Labor and Deliver Nursing Care

Scheduled admissions: C sections and Inductions, Unscheduled admissions: Spontaneous labor or rupture of membranes, Initial assessments: SVE, fetal movement, bleeding or discharge, assessment of fetus, Mother’s vital signs, pain S/S of preeclampsia

Three components:, 1- Dilation- how open (measured in centimeters, 0-10) is the cervix?, 2- Effecement- How thinned out is the cervix? 0-100%, 3- Station- How low if the fetal head in the pelvis? -5to+5

Scored from 0-3, Dilation, position of cervix, Effeacement, Station, Cervical Consistency, To see how “ripe” the cervix is a score of 8 or high indicates the cervix is “favorable” for induction

0- Closed, 1- 1-2 cm, 2- 3-4cm, 3- 5-6cm

0- Posterior, 1- Mid position, 2-Anterior, 3- Anterior

0- 0-30%, 1- 40-50%, 2- 60-70%, 3- 80%

0: -3, 1: -2, 2: -1, 0, 3: +1, +2

0- Firm, 1- Medium, 2- Soft, 3- Soft

0%

50%

“100%” in the lecture however she said its not a great representation however because the cervix really should be paper thin as seen with the balloon demo

Ok thanks!

Poterior

Midline

Anterior

Membrane sweep, Balloon catheter (mechanical), Pitocin or oxytocin (hormonal) (can’t be used until cervix is ripe)

Cook catheter

Painful contractions with ACTIVE cervical change, Can have ruptured membranes and not be in labor, SROM is a reason to go to the hospital!!, Can be induced and not be in labor, Labor begins when your body is ready and “takes over”

Contractions are they painful? If you drink a cup of water and out feet up do they go away?, How often are they happening and how long are they lasting? Should be in a patter q 2-3 mins and last at least 60 seconds, Can have contractions for weeks and never be in labor, Generally, nulliparas progress slower than multiparas

Gravida

Term

Preterm

Abortions

Living (multiples are only counted here in the living count!)

1- Establish therapeutic relationship with patient and support person, respectful of cultural norms and traditions, while staying inline with institutional policy, 2- Maternal assessment including labor progress, 3- Fetal assesssment

EFM, VS, SVE, EDC, GTPAL, OB/Medicla history, Leopold’s maneuver, allergies, last food intake, medications, herbs, tobacco/alcohol use, STDs, birth plan, pain management plan, support person involvement, abuse, sucide, mental health assessments, preeclampsia symptoms (including respiratory and neuro assessment), Labs (requires order): CBC, T&S, PLT, blood type/ RH, UA protien, Prenatal history review: Baseline trends, CBC, T&S, antibody screen, Hep B surface antigen, rubella, GBS, AFP,HIV,STDs, etc., If anticipating a precipitous delivery, only assess immediate priorities

Electronic fetal monitoring: place and record to evaluate status of fetus, Ultrasound to assess position of fetus, amount of amniotic fluid

(+) Pooling: a pool of fluid is noted near the cervix, (+) Nitrazine: Checks pH of fluid (Aminotest), (+) Ferning: Microscopic pattern of direct amniotic fluid

Assess: Time of rupture, SROM/AROM? color, presence of meconium, odor, amount, EFM changes, SVE, identification of prolapsed cord, Nursing Dx: risk for infection r/t ROM, Q2 hours temp checks, delivery within 24 hrs (term), limit SVE, use sterile techniques, keep pads clean, notify provider of ROM, AROM- Amnotomy VS SROM

Passenger, Passageway, Powers, Position, Psychological Response

The way the fetus passes throug the birth canal is affected by the size of the fetal head, the fetal presentation, the fetal lie, fetal attitude and fetal position.

Yes with the top two being the most ideal!

No

Thanks!

Frank breach, **note this as being the most common

Full breech

Single footling breech (can have double)

Is the bony pelvis and soft tissue of cervix, pelvic floor and vagina, Gynecoid: 50% of women have this pelvic type which is conducive to vaginal births, Android: 23% of women have this pelvic. The potential for a caesarean is greater because the fetal head engages in a transverse or posterior position and descent in the pelvis is slow

Contractions to promote fetal descent and labor progress to expel fetus through vaginal canal, There are both involuntary things- contractions and voluntary thing we can do to progress labor

No vaginal birth without contraction, Contracitons are involuntary can vary in DIF, DIF= duration intensity frequency, May or may not be painful

Position of the mother had the potential to facilitate or hinder descent of the fetus in the birth canal. Regular position changes during labor can relieve maternal fatigue, increase comfort and improve circulation

Is it time for my menty-b yet? 😭😭

Used when mom needs to remain in the bed usually due to epidural, Mom in semi reclined position, one leg over the ball, one leg to the side of the ball. The ball is pushed as close to mom’s hips as is comfortable., Promotes dilation and descent with a well-positioned baby

The psychological health is obviously just as important as physical health

Aromatherapy, Guided imagery, Music, Support team presence

Hydrotherapy (can help with pain in natural birth a lot), Massage and counter pressure

Stage 1: Cervix dilates 0-10cm (this stage has 3 phases), Stage 2: Pushing stage, Stage 3: Placental delivery, Stage 4: Early postpartum and passage of lochia

Begins with contractions, Ends with: complete dilation of cervix, 1 Latent phase:0-3, 2 Active phase: 4-7, 3 Transitional phase: 8-10

0-3cm, Contractions are irregular, mild to moderate, frequency from 5-30 minutes, durations 30-45 seconds, Patient is talkative

4-7cm, Contractions are regular, moderate to strong, frequency 3-5 minutes, duration 40-70 seconds, Client is in pain sometimes anxious

8-10cm, Contraction are regular, very strong, frequency 2 to 3 minutes, duration 45-90 seconds, Client is restless in a lot of pain, often states feeling need to pass bowel movement

Begins with: complete dilation of cervix to 10 cm, Ends with delivery of baby, Na:freq. assess. of fetal HR q5mins, Na: coach through pushing and position changes, Na: assist provider in delivery measures, Na: record delivery time and position, Na: Assessment of maternal bladder/straight catheterization

Coaching “Push like you’re pooping”, *Provide for privacy*, Providing comfort measures: cool washcloth, pericare, Tug of war, position changes

Usually done off to the side not down to perineum

Forceps assisted (FAVD): curved, metal instruments which lock together in the center. Used to assist mother in childbirth, usually due to maternal exhaustion or fetal distress. (damage is generally to mothers perineum), Vacuum assisted (VAVD): Used to assist mother in childbirth, uses suction to grasp the fetal head which is pulled during mother’s pushing efforts. Damage is generally to infant head

Warmer on and ready, warm blankets bulb syringe ready, Notify NICU if necessary, Assist with positioning of mother, assessing support person, Record delivery time, Dry and stimulate infant off as you’re placing skin to skin (as long as infant is vigorous), Start timer to record APGARs appropriately

The placenta separates from the uterine wall and is expelled, Begins with: delivery of baby, Ends with: delivery of placenta

Umbilical cord lengthens gush of blood, Placenta “squishes” out- record time in chart, Be ready with pitocin, Assess placenta for completion, Spontaneous vs Manual removal, Placenta orders?, Administer pitocin 10-20units IV in 1000 LR- gravity flow about 20-40gtts/min rate adjusted to uterine firmness

Recovery phase mom is assessed every 15 minutes including:, Repair of lacerations, episiotomy PRN, Fundal assessment and vigorous massage, Assessment of lochia, Vital signs, Highest risk for postpartum hemorrhage is during recovery, Cord blood to lab to determine cord gases and possibly baby’s blood type