Normal Labor and Delivery

Nursing Care

Stage 1 -- Latent PhaseSigns and Symptoms: Contraction: dilate 0-3 cm.

Mild Duration – 30-45 seconds Frequency – 5-20 minutes

Scant pinkish discharge, bloody show Mother’s response

Surge of energy and excited Talkative, outgoing Anxiety low **Best time to do teaching!

Stage 1 – Latent Phase Nursing Care: Welcome to the hospital Assess goals for this labor Assess Psychological response Orient to common procedures

Vital signs and FHT’s Enema IV NPO Assessment of Labor Progress –

dilation, effacement, station, lie, etc.

What would you do?

A woman is admitted to labor and delivery in latent labor. Upon reviewing her birth plan you recognize that you will not be able to honor the woman’s request to keep her baby with her at all times throughout the hospital stay.

Stage 1 – Active PhaseSigns and Symptoms:

Contractions – dilate 4-7 cm. Moderate Duration – 45-60 seconds Frequency – 2-5 minutes

Mother’s Response More serious Determined, Dependent Restless Focuses on self

Stage 1 – Active Phase Nursing Care: Anticipate Needs:

Sponge face with cool cloth Keep bed clean and dry- change chux Provide with mouth care – lip balm to

lips Assess voiding

Non-Pharmacological Measures Modified breathing Effleurage Music

Analgesia and Anesthesia

Stage 1 – Transition PhaseSigns and Symptoms: Contractions 7-10 cm

Strong Irregular with multiple peaks Duration – 60-90 seconds Frequency – 2 minutes

Mother’s response Withdrawn, drowsy, Nausea, trembling of legs Irritable, aggressive Urge to push

Stage 1- Transition PhaseNursing Care:

Provide support- may need to breathe with the patient – get in her face

Back rub Assist with pant-blow breathing Watch for hypervention – have breathe

in mask and slow down the breathing Do NOT allow to push by having patient

blow-blow-blow with urge. Do not be offended by irritability

Stage 2 of LaborSigns and Symptoms: Sudden Appearance of sweat on

upper lip An episode of vomiting Increase in bloody show Shaking of extremities Increased restlessness Pressure on rectum; involuntary

bearing down Bulging of perineum

Stage 2 of Labor Nursing Care:

1. The key to care during this stage

is to teach QUALITY PUSHING !2. Keep perineum clean and dry3. Provide quiet environment4. Support with positive feedback5. Repeat doctors instructions6. Allow to hold the baby ,

Congratulate!!

Stage 2 – Mechanisms of Labor

1. Engagement and Descent

2. Flexion

3. Internal Rotation

4. Extension

6. External Rotation

7. Expulsion

5. Restitution

Episiotomy vs Laceration

Episiotomy is the manual cutting of the perineum to increase room for delivery of fetus. Midline Mediolateral

Laceration: tearing of the tissue of the perineum, vagninal wall, or periurethral.

Degree’s of Vaginal Tears/Episiotomy 1st - Extends only through the vaginal

mucosa 2nd - Extends through the vaginal

mucosa and submucosal tissue 3rd - Extends as a partial or complete

transection of the anal sphincter muscle 4th - Extends through the anal sphincter

and the lining of the rectum

Stage 3 of Labor

Signs and Symptoms of Placental Separation:1. A globular rise in the abdomen

the placenta changes from a discoid to a globular shape

2. Sudden gush of blood

3. Lengthening of the cord

Stage 3 of Labor

Nursing Care: Congratulate on delivery of baby

Coach in relaxation for delivery of the placenta

Initiate contact with the infant May allow to breast feed if desires

Test Yourself!

The cardinal movement that facilitates the emergence of the fetal head is ____________.A. FlexionB. ExtentionC. External rotation

Cardinal movement that allows the smallest diameter of the head to pass through the pelvis is__________________. A. Flexion

B. Internal rotation C. Extension Cardinal movement that occurs as the fetal shoulders

engage and descend through the pelvis is termed ______.

A. Internal rotation B. External rotation

The End of Labor & Delivery

& The Beginning

of Pain in LaborRETURN

Causes of Pain in Labor

Stage One

Stretching of the cervix during dilation & effacement

Uterine Anoxia

Stretching of the uterine ligaments

Causes of Pain in Labor

Stage TwoStage Two

Distention of the vagina and perineum

Compression of the nerveganglia in cervix & lower uterus

Pressure on urethra, bladder, rectum during fetal descent

Traction on and stretching of the perineum

Factors affecting Mothers Response to Pain in Labor

Knowledge and confidence gained through childbirth classes

Cultural influences on expression of pain

Maternal fatigue and anxiety

Previous experiences with pain

Methods of Pain Relief

Non-pharmacologicNon-pharmacologic Childbirth methods

Breathing Techniques Relaxation Techniques Touch Focusing attention on one object

Effleurage

Methods of Pain Relief

Non-pharmacologic cont’dNon-pharmacologic cont’d Sensory Stimulation

Listening to music; subdued lighting Imagery Applying heat and cold Massage (lower back); Counter-pressure TENS Position Changes

Pain Relief in Labor

Pharmacologic Methods Analgesia

fentanyl morphine butorphinp; (Stadol) nalbuphine (Nubain)

Naloxone (Narcan) – narcotic antagonist

Tranquilizers Narcotic Poteniators hydroxyzine (Vistaril) promethazine (Phenergan)

Anesthesia Regional

Epidural Spinal

Duramorph Pudendal

Local Perineum

General Used mainly in cesarean deliveries

Spinal Block

Epidural Block

Pudendal Block

Local Anesthesia

General Anesthesia

Used for cesarean-section if: Spinal / Epidural ineffective Emergency situation – fetal distress Maternal conditions which

contraindicated regional anesthesia Maternal refusal of regional anesthesia

True or False ?

The anesthesia used for both labor and delivery is an epidural A. True

B. False

The anesthesia used for delivery and an episiotomy is pudendal

A. True B. False

True or False ?

The nurse would be careful to keep the patient flat following delivery with a pudendal block

A. True B. False

The initial side effect of an epidural anesthesia is fetal bradycardia

A. True B. False

The End

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