labor & delivery
Post on 15-Nov-2014
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LABOR & DELIVERYLABOR & DELIVERY
DEFINITION OF TERMSDEFINITION OF TERMS
LABOR - is the process of moving the fetus, placenta and membranes out of the uterus and through the birth canal. Synonymous with childbirth and parturition.
Delivery – is the actual birth of baby
TRUE LABOR FALSE LABOR
CONTRACTION
Regular increasing frequency, duration & intensityShortening of interval
IrregularNo change in frequency, duration & intensity
DISCOMFORT
Radiates from back around the abdomen
Pain at abdomen
REST /ACTIVITY
Contraction does not decrease with rest or activity/ walking
Contraction may lessen with activity or rest
CERVIX
Progressive effacement and dilatation of cervix
Cervical changes does not occur yet
pening cervical OS - Dilatation
oftening of the cervix
Escent of fetus into pelvic inlet - Lightening
ontraction of uterus that are progressive & regular
upture of BOW
ffacement – progressive thinning & shortening of cervix
pprehension
Ucus plug expulsion – bloody show
A. First Stage A. First Stage
- Stage of dilatation- Begins with true labor pain and
ends with complete dilatation of the cervix
PHASES DILITATION DURATION/INTERVAL
INTENSITY
LATENT 0-3 CM 10-30 sec, 5-30 mins.
Mild to moderate
ACTIVE 4-7 CM 30-40 sec.3-5 mins
Moderate to strong
TRANSITION 8-10 CM 45-90 sec.2-3 min
Strong
Duration – from the beginning of one contraction to the end of same contraction(A-B)Interval – from the end of one contraction to the beginning of the next contraction (B-C)Frequency – from the beginning of contraction to the beginning of next contraction (A-C)Intensity – strengths of contraction
Nursing CareNursing Care
A. Hospital admission – provides privacy and reassurance from the very start.Personal data – name, age, address, civil statusObstetrical data – determine EDC, obstetrical score, amount & character of SHOW, whether BOW have ruptured or not
2. General physical 2. General physical examination, internal exam examination, internal exam and leopold’s are done to and leopold’s are done to determine:determine:EFFACEMENT AND DILATATION
STATIONPRESENTATIONPRESENTING PARTPOSITION
3. Monitoring and evaluating 3. Monitoring and evaluating Uterine contractionBlood PressureFetal Heart Rate
4. Emotional Support is 4. Emotional Support is providedprovided
5. Health teachings5. Health teachings
B. Second StageB. Second Stage
Stage of ExpulsionBegin with complete dilatation of
the cervix and ends delivery of babyContractions change from the
characteristic crescendo-decrescendo pattern to overwhelming uncontrollable urge to push or bear down with each contraction as if to move her bowels
Woman perspire and the blood vessels in her neck may become distended
Crowning takes placeThe need to push become
intense and the woman cannot stop herself
6 Cardinal Movements of the 6 Cardinal Movements of the Mechanism of labor ED FIRE Mechanism of labor ED FIRE EREEREEngagement – presenting fetal part
at station or below
Descent – downward movement of the biparietal diameter of the fetal head to within the pelvic inlet◦full descent occurs and the fetal head
extrudes beyond the dilated cervix and touches the posterior vaginal floor
Flexion – the head bends forward onto the chest, making the smallest anteroposterior diameter
Internal Rotation – the occiput rotates until it is superior, or just below the symphysis pubis, bringing the head into the best relationship to the outlet of the pelvis
Extension – as the occiput is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head, the face and chin are born.
External Rotation – almost immediately after the head of the infant is born, the head rotates (from the anteroposterior position it assumed to enter the outlet) back to the diagonal or transverse position of the early part of labor
Expulsion – the rest of the baby is born easily and smoothly because of its smaller part size. The end of the pelvic division of labor.
Nursing Care:Nursing Care:
Put both legs at the same time when positioning to the lithotomy position
Instruct mother to push as fetal head crowns. If hyperventilation occurs, let patient breathe into a brown paper or a cupped hand.
C. Stage 3 C. Stage 3 Placental Stage – begins from the
delivery of the baby up to the delivery of the placenta
2 Phases:
a. Placental SeparationSigns:◦Lengthening of the cord◦Sudden gush of blood◦Change of shape of the uterus
Types of Placental Types of Placental PresentationPresentation
Schultze’s – appearing shiny and glittering from the fetal membranes
Duncan – it looks raw, dirty, meaty, red and irregular(maternal surface)
b. Placental Expulsion- Brandt Andrew’s Maneuver – tract the cord slowly, winding it around the clamp until placenta spontaneously comes out rotating it slowly so that no membranes are left
Nursing Care:Nursing Care:Don’t hurry the expulsion of the
placenta, just watch for the signs of placental separation
Take note of the time of placental delivery
Inspect for the completeness of the placenta
Palpate the uterus to determine degree of contraction. If relaxed, massage gently and apply ice cap
Inspect for lacerations
Stage 4Stage 4(Puerperium Stage)– first 4 hours after delivery of placenta Degrees of Perineal Lacerations:
1. First Degree – skin and superficial to muscle
2. Second Degree – muscles of the perineum
3. Third Degree – continues to anal sphincter
4. Fourth Degree – involves the anterior anal wall
Episiotomy – incision made to the perineum to enlarge the vaginal opening for easy delivery
Types:a. Midline/Medianb. Mediolateralc. Lateral
Advantages:
1. Enlarging of the vaginal opening2. Shortening of the second stage
of labor3. Minimizing the stretching of the
perineal muscle 4. Preventing perineal tearing
POST PARTUM POST PARTUM ASSESSMENTASSESSMENT
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