9 Labor and Delivery

8/3/2019 9 Labor and Delivery

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CARING FOR A WOMAN IN LABOR AND DELIVERY

Definition:

Providing a safe and therapeutic environment for mother experiencing labor and delivery.

Purpose:

1. Assess fetal and maternal well being

2. To help the woman feel confident in her ability to control pain and the progress of

labor

3. To assist the pregnant woman to a safe delivery of the infant

Indication:

Pregnant woman experiencing true labor pains

Client Education:

1. Provide information regarding labor pattern, progress of labor and planned

intervention

2. Teach the woman about the proper breathing techniques during labor and delivery.

3. Keep the woman informed of the progress of fetal descent.

Special Considerations:

1. The delivery process varies from one patient to another and the nurse must be quick

to provide an atmosphere of receptivity to client’s needs

2. Some institutions permit the father to accompany the mother in the delivery room

3. Some physician may order enema to ensure that no stool would be expelled during

delivery

4. Ambulation is allowed if the presenting part is engaged, the membranes are not

rupture and the woman is not medicated



Equipments:

• OB bundle (sterile gowns, 2

leggings and 3 towels)

• Kelly pad,

• Primi set (2 Kellies, 1 needle

holder, 1 tissue forceps)

• Bandage scissors

• Suture scissors

• local anesthesia

• 10 cc syringe

• G23 needle

• Sponges (vaginal packs

and OS)

• Sterile gloves

• Adult diaper

• suction bulb

• Basins

PROCEDURE RATIONALE

ADMISSION

1. Obtain vital signs, including

temperature, and weight

To obtain baseline data and determine

For any problems. Blood pressure is

taken between contractions because

BP rises 5-15 mm hg during a

contraction. An increase in BP may

Indicate the development eclampsia.

A decrease in BP may indicate

hemorrhage.

2. Obtain relevant data related to the

pregnant woman such as LMP, AOG,

and EDC.

This data helps establish the viability of

Fetus

3. Place client on a supine position with

knees flexed, and measure the fundic

height and perform Leopold’s

maneuver.(refer to the checklist)

To relax the abdomen. Performing Leopold’s

maneuver will determine the feral position

4. Prepare the client for vaginal

examination (refer to the checklist)

to assess cervical readiness

5. Monitor for frequency, interval and

duration of the uterine contractions,

and record in the monitoring sheet

To assess progress of labor and monitor fetal

well being

6. Encourage the client to urinate and

defecate.

A full bladder may impede descent of the

presenting part; over distention may cause

injury as well as postpartum voiding difficulty.

7. Encourage her to walk and rest

alternately, unless contraindicated.

This will reduce muscle tension, relieves

pressure and promotes fetal descent



PROCEDURE RATIONALE

8. Administer IV fluids as ordered by

the Attending Physician.

Maintains hydration and provides venous

access for medication.

CARING FOR A WOMAN IN THE 2ND STAGE

OF LABOR

1. Wash hands. Wear mask and bonnet Deters spread of infection

2. Gather the equipments needed Organization facilitates ease in the

performance of the task

3. Transfer the woman from the labor

room to the delivery room when the

cervix is fully dilated.

To provide an environment necessary for

delivery

4. Assist patient into the delivery table

and place her in lithotomy position

with both legs hanging in the table’s

stirrups

For a good visualization of the perineum

5. Shave the perineum and do perineal

skin preparation. Use sterile gloves or

working forceps to clean the perineal

area. Use cherry balls soaked with

antiseptic solution or 7% betadine

solution

To reduce the number of microorganisms in

the skin

6. Perform hand washing and put on

sterile gloves.

To prevents spread of infection

7. Put on drapes and towels

Place a towel sheet under the buttocks

Slide leggings over each leg, protecting the

gloved hands in the folded cuffs

Place a towel sheet across the abdomen from

the level of the pubis.

Proper draping will provide a sterile field and

prevents contamination



PROCEDURE RATIONALE

8. Arrange the instruments in the mayo

table according to their uses.

To facilitate a systematic progression of the

procedure

9. Instruct the client to breathe out and

push and pant in between

contractions.

Exhaling during contraction prevents

valvalva’s maneuver which could impede

blood return to the heart because of increase

intrathoracic pressure. This could also

interfere with blood supply to the uterus. The

woman is asked to push until the occiput of

the fetal head is firmly at the pubic arch.

Panting in between contractions can minimize

the urge to push.

10. As the fetal head is pushed towards

the perineum, support the perineum

with sterile gauze. This time the

doctor will perform episiotomy with a

blunt tip scissors

Supporting the perineum will prevent

laceration and performing episiotomy will

prevent tearing of the perineum and release

pressure of the fetal head with birth.

11.Pass on the appropriate instruments

and materials to the doctor asnecessary

To assist the doctor in efficient performance

the procedure

12. Provide support to the birth canal by

pressing an OS against the perineum

with the palm of the hand

Pressing against the incised perineum will seal

the cut edges and minimize bleeding

13. When the head is delivered, support it

with both hands hyperextended and

the doctor will pass her finger along

the occiput of the newborn’s neck.

Prepare the suction bulb, wipe first

and suction the baby’s mouth first

then the nose.

Passing fingers along the occiput of the

newborn’s neck determines whether a loop of

umbilical cord is encircling the neck. If a loop

is felt, it is gently loosed and drawn over to

the fetal head. If it is tight, it must be

clamped and cut before shoulders are

delivered. Suctioning removes secretions and

prevents aspiration

14. As the head restitute and rotates, give

a steady, gentle downward pull and

slowly give upward lift.

The downward pull allows the delivery of the

anterior shoulder and the upward lift will

deliver the posterior shoulder to slide over the

perineum



PROCEDURE RATIONALE

15. Assist the doctor as necessary in the

delivery of baby and note the time of

delivery gender of the infant.

The baby is slippery and may slip off. The

time of delivery serves as the time of birth. It

is the responsibility of the nurse to check and

record accurate data especially the gender

and time of birth.

16. Hand 2 kellies, one clamp at a time.

(The doctor will clamp approximately

8-10 inches from the base of the

cord.) Then pass the bandage scissors

for cutting of the umbilical cord.

Check the cord for presence of 3vessels ( 2 arteries and one vein)

2 clamps will prevent the flow of blood from

the baby and from the placenta during

cutting. Clamping the cord is a part of the

stimulus that initiates the first breath.

17. Place the baby on the woman’s

abdomen. Dry the baby quickly and

Bring the infant to the NICU for

further management

Placing the baby on the abdomen can

promote bonding and visualization of the

newborn. Drying can prevent heat loss. For

immediate care of the neonate and prevent

complications

CARING FOR A WOMAN IN THE 3rd

STAGE

OF LABOR

1. Once you see signs of placental

separation, deliver the placenta using

a gentle touch on the cord

Signs of placental separation are lengthening

of the cord, a sudden gush of blood and

changing of the size of the lower abdomen

2. When the placenta is coming out, twist

the trailing membrane until it is

completely delivered

This maneuver promotes the delivery of the

placenta

3. Assess placenta for size, shape and

completeness then place it the basin

( may drop in the bucket if there’s no

tray available)

To ascertain that placenta is intact and

normal in appearance and weight. Normally, a

placenta is one-sixth of the weight of the

infant.

4. Wipe vulva with sterile gauze for the

doctor to check the lacerations

To check and for bleeders and note for

laceration to be repaired.

5. Aspirate the local anesthetic using

sterile technique and prepare sutures

place in the needle holder, then assist

in episiorrhapy

To prevent contamination of the sterile field.

Anesthesia provides can lessen pain sensation

during the repair



PROCEDURE RATIONALE

6. As soon as repair is done, perform

perineal flushing

This will remove blood stains, and promote

comfort

7. Remove drapes and Kelly pad and put

on adult diaper.

Removing Kelly pad after flushing will prevent

a messy workplace

8. Place ice pack over the perineum. To promote uterine contraction

9. Remove drapes covering the patient

and lowers both legs from the stirrup

simultaneously... Offer a clean gown

and a warm blanket. Transfer the

patient to the stretcher

Lowering the legs simultaneously can prevent

back injury. The mother may experience chill

and shaking sensation. Clean gown and a

warm blanket can provide her comfort.

10.Remove your gloves and discard it

properly. Do after care.

Bloody instruments must be properly cleaned

to eliminate microorganism. After care will

ensure a clean environment for labor and

childbirth.

11. Document the care performed to the

patient, the medications, intravenous

fluids given, and patient’s response

and endorse

Serves as a record and basis for further

assessment.

Documents

9 Labor and Delivery