maternity nursing overview 1 of 2

To A Beautiful Mom

MATERNAL HEALTH

NURSING

• Recognize common terminology related to the postpartum and newborn areas in maternal health nursing

• Demonstrate the proper technique of massaging the fundus and explain why this is done

• List seven newborn primitive reflexes and demonstrate each one

• Describe 3 interventions to prevent hypoglycemia in the newborn

• Define the 5 Rights of medication administration

OBJECTIVES

To A Beautiful MomTerminology to Know!EDC – Estimated date of confinement

EDD – Estimated date of delivery

Amniocentesis – Transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid that contains fetal cells and biochemical substances for lab examinations

Gravida – A woman who has been pregnant regardless of the duration or outcome of the pregnancy

Para – A woman who has given birth after a pregnancy of at least 20 weeks gestation – also designates the number of pregnancies that end after at least 20 weeks (twins and triplets are considered 1 birth when calculating parity)

Fundus – Part of the uterus that is farthest from the cervix – top of the uterus

Stillbirth – Birth of a dead child

PROM – Premature Rupture of Membranes – spontaneous rupture of membranes before the onset of labor

ROM – Rupture of membranes

Placenta abruption/abruptio – Premature separation of normally implanted placenta

Placenta previa – Abnormal implantation of the placenta in the lower uterus at or near the cervical os

HCG – Human chorionic gonadotropin (secreted by the placenta and present in maternal blood and urine after conception)

Terminology to Know! (cont.)


Surfactant – Combination of lipoproteins produced by the lungs of the mature fetus to reduce surface tension in the alveoli which promotes lung expansion after birth

Lanugo – Fine, soft hair that cover the fetus

Fontanel - Space at the intersection of sutures connecting fetal or infant skull bones

Molding – Shaping of the fetal head during movement throughout the birth canal

Fetal lie – Relationship of the long axis of the fetus to the long axis of the mother


Primipara – A woman who is pregnant for the first time

Primigravida – a woman (after a pregnancy of 20 weeks) who has given birth

Multipara – A woman who has given birth after two or more pregnancies of at least 20 weeks/a woman who has been pretnat more than once

Nulligravida – A woman who has never been pregnant

Nullipara – A woman who has not completed a pregnancy to at least 20 weeks gestation


Terminology to Know! (cont.)APGAR Scoring – Method of rapid evaluation of the infants

cardiorespiratory adaptation after birth. The infant is scored at 1 minute and 5 minutes in each of five areas.

A = AppearanceP = PulseG = Grimace(reflex irritability)A = ActivityR = Respiration

Scoring8-10 Normal5-7 Mild Depression – stimulation needed3-4 Moderate Depression – Oxygen and/or insertion of stomach tube

to decompress stomach0-2 Severe Depression – Life support needed

Presentation - 3 fixed fetal reference points

1. Occiput – back of head presentation

2. Mentum – chin presentation

3. Breech/Footling Breach – Fetal buttocks or foot presentation


Vernix Caseosa – Thick white sustance that protects the skin of the fetus

Meconium – First stool excreted by the newborn which consists of vernix, skin cells, hair, cells from intestinal tact, bile and other intestinal secretions. Greenish black, thick, sticky and tarlike

Mongolian spots – Bruise like marks on newborns with darker skin tones.


Effacement – The shortening and thinning of the cervix

Contraction – Physiological effect of the birth process; coordinated, involuntary and intermittent. Each contraction consists of three phases:

-Increment – begins in the fundus and spreads throughout the uterus

-Peak/Acme – time when contraction is the most intense

-Decrement – decreasing intensity as uterus relaxes

Lightening – Decent of the fetus toward the pelvic inlet before labor

Bloody Show – Mixture of cervical mucus and blood from ruptured capillaries in the cervix; precedes labor and increases with cervical dilation


Braxton Hicks Contractions – Irregular mild uterine contractions that occur throughout pregnancy becoming stronger during the last trimester

Crowning – Appearance of the fetal scalp or presenting part at the vaginal opening

Station – Measurement of fetal decentin relation to the ischial spinesof maternal pelvis


Leopold’s Maneuvers – Used to determine presentation and position of the fetus and aid in location of fetal heart sounds


Engorgement – Temporary swelling and fullness of breasts that peaks at 72-96 hours after birth when the production of milk begins to increase

Antepartum – The time during pregnancy before the onset of labor

Intrapartum – Time of labor and childbirth

Postpartum – The first 6 weeks after childbirth

Gestation – Period of fetal development from conception to birth

Term – a birth that occurs between the 38th and 42nd weeks of gestation


Preterm/premature labor – Onset of labor after the 20th week and before the beginning of the 38th week of gestation

Postterm labor – a birth that occurs after 42 weeks of gestation

Decelerations – classified as early, late, and variable

Early – not associated with fetal compromise - caused by compression of fetal head which increases intracranial pressure causing the vagus nerve to slow the heart rate

http://www.childbirths.com/cypress/fetalmonitoringetc.htm


Late – Reflects possibility of impaired placental exchange (uteroplacental insufficiency)

Variable – Reflects umbilical cord compression

http://www.childbirths.com/cypress/fetalmonitoringetc.htm


To A Beautiful Mom

POSTPARTUM

POSTPARTUM ASSESSMENTFUNDUS LOCATION

The fundus should be at the midline, feel hard and round 1-2 finger breadths below the umbilicus

If the fundus is displaced, have the patient void as most likely the full bladder is to blame.

If the fundus is soft (boggy) it is important to massage the fundus until firm.

A soft fundus is also referred to as Uterine Atony (a lack of muscle tone). This is the cause of early Postpartum Hemorrhage.

Technique for massage: The non-dominant hand supports and anchors the lower uterine segment, the dominant hand massages the top part of the fundus.

HOW TO MASSAGE THE FUNDUS

POSTPARTUM ASSESSMENT (Cont.)

Assessment of Perineum

§ Should be pink and no signs of bruising

§ May be edematous – apply ice for comfort and promotion of vasoconstriction

§ Assess episiotomy and document

REEDA Acronym

R – RednessE – EdemaE – EcchymosisD – DischargeA – Approximation (edges of wound should be close)


LOCHIAScant – Blood only on tissue when wiped or

less than 1 inch stain on peripad

Light - Less than 4 inch stain on peripad

Moderate – Less than a 6 inch stain on peripad

Heavy - Saturated peripad within 1 hour

Heavy bleeding could be from lacerations, uterine atony or post partum hemorrhage


POSTPARTUM HEMORRHAGEPREDISPOSING FACTORS

v Multiple gestationv Large infantv Multiparity (5 or more)v Prolonged laborv Use of forceps or vacuum extractorv Cesarean birthv Manual removal of the placentav Uterine inversionv Placenta previa, placenta accreta or low

implantation


Assess:§ Lung sounds, heart sounds and pedal

pulses§ Check lower extremities for redness,

swelling, and warmth§ Check Homan’s sign


VITAL SIGNS:Pulse may be slightly decreased from labor

Pulse > 100 could indicate postpartum hemorrhage

Blood Pressure May be elevated secondary to painIf > 140/90 may indicate preeclampsia

If decreased – may indicate hypovolemia from excessive bleeding (postpartum hemorrhage)

Temperature – If greater than 100.4, could indicate early postpartum infection


BREASTFEEDINGBENEFITS


FOR THE INFANT

üDecreased allergiesüImmunologic propertiesüDecreased incidence of:

DiabetesCancerSIDS

üNutritional needs metüEasily digestedüProtein fat and carbs in correct

proportionüNo improper dilution issuesüNot likely to be contaminatedüLess likely to result in overfeeding

FOR THE MOTHER

üOxytocin released – enhancedinvolution

üDecreased loss of blood – mensesdelayed

üMother rests during feedingsüReduction of stress hormone levelsüMother more likely to eat properlyüSkin-to-skin contact enhances

bondingüConvenientüEconomicalüInfant less likely to be illüRisk reduction of some cancers

POSTPARTUM DISCHARGE TEACHING

• Uterine massage• Lochia • Involution• Episiotomy care• Care of abdominal incision• Breast care• Bowel/Urinary function• Nutrition• Rest/Exercise• Sexual activity• Contraception• Medications• Emotional responses• Infant care


To A Beautiful Mom

THE NEWBORN

90% of newborns make a smooth transition to extra uterine life

10% may need help

WARMTH IS IMPERATIVE– get them in the warmer, dry them off and remove wet linen – keep head in a ‘sniffing position’ (optimum position of opening the airway)

THE HEALTHY NEWBORN

THE HEALTHY NEWBORN (cont.)INFANT RADIANT WARMER

On/OffSwitch

Skin/Manual switch

Digital temperature display

maternity nursing overview 1 of 2

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