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Maternal child health

Maternal child health. Module 5. Objectives. Discuss labor and the admission process. The birth process. Introduction . Changes in birthing Home-like environment … and home environment Planned birthing process Cultural considerations and birthing traditions. Onset of labor. Theories

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Maternal child health

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  1. Maternal child health Module 5

  2. Objectives • Discuss labor and the admission process

  3. The birth process

  4. Introduction • Changes in birthing • Home-like environment … and home environment • Planned birthing process • Cultural considerations and birthing traditions

  5. Onset of labor • Theories • Mechanical • Uterine stretching • Hormonal • Release or decrease in hormones • Oxytocin stimulation • Progesterone withdrawal • Estrogen stimulation • Fetal cortisol

  6. Signs of impending labor • Lightening • Braxton-Hicks contractions • Cervical changes • Softening, dilation, effacement • Bloody show • Rupture of membranes • Sudden energy burst

  7. 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

  8. Variables affecting labor • Passage • Pelvis • Uterus • Cervix • Vagina • Perineum

  9. Variables affecting labor • Passenger • Size and skull • Fetal attitude • fetal position • Fetal presentation: cephalic, breech, shoulder • Fetal lie

  10. Fetal attitudes

  11. Fetal positions (see FON p 814 Fig 26-5)

  12. Fetal presentation

  13. Fetal lie:

  14. Variables affecting labor • Powers • Uterine contractions (primary) • Maternal pushing (secondary) • Psyche • Attitude (experiences, expectations, values) • Anxiety/fear • Cultural beliefs

  15. Stages of 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

  16. Stages of labor • Second stage: • Delivery of newborn • Mechanisms of labor • Engagement • Descent • Flexion • Internal rotation • Extension • Restitution • External rotation • expulsion

  17. Stages of labor • Third stage • Delivery of placenta • Oxytocin • Breastfeeding • Fundal massage • Pitocin • IV • IM

  18. Stages of labor • Fourth stage • Recovery/stabilization • 2-4 hours • Vital signs/assessment • 1st hour: Q15 minutes • 2nd hour: Q 30 minutes

  19. Maternal systemic labor responses • 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

  20. 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

  21. 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

  22. Admission of client in labor • Initial assessment • History • Determining stage of labor • Physical exam • FHR • Station, dilation, effacement • Contractions • Nursing management

  23. Assessment: Labor • Subjective data • Histories • Medical, obstetric, current pregnancy, psychosocial • Objective data • Assessments: V/S, general, pelvic, fetal, FHR tracing, contraction patterns, amniotic fluid

  24. Planning and outcome identification • FON p 836 nursing care plan • Pain and anxiety • Fatigue • Risk for infection

  25. Nursing interventions • Assisting client and support person • Breathing techniques • Avoid holding breath! • Assessing best means of relaxation • Birth plans

  26. Comfort measures Systemic medications • should not be given until phase of labor estimated • Demerol (meperidine): narcotic • Monitor mom/fetus for CNS depression, decreased heart rate • Stadol (butorphanoltartrate): opioid agonist/antagonist • Monitor mom/baby for CNS depression, decreased heart rate; mom may report weird dreams • fentanyl (Sublimaze): usually given at/after surgery

  27. Comfort measures • Regional blocks • Paracervical block • Pudendal block • Epidural • Saddle block low spinal

  28. 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

  29. Comfort measures • Non-pharmacological • Movement • Warmth/cold • Counterpressure • Psychosocial/spiritual support • Empowerment • Prepared childbirth methods • Patterned and non-patterned breathing

  30. Awwwww…..

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