Module 5

 Discuss labor and the admission process

 Changes in birthing  Home-like environment … and home environment  Planned birthing process  Cultural considerations and birthing traditions

 Theories ◦ Mechanical  Uterine stretching ◦ Hormonal  Release or decrease in hormones  Oxytocin stimulation  Progesterone withdrawal  Estrogen stimulation  Fetal cortisol

 Lightening  Braxton-Hicks contractions  Cervical changes ◦ Softening, dilation, effacement  Bloody show  Rupture of membranes  Sudden energy burst

 Contractions: increase in frequency, duration, strength  Cervix: dilating to about 10 cm  Fetus: descending through birth way  Teaching: ◦ Notify provider when bag of waters (amniotic sac) breaks: time, color, amount, odor ◦ Call or go to delivery setting when contractions:  every 5 minutes  60 seconds each  For at least an hour

 Passage ◦ Pelvis ◦ Uterus ◦ Cervix ◦ Vagina ◦ Perineum

 Passenger ◦ Size and skull ◦ Fetal attitude ◦ fetal position ◦ Fetal presentation: cephalic, breech, shoulder ◦ Fetal lie

Fetal attitudes

Fetal positions (see FON p 814 Fig 26-5)

Fetal presentation

Fetal lie:

 Powers ◦ Uterine contractions (primary) ◦ Maternal pushing (secondary)  Psyche ◦ Attitude (experiences, expectations, values) ◦ Anxiety/fear ◦ Cultural beliefs

 First stage ◦ Dilation and effacement  Early/latent:  0-3 cm  5-8 min/apart  sec/each  Active  4-7 cm  3-5 min/apart  sec/each  Transition  7-10 cm  2-3 min/apart  Up to 80 sec/each

 Second stage: ◦ Delivery of newborn  Mechanisms of labor  Engagement  Descent  Flexion  Internal rotation  Extension  Restitution  External rotation  expulsion

 Third stage ◦ Delivery of placenta  Oxytocin  Breastfeeding  Fundal massage  Pitocin  IV  IM

 Fourth stage ◦ Recovery/stabilization  2-4 hours  Vital signs/assessment  1 st hour: Q15 minutes  2 nd hour: Q 30 minutes

 Cardiovascular ◦ Higher blood pressure indicates pain or problem  Respiratory ◦ Should remain as deep and relaxed as possible. Avoid hyperventilation  Renal ◦ Normal or decreased ◦ Encourage voiding every 2 hours so baby can move down

 Gastrointestinal ◦ Decreased motility ◦ Eating/drinking not contraindicated for labors at low risk of general anesthesia  Fluid/electrolyte balances ◦ Not eating/drinking can dehydrate ◦ IV may increase edema ◦ IV pitocin additive may increase edema  Immunity ◦ Temperature rise normal – may also be infection ◦ IV antibiotics will be used if Strep B infection present

 Integumentary ◦ Cervix softens ◦ Perineum stretches – may be massaged with lubricant ◦ lacerations, episiotomy may complicate  Musculoskeletal ◦ Fetal head may press against mom’s bony places, causing pressure/pain ◦ Back labor  Neurological ◦ May have heightened responses

 Initial assessment ◦ History ◦ Determining stage of labor ◦ Physical exam ◦ FHR ◦ Station, dilation, effacement ◦ Contractions ◦ Nursing management

 Subjective data ◦ Histories  Medical, obstetric, current pregnancy, psychosocial  Objective data ◦ Assessments: V/S, general, pelvic, fetal, FHR tracing, contraction patterns, amniotic fluid

 FON p 836 nursing care plan ◦ Pain and anxiety ◦ Fatigue ◦ Risk for infection

 Assisting client and support person ◦ Breathing techniques  Avoid holding breath! ◦ Assessing best means of relaxation ◦ Birth plans

Systemic medications  should not be given until phase of labor estimated ◦ Demerol (meperidine): narcotic  Monitor mom/fetus for CNS depression, decreased heart rate ◦ Stadol (butorphanol tartrate): opioid agonist/antagonist  Monitor mom/baby for CNS depression, decreased heart rate; mom may report weird dreams ◦ fentanyl (Sublimaze): usually given at/after surgery

 Regional blocks ◦ Paracervical block ◦ Pudendal block ◦ Epidural ◦ Saddle block low spinal

 General anesthesia ◦ Nitrous oxide (inhaled) ◦ Pentothal (IV) ◦ Should be monitored post-op in PACU ◦ Will be transferred to postpartum room when stable ◦ Additional pain control should be used

 Non-pharmacological ◦ Movement ◦ Warmth/cold ◦ Counterpressure ◦ Psychosocial/spiritual support ◦ Empowerment ◦ Prepared childbirth methods  Patterned and non-patterned breathing

Awwwww…..