INTRAPARTUM:Labor and Birth

Maternal-Newborn and Child NursingLondon, Ladewig, Ball, & Bindler

Prepared by Mary Ann Gagen, Professor of Nursing

“Pa…I think it’s time to go!”

Process and Stages of Labor and Birth: Chapter 15

Critical Factors in Labor The birth passage The fetus The relationship between the passage

and the fetus Primary forces of labor Psychosocial considerations

Table 15-1: p 310

The Birth Passage

Implications of Pelvic types for Labor and Delivery Table 15-2, p 310

The Fetus Head

The Fetus

Attitude Lie Presentation

Top: Fetal Attitude flexion, fetal lie longitudinal

Bottom: Fetal Attitude flexion, fetal lie transverse

Relationship between the passage and the fetus

Engagement Station Fetal position

The Forces of Labor

Primary Secondary Phases of Contractions

Increment Acme Decrement

Characteristics of contractions Frequency Duration Intensity

Psychosocial Considerations

Motivation for pregnancy

Support Preparation Trust in staff Maintaining control Cultural influences Table 15-3

Physiology of Labor

Premonitory signs of labor Lightening or quickening Braxton Hicks Contractions Cervical changes Bloody show Rupture of membranes Sudden burst of energy Other: diarrhea, nausea, etc

True vs False LaborTable 15-4: p 321

Stages of Labor and Birth

First stage Latent Active Transition

Second stage Crowning Positional changes of the fetus

Table 15-5: Characteristics of Labor, p 323

Stages: cont’d

Third stage Placental

separation Placental delivery

Fourth stage 1-4 hours

Stages: cont’d

Maternal responses to labor Cardio, B/P Respiratory Renal, GI Immune/blood Pain

Causes Fetal responses

Intrapartal Nursing AssessmentChapter 16

Admission assessment Data Collection Assessments

Assessment Guide, pp 335 - 339

Intrapartal Nursing Assessment, cont’d

Evaluating labor progress Leopold’s Maneuvers FHR and Pattern

Accelerations Decelerations Early Late Variable

Evaluations of FHR Tracings

Intrapartal Nursing Assessmentcont’d

Contractions Frequency Intensity Duration

Vaginal exam

The Family in Childbirth:Needs and Care, Chapter 17

Nursing management The admission process The first stage of labor Family expectations Cultural beliefs

Pain, modesty Promotion of comfort Clinical Pathways

pp355 - 357

The Family in Childbirth: Needs and Care, cont’d

Nursing management Second stage

comfort Third stage

Initial care of newborn Apgar Umbilical cord Warmth Newborn identification

The Family in Childbirth: Needs and Care, cont’d

Nursing management

Fourth stage Delivery of placenta

Enhancing attachment