The Process of Labor and Birth
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
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
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
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
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)
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
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
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
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
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
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)
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
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
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...
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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. php?&A=delivery
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
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
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
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
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
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
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
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
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
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