2. Labor and Delivery

3. AntePartum and labor & Delivery The period prior to and giving birth. Antepartum-Building up to delivery, pre-contractions. (stages of pregnancy) Labor & Delivery- Process of Labor -Three Stages of Labor

4. Stages of Labor Stage 1- Early Labor Contractions begin and “Water” might break: Dilation and effacing of cervix occur Stage 2- Active Labor Mom pushes and baby is moved down birth canal, up to “crowning”. During this stage Baby is delivered Stage 3- Delivery of Placenta and contraction of Uterus back down

5. Pain Management Epidural – regional pain control IV Pain medications – has some effects on baby, can be sedative for mom and make it hard to push Natural – no medication General Anesthetics (surgical) – has effects on baby, usually done with emergency procedure

6. Equipment IV pumps and poles BP and Heart monitor for mom TOCO monitor for baby and mom contractions Can sense fetal HR and contractions Labor and Delivery bed

7. Contractions of Uterus Assessed by evaluating the height and consistency of the fundus (the part of the uterus that can be palpated abdominally). – Mild - end of nose – Moderate - chin – Strong - forehead Oxytocin is the hormone produced in the pituitary gland that induces contractions Manufactured oxytocin in Pitocin and is used to either induce or augment labor

8. Signs of True Labor When did your contractions start? How far apart are the contractions? How long so they last? How strong are they? Once at the hospital staff will check for dilation and effacing

9. True Labor Cont. Contractions should be Regular and 5-10 minutes apart Become progressively longer contraction Become progressively stronger contraction Length of time between contractions shortens Changing position or activity does not change contraction pattern May have bloody show, loss of mucous plug or rupture of membranes (only 1 in 10 women have spontaneous rupture of membranes)

10. Prepaired for Delivery Fully effaced – thickness of cervix has thined Dilated to a 10 + Diameter of the cervix in greater than 10 cm Lid comparison – 20 oz coke bottle top to a wide mouth pickle jar Babies head has moved down into birth canal

11. Team members for Delivery OB/GYN physician L&D nurse CNA Anesthesiologist Nursery nurses Pediatrician Lactation consultant

12. Focus On BABY Normal Pregnancy- 9 months (3 trimesters) 1 st Trimester- develops heart beat, brain and spinal cord form, forming arms, legs, fingers toes 2 nd Trimester- mom feels movement. Baby can move extremities 3 rd Trimester- Optimal growth and Development

13. Focus on Baby Full term is considered anything over 38 weeks Premature is anything less than 37 weeks After 40 weeks is considered over due

14. Other things to consider… Nursery nurses and Labor and Delivery nurses work to gether to take care of 2 or more patients. When might it be more?

15. Now Practice Based on the following assessments, what stage of labor would you place each expectant mother in? Why? Would you send her home to wait, or would you admit her to Labor and Delivery? Why?