1. The Process of Labor and Birth

2. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Powers (physiologic forces)  Passageway (maternal pelvis)  Passenger (fetus and placenta)  Passageway + passenger relationship  Psychosocial influences

3. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Uterine contractions—primary force  Maternal pushing efforts—secondary force  Characteristics of uterine contractions  Increment  Acme  Decrement

4. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Characteristics  Frequency  Duration  Intensity  Palpation  Electronic fetal monitoring

5. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  External monitor—tocodynamometer  Noninvasive  Internal monitor—internal pressure catheter  Invasive

6. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Effacement: shortening and thinning of cervix  Expressed as a percentage (0% to 100%)  Dilation: opening and enlargement of cervix  Expressed in centimeters (1 to 10 cm)

7. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  “Bearing down” sensation  Urge to push  No urge to push

8. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Four classic types  Gynecoid—normal female  Android—heart shaped, male  Anthropoid—apelike  Platypelloid—flat oval

9. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Fetus and fetal membranes  Molding of head  Fetal lie  Longitudinal  Transverse  Oblique

10. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Fetal attitude—flexion  Fetal presentation  Cephalic Vertex Military Brow Face

11. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Head usually largest part of infant  Molding  Optimal shape—smooth and round

12. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Buttocks enter maternal pelvis first  Frank: legs extended toward shoulders  Complete: legs flexed  Footling: one or both feet present first into maternal pelvis  (SACRUM is landmark)

13. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Risk of cord prolapse  Presenting part less effective in cervical dilation  Risk of cord compression  Risk of prolonged labor

14. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Occurs when fetus in transverse lie  Cannot be delivered vaginally unless rotation occurs

15. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Engagement  Station  Ischial spines—0 station  Above ischial spines—(–) minus station  Below ischial spines—(+) plus station  +4 cm means that...

16. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Vertex—occiput (O)  Face—chin (M = mentum)  Breech—sacrum (S)  Shoulder—acromion process (A)  Four quadrants of maternal pelvis

17. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Abbreviations are used  First and last letter—maternal pelvis  Middle letter—fetus presenting part  Examples  ROA (right occiput anterior)  ROP  LSP

18. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Other critical factors  Readiness, educational preparedness, etc.  Cultural views of childbirth  Role transition facilitated by positive childbirth experience  Negative experience interferes with bonding and maternal role attainment

19. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Signs and Symptoms of Impending Labor

20. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  May cause  Leg cramps  Increased pelvic pressure  Increased urinary frequency  Increased venous stasis  Increased vaginal secretions

21. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Braxton Hicks contractions  Cervical changes  Bloody show  Rupture of membranes  Energy spurt  Weight loss, GI disturbances

22. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  TRUE labor  Leads to dilation and effacement of cervix  Regular contractions  Contractions increase in duration, frequency, and intensity

23. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  FALSE labor  No cervical changes  Contractions Felt in abdominal region Do not increase in intensity Often stop with activity

24. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Childbirth Settings and Labor Support

25. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Establish positive relationship  Collect admission data  Initial admission assessments  Focused  Psychosocial assessment  Cultural assessment  Laboratory tests

26. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Stage of dilation  Three phases  Latent phase—0 to 3 cm  Active phase—4 to 7 cm  Transition—8 to 10 cm  Friedman curve

27. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Ongoing assessment  Facilitate a positive birth experience  Manage discomfort  Advocate for patient’s needs  Provide anticipatory guidance

28. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Presence  Promote comfort  Environment  Personal hygiene  Elimination  Supportive relaxation techniques

29. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Position  Fetal heart sounds  Baseline FHR  Presence of Variability Accelerations Decelerations

30. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Consider contraction frequency and intensity, stage of labor, and earlier FHR pattern  Reassuring  Non-reassuring

31. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  FHR decelerations  Early: no action  Variable and late Lateral position changes Oxygen per face mask Palpation for hyperstimulation Discontinue oxytocin Increase IVF rate

32. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Full dilation through birth of infant  Urge to push  Promote effective pushing  Closed-glottis  Open-glottis  Position of comfort

33. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Bulging of the perineum and rectum  Flattening and thinning of the perineum  Increased bloody show  Labia begin to separate

34. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Crowning  Burning sensation  Intense pressure in rectum  Episiotomy  Midline  Mediolateral

35. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Descent  Flexion  Internal rotation  Extension

36. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Restitution  External rotation  Expulsion

37. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  You may wish to incorporate this animation into your teaching plan. It may be necessary to download QuickTime—Click on Get QuickTime and install the program. www.medicallegalart.com/displayanimation. php?&A=delivery

38. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Controversy regarding when, how  Nurse—inspect cut cord for presence of two arteries and one vein  Collect cord blood sample for laboratory analysis

39. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Pain  Knowledge deficit  Anxiety  Fatigue  Risk for infection  Impaired fetal gas exchange

40. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Immediate care of the newborn  Delivery of the placenta  Monitoring and assisting mother with physiological adjustments following birth  Facilitating maternal-infant attachment

41. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Birth of baby to complete delivery of placenta  Smaller, spherical uterus  Elevation of uterus in abdomen  Lengthening and protrusion of cord  Gush of blood from vagina

42. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Separation and Expulsion of the Placenta

43. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Observe for signs that placenta has separated  Oxytocic medications to control blood loss  Examine cotyledons  Offer emotional support  Foster infant attachment

44. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Airway  Warmth  Appraisal—Apgar score  Identification of newborn

45. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Delivery of placenta through 1 to 2 hours after birth  Monitor position and firmness of uterus  “Boggy,” soft uterus Report immediately Initiate fundal massage

46. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Assess lochia  Vital signs and urine output  Shivering—offer blankets  Promote comfort  Facilitate attachment and breastfeeding

47. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Hypotension  Tachycardia  Excessive bleeding  Noncontracting uterus