Normal Labor and Delivery Nursing Care
Signs and Symptoms of the Stage 1 -- Latent Phase • 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!
Nursing Care Stage 1 – Latent Phase • 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.
Stage 1 – Active Phase Signs 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 Phase Signs 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cm • Strong • Irregular with multiple peaks • Duration – 60-90 seconds • Frequency – 2 minutes • Mother’s response • Withdrawn, drowsy, • Nausea, trembling of legs • Irritable, aggressive • Urge to push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 Nursing 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 Two of Labor • Signs 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 Nursing Care • The key to care during this stage is to teach QUALITY PUSHING ! • Keep perineum clean and dry • Provide quiet environment • Support with positive feedback • Repeat doctors instructions • Allow to hold the baby , Congratulate!!
Stage 2 – Mechanisms of Labor 1. Engagement and Descent 2. Flexion 3. Internal Rotation 4. Extension 5. External Rotation 6. Expulsion
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 – 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 ____________. A. Flexion B. Extention C. 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
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Causes of Pain in Labor Stretching of the cervix during dilation & effacement Stage One Uterine Anoxia Stretching of the uterine ligaments
Causes of Pain in Labor Distention of the vagina and Perineum Compression of the nerve ganglia in cervix & lower uterus Stage Two 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 • Nonpharmacologic • Childbirth methods • Breathing Techniques • Relaxation Techniques • Touch • Focusing attention on one object • Effleurage
Non-Pharmacological • Sensory Stimulation • Listening to music; subdued lighting • Imagery • Applying heat and cold • Massage (lower back); Counterpressure • TENS • Position Changes
Pain Relief in Labor • Pharmacologic Methods • Analgesia • Demerol • Stadol • Barbiturates • Seconal; Nembutal • Tranquilizers • Vistaril
Anesthesia • Regional • Paracervical • Epidural; Caudal • Spinal • Pudendal • Local • General • Used mainly in cesarean deliveries
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 paracervical. 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
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