1. Length of Pregnancy A full term pregnancy is 36-40 weeks. A full term pregnancy is 36-40 weeks. Three trimesters of about 3 months each. Three trimesters of about 3 months each. Deliveries before 36 weeks are premature. Deliveries before 36 weeks are premature. Lungs not fully developed until after 36 weeks Lungs not fully developed until after 36 weeks

2. Onset of Labor Labor pains Labor pains –False labor - Braxton-Hicks contractions Occur as early as 3-4 weeks (part of natural stretching) Occur as early as 3-4 weeks (part of natural stretching) Contractions irregular, intensity unchanged Contractions irregular, intensity unchanged Located in abdomen Located in abdomen No affect or relief with walking No affect or relief with walking

3. Onset of Labor Labor pains Labor pains –True labor Usually begin as aching in the small of the back Usually begin as aching in the small of the back Next, become cramp-like pains in the lower abdomen Next, become cramp-like pains in the lower abdomen Regular intervals that shorten - intensity gradually increases Regular intervals that shorten - intensity gradually increases Intensify with walking Intensify with walking

4. Labor and Delivery 3 Stages of Labor First stage: Onset of contractions, dilation and effacement First stage: Onset of contractions, dilation and effacement Second stage: Expulsion of the infant Second stage: Expulsion of the infant Third stage: Delivery of the placenta Third stage: Delivery of the placenta

5. First Stage of Labor Three Phases Three PhasesLatentActiveTransitional

6. Second Stage of Labor “Pushing” Full dilation of the cervix to delivery of baby Full dilation of the cervix to delivery of baby Deliver or transport? Deliver or transport? Pressure on the rectum(feels like a BM) Pressure on the rectum(feels like a BM) May have the urge to push May have the urge to push Perineum will begin to bulge - look for crowning Perineum will begin to bulge - look for crowning

7. Third Stage Birth of the infant to delivery of the placenta Birth of the infant to delivery of the placenta This may take up to 30 minutes This may take up to 30 minutes Save placenta and bring to hospital Save placenta and bring to hospital

8. Preparing for Delivery When to consider field delivery When to consider field delivery Look for crowning Look for crowning Questions to ask Questions to ask

9. Preparing for Delivery Check for crowning Check for crowning Spread legs apart gently Spread legs apart gently Once pushing begins it can’t be slowed down Once pushing begins it can’t be slowed down Never attempt to hold mother’s legs together and don’t let her go the bathroom! Never attempt to hold mother’s legs together and don’t let her go the bathroom!

10. Delivery You are only assisting the mother You are only assisting the mother Guide and support the infant as it is born Guide and support the infant as it is born Support the head with your hand as it emerges Support the head with your hand as it emerges

11. Delivering the Infant Check for the cord around the neck Check for the cord around the neck Suction the mouth first, then nostrils Suction the mouth first, then nostrils Let shoulders come out Let shoulders come out Use towels to dry and hold when it comes out- slippery little things! Use towels to dry and hold when it comes out- slippery little things!

12. Postdelivery Care Wrap in a clean, dry towel Wrap in a clean, dry towel Keep the face exposed and make sure the top of the head is covered(heat loss) Keep the face exposed and make sure the top of the head is covered(heat loss) Place baby on Mom’s abdomen if the cord is long enough Place baby on Mom’s abdomen if the cord is long enough Clamp and cut the cord Clamp and cut the cord

13. Delivery of the Placenta Placenta usually comes out by itself Placenta usually comes out by itself Never pull on the cord Never pull on the cord Gentle massaging of the uterus after delivery of the placenta helps prevent heavy bleeding Gentle massaging of the uterus after delivery of the placenta helps prevent heavy bleeding Breast feeding helps contract the uterus Breast feeding helps contract the uterus

14. Apgar Score Appearance Appearance Pulse Pulse Grimace or irritability Grimace or irritability Activity or muscle tone Activity or muscle tone Respirations Respirations Check at 1 and 5 minutes after birth Check at 1 and 5 minutes after birth

16. Hemorrhage If signs of shock, place Mom on left side during transport If signs of shock, place Mom on left side during transport High flow oxygen High flow oxygen Sterile pad over vagina replace as necessary and save the pads Sterile pad over vagina replace as necessary and save the pads Save any tissue that may be passed Save any tissue that may be passed

17. Breech Presentations Frank Frank Complete Complete Footling Footling

19. Rare Presentations Limb Limb Face Face Prolapsed cord Prolapsed cord

22. Twins Need to clamp two cords-label as 1 st and 2 nd Need to clamp two cords-label as 1 st and 2 nd Second usually delivers a few minutes after the first Second usually delivers a few minutes after the first Record time of delivery and apgar scores for both infants Record time of delivery and apgar scores for both infants