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Title: Maternal Newborn:PROCESS AND STAGES OF LABOR AND BIRTH
Description: These is a summary of maternal Newborn Nursing notes.The notes contains key points on stages of labor and birth.
Description: These is a summary of maternal Newborn Nursing notes.The notes contains key points on stages of labor and birth.
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MATERNAL NEWBORN NURSING
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The Physiology of Labor
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Theories explaining the onset of labor:
•
Increased levels of oxytocin stimulate the uterine muscle causing myometrial (uterine
muscle) activity
...
•
Progesterone levels decline allowing estrogen to stimulate contractions
...
•
Uterus becomes over-stretched leading to a natural expulsion of the contents
...
•
Internal
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Musculature changes in the pelvic floor:
•
Levator ani and fascia pull the vagina and rectum upward and forward with each
contraction
...
Signs of labor:
•
Bloody show
...
•
Rupture of membranes (ROM)
...
•
Contractions
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Effacement
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Difference between true and false labor:
•
•
True labor:
Regular intervals
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Increased duration over time
...
Cause effacement and dilation
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Unchanged with warm shower or rest
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Does not increase in duration
...
Reduces with rest or a warm shower
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Critical Factors in Labor
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Midpelvis
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Passenger:
•
Fetal head
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‒
Transverse
...
•
Fetal presentation:
‒
Cephalic
...
‒
Shoulder
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Fetal position:
•
(O): landmark for the head or cephalic presenting part is the occipital bone
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Maternal pelvis divided into four quadrants:
•
Left anterior
...
•
Left posterior
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Position indicated by a three-letter abbreviation:
•
First letter: indicates if presenting part is tilted toward left (L) or right (R) of the
maternal pelvis
...
•
Third letter: indicates location of presenting part in relation to anterior part or posterior
part of maternal pelvis
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Fetal attitude:
•
Positioning of the fetus
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Fetal station:
•
Measurement in centimeters of fetus head in relation to maternal ischial spines in
pelvis
...
•
Ranges from −5 cm to +5 cm
...
‒
Head is 1 cm above the ischial spines: measurement is −1
...
‒
Head is through ischial spines 1 centimeter: termed +1 station
...
‒
The acme
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Terms used to describe contractions:
‒
Onset
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‒
Frequency
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(Patient Teaching Guidelines: How to Time Uterine Contractions)
...
‒
Sitting
...
‒
Walking
...
‒
Lateral
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Psyche
...
•
Trust in the health-care provider and staff
...
•
Information updates
...
•
Reassurance and praise for managing labor
...
•
Assisting to maintain sense of control and the labor situation
...
•
Wide range of pain management methods used during childbirth
...
Methods to increase patience:
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Educate the patient and family
...
•
Avoid induction of labor when the cervix has not softened sufficiently
...
•
Provide reassurance of fetal well-being during the labor process
...
•
If the fetal monitor indicates that the fetus is healthy, do not rush the birth
...
First Stage:
•
Begins with regular uterine contractions and ends with complete cervical dilation at 10
cm
...
‒
Characteristics:
Uterine contractions mild and erratic before becoming regular and
stronger
...
Most of the cervical effacement occurs
...
Excited and relieved that labor has started
...
Pain of contractions controlled with relaxation and breathing
techniques
...
‒
Length: 5 hours in primiparas ; 2 hours multiparas
...
‒
Contractions 2-3 minutes apart; duration around 60 seconds
...
‒
Cervical dilation averages 1
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5 cm/hr for multiparas
...
‒
Patient labor-focused and requires assistance to cope with intensity of uterine
contractions
...
Characteristics:
‒
Painful uterine contractions 2-3 minutes apart lasting 60-90 seconds
...
‒
Pelvic or rectal pressure
...
‒
Nausea and vomiting are common
...
•
Second Stage:
•
Unexpected problems may lead to a cesarean birth
...
Characteristics:
‒
Uterine contractions every 2-3 minutes and last 60-80 seconds
...
‒
Urge to bear down and push
...
Techniques for pushing:
•
Closed glottis
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Fetal Position Changes
...
•
Descent: downward passage of the fetus through the pelvis
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5 cm
...
•
Extension follows descent and flexion of the head when uterine contractions cause
occiput to extend and rotate around symphysis
...
•
Expulsion: final step as fetal head is delivered and the anterior shoulder is rotated under
the symphysis followed by the posterior shoulder and the rest of the body
...
Placental separation:
•
Delivery of placenta expected within 30 minutes of the delivery of the baby
...
‒
Sudden trickle of blood at the vaginal opening
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Placental expulsion:
•
Placenta guided out of the birth canal
...
‒
Maternal side (red, raw appearance)
...
•
After delivery of the placenta, massage uterus to minimize blood loss
...
•
Length: 1-4 hours
...
‒
Lochia heavy with bright red blood mixed with clots
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Maternal Systemic Response to Labor
...
•
Raises blood pressure and decreases pulse rate
...
•
Labor in a side position or slightly upright to avoid hypotension
...
•
Hyperventilation can occur
...
•
Full bladder can impede labor and fetal descent
...
Gastrointestinal system:
•
Gastric motility slows down
...
Hematopoietic system:
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Expected blood loss vaginal delivery 500 ml
...
•
Fibrinolysis slows down promoting coagulation when the placenta separates
...
Fetus experiences labor with the mother
...
Fetal responses to labor:
•
Heart rate changes
...
•
Increased arterial carbon dioxide pressure (PCO2)
...
•
Decreased fetal breathing movements
Title: Maternal Newborn:PROCESS AND STAGES OF LABOR AND BIRTH
Description: These is a summary of maternal Newborn Nursing notes.The notes contains key points on stages of labor and birth.
Description: These is a summary of maternal Newborn Nursing notes.The notes contains key points on stages of labor and birth.