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 PhaseNursing 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cm • Strong • Irregular with multiple peaks • Duration – 60-90 seconds • Frequency – 2 minutes • Mother’s response • Withdrawn, drowsy, • Nausea, trembling of legs • Irritable, aggressive • Urge to push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 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 of LaborNursing 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. Restitution 6. External Rotation 7. Expulsion
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 LaborNursing 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. 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
Causes of Pain in Labor Stretching of the cervix during dilation & effacement Uterine Anoxia Stage One 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 • Non-pharmacologic • Childbirth methods • Breathing Techniques • Relaxation Techniques • Touch • Focusing attention on one object • Effleurage
Methods of Pain Relief • Non-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 • Paracervical • Epidural; Caudal • Spinal • Duramorph • Pudendal • Local • Perineum • General • Used mainly in cesarean deliveries
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
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