1. Prof.Carole A. Devine RN.MSN.1 The Process of Birth

2. 2 Assessment And Responsibilities During Labor and Birth Goal of Care: To provide for a safe labor and birth of a healthy baby and to promote maternal comfort in the process….. 1. Comfort Measures: 2. Physical Needs: 3. When to call the Physician Responsibilities of the Attendants at the Birth

3. Prof.Carole A. Devine RN.MSN.3 Immediate Care of the Newborn Assessments: Vital Signs /Color of Infant Apgar Scores Check Cord Assess Infant Weight Assess U/A and G.I. Systems

4. 4 Assessments (Cont.) Protect against infection Identification of Infant Prevent hypothermia Promote parental attachment

5. Prof.Carole A. Devine RN.MSN.5 Managing the Pain of Labor and Delivery

6. Prof.Carole A. Devine RN.MSN.6 Labor Pain-Introduction Historical Perspective Management Strategies: 1.Non- Pharmaceutical Measures 2. Pharmaceutical Choices The Challenge to Nurses!

7. Prof.Carole A. Devine RN.MSN.7 What Exactly is Labor Pain ????

8. Prof.Carole A. Devine RN.MSN.8 Factors Affecting The Woman in Labor 1.Parity& Age 2.Racial/Cultural 3.Coping Strategies 4.Relaxation Measures 5.Emotional/ Attitude 6.Knowledge base 7.Confidence level 8.Support Systems 9. Environment 10.Fatigue/length of labor 11.N/V & Diarrhea 12. Maternal & Fetal Positions 13.Pain Level

9. Prof.Carole A. Devine RN.MSN.9 Non-Pharmacologic Methods of Pain Relief Hydrotherapy Application of heat /cold Acupressure Imagery/Visualization Effleurage Comfort Measures Distraction Breathing Techniques

10. Prof.Carole A. Devine RN.MSN.10 Pharmacological Methods of Pain Relief

11. Prof.Carole A. Devine RN.MSN.11 Goal of Administering Systemic Medication: Three Factors to be Considered in the use of Systemic Medication 1.Effect on The Mother 2. Effect on the Fetus 3. Effect on Labor contractions

12. Prof.Carole A. Devine RN.MSN.12 Analgesia/Anesthesia Analgesics: (Opioids,Tranquilizers &Sedatives) Common Ones: Demerol Stadol Nubain Fentanyl Morphine

13. Prof.Carole A. Devine RN.MSN.13 Demerol (Meperidine) Action: Usual dose: Pros : Cons: Maternal Cons: Neonatal

14. Prof.Carole A. Devine RN.MSN.14 Stadol (Butorphanal) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

15. Prof.Carole A. Devine RN.MSN.15 Nubain (Nalbuphine) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

16. Prof.Carole A. Devine RN.MSN.16 Fentanyl (Sublimaze) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

17. Prof.Carole A. Devine RN.MSN.17 Morphine (Duromorph) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

18. Prof.Carole A. Devine RN.MSN.18 Nursing Considerations with Opioids: Opioid Antagonist NALOXONE (Narcan) Reverses opioid induced Resp.Depression Dose: Neonate: 0.01mg/Kg IV,IM or SC q 2-3min. Mother: 0.1-0.2mg IVQ 2-3min Have Crash Cart Handy!!!!

19. Prof.Carole A. Devine RN.MSN.19 Anesthesia 1. Local Infiltration: 2.Regional: Pudendal Block Epidural Block Goal Procedure Complications 1. Maternal 2.Neonatal Nursing Considerations Advantages vs Disadvantages

20. Prof.Carole A. Devine RN.MSN.20 Spinal Block (Subarachnoid) Intrathecal) Goal Procedure Pros: Complications: Nursing Responsibilities/Considerations General Anesthesia

21. Prof.Carole A. Devine RN.MSN.21 Fetal Response to Labor Intrapartal Fetal Assessment: Electric Fetal Monitor ( EFM) Purpose Factors that Impact Fetal Oxygenation 1. Maternal Bld. O2 Saturation 2. Normal flow of oxygenated bld. thru the Placenta 3. Normal Utero-Placental exchange 4. Patent umbilical cord vessels (AVA) 5. Normal Fetal circulation and oxygen-carrying function

22. Prof.Carole A. Devine RN.MSN.22 Types of Intrapartal Fetal Assessments 1. Low -Tech Approach 2. EFM a. Equipment: 1. External ( Indirect) Uses two Transducers: Pressure and ultrasound 2. Internal (Direct ) Uses a Fetal Scalp Electrode

23. Prof.Carole A. Devine RN.MSN.23 Evaluating Fetal Monitoring Strips Fetal Heart Rate: Baseline Tachycardia Causes: Bradycardia Causes: Variability Presence of Periodic Changes: Accelerations? Decelerations?

24. Prof.Carole A. Devine RN.MSN.24 Decelerations/Types: Early,Late or Variable Early Decelerations: Characteristics: Pattern: Cause: Rx: Late Decelerations: Characteristics: Pattern: Cause: Rx:

25. Prof.Carole A. Devine RN.MSN.25 Variable Decelerations: Characteristics: Pattern: Cause Treatment: AN OMINOUS SIGN- LATE DECELERATION and DECREASED VARIABILITY OF FETAL HEART RATE!!!!

26. Prof.Carole A. Devine RN.MSN.26 Significance of Fetal Heart Patterns:”Reasssuring”vs. “Non-Reassuring” Reassuring Patterns of FHR 1. Show signs of fetal well being 2. Fetus is compensating Non-Reassuring Patterns of FHR 1. Associated with Hypoxia and Acidosis 2. Suggest some level of Fetal compromise !

27. Prof.Carole A. Devine RN.MSN.27 THE END GOOD LUCK To All Of YOU !!!!!