Presentation is loading. Please wait.

Presentation is loading. Please wait.

Labor and Birth Process and Nursing Management Chapter 13 & 14

Similar presentations

Presentation on theme: "Labor and Birth Process and Nursing Management Chapter 13 & 14"— Presentation transcript:

1 Labor and Birth Process and Nursing Management Chapter 13 & 14
Mary L. Dunlap MSN Fall 2015

2 Labor Definition Coordinated sequence of involuntary uterine contractions Contractions 3 minutes apart or less lasting 60 seconds or longer Resulting in effacement and dilatation of the cervix and delivery of the fetus and placenta.

3 Possible Causes of Labor Maternal
Uterine muscle stretching Pressure on the cervix Oxytocin Placental aging Estrogen/Progesterone ratio change Fetal cortisol concentration Prostaglandins

4 Possible Causes of Labor Fetal
Placental aging Fetal Cortisol concentration Prostaglandin

5 Signs Preceding Labor Energy burst Lightening
Braxton-Hicks contractions Weight loss Bloody show Lightening Increase vaginal discharge Cervix softening Rupture of membranes

6 False Labor Does not cause cervical change Irregular contractions
Activity does not increase contractions Sedation will stop or decrease contractions Irregular contractions No regular pattern Discomfort in lower abdomen and groin Show is not present

7 True Labor Activity increases contraction frequency
Sedation does not diminish contraction pattern Causes cervical changes Show usually present Regular contractions Contractions Progresses to a pattern Discomfort begins in back and radiates to the abdomen

8 Factors That Affect Labor
The Five P’s: Passageway (birth canal) Passenger (fetus and placenta) Powers (contractions) Position of the mother Psychologic response

9 Passageway Pelvic structure and shape Soft tissues cervix Pelvic floor

10 Passenger Size of the fetal head Presenting part Fetal lie
Fetal attitude Fetal position

11 Passenger: Fetal Skull
Largest and least compressible structure Sutures: allow for overlapping and changes in shape (molding); help identify position of fetal head Fontanels: intersections of sutures; help in identifying position of fetal head and in molding

12 Fetal Skull Figure 13-3 p.399

13 Passenger: Presenting Part
Cephalic Breech Frank Full or complete Footling or incomplete Shoulder Fetal presentation- fetal part enters pelvic inlet 1st

14 Breech Presentations

15 Fetal Lie Fetal lie is the relationship of the spine of the fetus to the spine of the mother Longitudinal Transverse Go to next slide and use picture and mannequins to discuss concept


17 Fetal Attitude Fetal attitude is flexion or extension of the joints and the relationship of fetal parts to one another


19 Passenger: Fetal Position
Fetal position- relationship of the presenting part of the fetus to a designated point of the maternal pelvic structure

20 fig 13.9 pg. 402

21 Powers Contractions primary force Frequency Duration Intensity
Pushing secondary force

22 Maternal Position Affects woman’s anatomic and physiologic adaptations to labor Frequent changes in position Relieve fatigue Increase comfort Improve circulation Facilitates decent and rotation

23 Psychological Response
Factors Influencing a Positive Birth Experience Clear information on procedures Support, not being alone Sense of mastery, self-confidence Trust in staff caring for her Positive reaction to the pregnancy Personal control over breathing Preparation for the childbirth experience

24 Factors That Affect Labor
5 Additional P’s Philosophy Partner Patience Pain management

25 Cardinal movements of Labor
Engagement Descent Flexion Internal rotation Extension External rotation (restitution) Expulsion (birth)


27 Four Stages of Labor First Stage starts with Onset of labor to complete dilation Latent phase Dilatation 0 to 3 cm Effacement 0 to 40% Active phase Dilatation 4 to 7 cm Effacement 40 to 80% Transition Dilatation 8–10 cm Effacement 100%

28 Stages of Labor Second stage–complete dilation to birth
Third stage–birth to placental separation and expulsion Fourth stage–four hours following delivery of the placenta


30 Initial Maternal Assessment
Presenting complaint EDC Gravida/Para Contraction Pattern Membrane status Presence of fetal movement Complications

31 Fetal Assessment FHR provides information about the fetal oxygen status. Locations for auscultating Doppler Nursing Procedure 12.1 pg. 355 Continuous FHR via ultrasound transducer Fetal movement


33 Doppler

34 Doppler

35 Continuous Fetal Monitoring

36 Contraction Assessment
Frequency Duration Strength/Intensity Resting tone

37 Contraction Phases



40 Pelvic Exam Effacement Dilation Presenting part Station
Status of membranes


42 New classifications -5 to +5 measured in centimeters now

43 General Systems Assessment
Vital signs General physical assessment Leopold’s maneuvers Procedure 14.1 pg. 424 DTR and clonus Review prenatal record for lab results and history


45 Leopold’s Maneuver Video12310

46 Physiologic Adaptation to Labor
Maternal Adaptation Cardiovascular changes Respiratory changes Musculoskeletal changes Gastrointestinal changes

47 Physiologic Adaptation to Labor
Fetal adaptation to labor Fetal heart rate changes due to contractions Fetal circulation & respiratory changes preparing for birth Fetal heart rate baseline and variability Fetal heart rate response to contractions

48 Nurses Role During labor and delivery fetal assessment includes determining fetal well-being and interpreting signs and symptoms of possible compromise Nurse needs to be knowledgeable of the different FHR categories and the appropriate interventions that may be required

49 Monitoring Techniques
Electronic fetal monitoring External monitoring FHR—ultrasound transducer UCs—Toco transducer Internal monitoring (invasive) Spiral electrode (FSE) Intrauterine pressure catheter (IUPC)


51 Amnio Hook


53 Fetal Scalp Electrode

54 Placement of FSE


56 Internal Fetal Monitoring

57 FHR Categories Category I normal Category II indeterminate
Category III Predictive of abnormal fetus acid base status Tab pg.429 Developed to have effective clinical communication about variant FHR patterns Preventing miscommunication between professionals & To promote maternal fetal safety Category I normal no intervention required Category II indeterminate requires evaluation and continued monitoring Category III Predictive of abnormal fetus acid base status requires prompt evaluation and interventions

58 Determining FHR Patterns
Fetal assessment Baseline FHR Variability Accelerations Periodic changes (decelerations) Early (head compression) Late (placental insufficiency) Variable (cord compression)


60 Baseline Fetal Heart Rate
Baseline Rate is the average FHR that occurs during a 10-minute segment excluding periodic or episodic rate changes Normal Bradycardia <110 Tachycardia >160

61 Fetal Heart Rate Variability
Irregular Fluctuations in FHR baseline measured as amplitude of the peak to trough in bpm Absent fluctuation undetectable Minimal <5 bpm Moderate (normal) 6-25 bpm Marked >25bpm

62 Fetal Heart Rate Patterns
Changes in fetal heart rate Periodic occur with Contractions Episodic (non-periodic) not associated with contractions Accelerations Decelerations

63 Accelerations Positive sign of fetal wellbeing
Abrupt increase in FHR above the base line lasting <30 sec from onset to peak Term 15 bpm above baseline & duration >15 sec. but <2min Prior to 32 weeks 10 by 10 Prolonged 2 min. to <10min

64 Decelerations Early decelerations Late decelerations
Variable decelerations Prolonged decelerations

65 Early Decelerations Gradual decrease in FHR, nadir coincides with the peak of the contraction Mirror image of the contraction Head compression/vagal response No treatment required/benign pattern


67 Late Decelerations Gradual decrease in FHR with the nadir of the deceleration occurring after the peak of the contraction. The FHR does not return to baseline until the contraction has ended Caused by uteroplacental insufficiency Fetus is in distress Interventions Box pg.432




71 Variable Decelerations
Abrupt decrease in FHR below the baseline. The decrease is at least 15 bpm, lasting between 15 sec and under 2 minutes. They can vary with contractions. Shaped like a “V” or a “W” Associated with cord compression


73 Prolonged Deceleration
Abrupt decrease in FHR of at least 15 bpm lasting longer than 2 minutes, but less than 10 minutes. FHR usually drops to less than 90 bpm

74 Decelerations

75 Fetal Heart Rate V Variable E Early A Acceleration L Late C Cord
H Head Compression O Oxygenated fetus P Placental problems

76 Fetal Assessment Methods
Umbilical Cord Blood Analysis Fetal Scalp Stimulation

77 Pain Management Nonpharmacologic Pharmacologic

78 Nonpharmacologic Management
Simple, safe, and inexpensive Provide sense of control over childbirth Natural child birth requires practice for best results Try variety of methods and seek alternatives, including pharmacologic methods if needed

79 Nonpharmacologic Management
Imagery and visualization Position Changes Table 14.2 pg.437 Music Touch and massage Breathing techniques Effleurage and counter pressure Water therapy (hydrotherapy) Nonpharmacologic Management


81 Pharmacologic Management
Systemic Analgesia Regional Analgesia/Anesthesia

82 Systemic Analgesia Use of one or more drugs administered orally, IM, or IV. These meds are distributed via the circulatory system. Pain relief can occur within a few min. and last up to several hrs. Side effect can be respiratory depression in the mother as well as the newborn after birth

83 Systemic Analgesia Opioids Ataractics/Antiemetics Benzodiazepines
Drug Guide 14.1 pg. 441

84 Regional Analgesia/Anesthesia
Pudendal never block Epidural (Vaginal Del or C/S) Spinal (C/S) General (C/S)


86 Epidural Analgesia Combination of local anesthetic (lidocaine) & an opioid (morphine or fentanyl) Injected into the epidural space Medication can be balanced to provide pain relive and the ability to ambulate

87 Epidural Analgesia

88 General Anesthesia Reserved for emergency cesarean births when there is not enough time to do a spinal or epidural for anesthesia Combination of IV injection and inhalation agents


90 Epidurals/Spinals/General Anesthesia
Anesthesia interview Consent form Labs (platelets less than 100,000 can place an epidural/spinal)

91 Nursing Responsibilities During 1st Stage of Labor
Vital signs Hydration and nutrition Elimination Assessment of contractions and FHR Labor Support Comfort measures/Pain management Education

92 Second Stage of Labor Assessment of contractions and FHR Fetal descent
Psychological considerations Maternal positioning Coaching maternal breathing and pushing efforts

93 Preparation for Delivery
Prepare instrument table Adequate lighting Oxygen and suction equipment Radiant warmer, blankets, identification for newborn Pitocin

94 Delivery Table

95 Preparation for Delivery
Positioning of mother for birth Gown, gloves, and protective equipment for personnel Cleansing of the perineum Deliver the newborn


97 Second Stage of Labor Perineal Lacerations (Depth) * 1st degree
* 2nd degree * 3rd degree * 4th degree Episiotomy * midline * mediolateral




101 Third Stage of Labor Delivery of the placenta
Assess for perineal trauma Repair of episiotomy/Perineal lacerations Newborn care Emotional support /Foster bonding

102 Episiotomy

103 Episiotomy Repair


105 Apply ice pack as soon as possible

106 Third Stage of Labor Placental separation and expulsion
Firmly contracting fundus Change in uterus Sudden gush of dark blood from introitus Apparent lengthening of umbilical cord Vaginal fullness



109 Fetal Side Shinny Schults

110 Maternal Side Dirty Dunkin

111 Third Stage of Labor Newborn care Time of birth noted
Drying, stimulation, suctioning of the newborn Respiratory effort, heart rate, color, tone noted One- and five-minute Apgar scores Cord blood obtained Identification

112 Apgar Score Assessment 0 Point 1 Point 2 Point Heart Rate Absent
< 100 bpm > 100 bpm Respiratory effort Apneic Slow, irregular, shallow Regular breaths/min Strong, good cry Muscle Tone Limp, Flaccid Some flexion, limited resistance to extension Tight flexion, good resistance to extension with quick response to flexed position Reflex irritability No Response Grimace or frown when irritated Sneeze, cough, or vigorous cry Skin color Cyanotic or Pale Appropriate body color; blue extremities Completely pink A= appearance (color) P = pulse (heart rate) G = grimace ( reflex irritability) A = activity ( muscle tone) R = respiratory ( respiratory effort)

113 Apgar Score









122 Fourth Stage of Labor Maternal Assessment Uterus Lochia Perineum
Bladder Vital signs Pain Newborn-family attachment Breastfeeding initiated



Download ppt "Labor and Birth Process and Nursing Management Chapter 13 & 14"

Similar presentations

Ads by Google