains contracted. -etention of the tissues in the uterus can lead to uterine

atony and cause hemorrhage. ;assaging the fundus gently will ensure that it remains contracted.

b. Allo+ t)e mot)er to *ond +it) t)e infant,0how the infant to the mother and allow her to hold theinfant.

c.-ecord the following information.

a. "ime the placenta is delivered.

b.

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3t) STAGE OF LABOR #RECO&ER' STAGE(

Nursing care during the fourth stage of labor:

a. Transfer t)e patient from t)e deliver. ta*le, -emove the drapes and soiled linen. -emove both legsfrom the stirrups at the same time and then lower both legs down at the same time to prevent cramping.

Assist the patient to move from the table to the bed.

b. Provide !are of t)e perineum,An ice pac2 may be applied to the perineum to reduce swelling fromepisiotomy especially if a fourth degree tear has occurred and to reduce swelling from manualmanipulation of the perineum during labor from all the e!ams. Apply a clean perineal pad between thelegs.

c. Transfer t)e patient to t)e re!over. room, "his will be done after you place a clean gown on thepatient, obtained a complete set of vital signs, evaluated the fundal height and firmness, and evaluatedthe lochia.

d. Ensure emergen!. e4uipment is availa*le in t)e re!over. roomfor possible complications.

(1) 0uction and o!ygen in case patient becomes eclamptic.

() #itocin9is available in the event of hemorrhage.

() +& remains patent for possible use if complications develop.