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Chapter 6Chapter 6

Nursing Care of Mother and Infant During Labor and Birth

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Cultural Influence on Birth PracticesCultural Influence on Birth Practices

Role of woman in labor and delivery Role of father/partner in labor and delivery

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Settings for ChildbirthSettings for Childbirth

Hospitals Advantages Disadvantages

Freestanding Birth Centers Advantages Disadvantages

Home Advantages Disadvantages

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Components of the Birth ProcessComponents of the Birth Process

The Four “Ps” Powers Passage Passenger Psyche

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Factors That Influence the Progress of Labor

Factors That Influence the Progress of Labor

Preparation Position Professional Place Procedures

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Uterine ContractionsUterine Contractions

Effect of contractions on the cervix

Phase of contractions Increment Peak Decrement

Frequency Duration Intensity

Mild Moderate Firm

Maternal pushing

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Cervical Effacement and DilationCervical Effacement and Dilation

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Contraction Cycle

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Nursing Tip Nursing Tip

Provide emotional support to the laboring woman so she is less anxious and fearful

Excessive anxiety or fear can cause greater pain, inhibit the progress of labor, and reduce blood flow to the placenta and fetus

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The PassageThe Passage

Bony pelvis Soft tissues

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The Passenger—Fetal Skull, LieThe Passenger—Fetal Skull, Lie

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Passenger—PresentationPassenger—Presentation

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Classifications of Fetal Presentations and Positions

Classifications of Fetal Presentations and Positions

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PsychePsyche

The woman’s cultural and individual values influence how she will be able to cope with childbirth

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Normal ChildbirthNormal Childbirth

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Signs of Impending LaborSigns of Impending Labor

Braxton-Hicks contractions Increased vaginal discharge Bloody show Rupture of the membranes Energy spurt Weight loss

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Mechanisms of LaborMechanisms of Labor

Descent Engagement Flexion Internal rotation External rotation Expulsion

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Birth StationBirth Station

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Admission to the Hospital or Birth Center

Admission to the Hospital or Birth Center

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When to Go to the Hospital or Birth Center

When to Go to the Hospital or Birth Center

Contractions Ruptured membranes Bleeding other than bloody show Decreased fetal movement Any other concern

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Admission Data CollectionAdmission Data Collection

Three major assessments performed promptly on admission: Fetal condition Maternal condition Impending birth

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Admission ProceduresAdmission Procedures

Permits/consents Laboratory tests Intravenous infusion Shave prep Determining fetal position and presentation

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Comparison of False and True Labor

Comparison of False and True Labor

False labor Contractions irregular Walking relieves

contractions Bloody show usually not

present No change in

effacement/dilation of cervix

True labor Contractions gradually

develop a regular pattern Contractions become

stronger and more effective with walking

Discomfort in lower back/abdomen

Bloody show often present

Progressive effacement and dilation of cervix

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Nursing Care Before BirthNursing Care Before Birth

After admission to the labor unit, nursing care consists of: Monitoring the fetus Monitoring the laboring woman Helping the woman cope with labor

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Monitoring the FetusMonitoring the Fetus

Fetal heart rate Intermittent auscultation Continuous electronic fetal monitoring Evaluating fetal heart rate patterns

Accelerations Early decelerations Variable decelerations Late decelerations

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Reassuring and Nonreassuring Fetal Heart Rate and Uterine Activity Patterns

Reassuring and Nonreassuring Fetal Heart Rate and Uterine Activity Patterns

Reassuring Patterns Nonreassuring Patterns

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Monitoring the WomanMonitoring the Woman

Vital signs Contractions Progress of labor Intake and output Response to labor

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Helping the Woman Cope With Labor

Helping the Woman Cope With Labor

Teaching Providing encouragement Supporting the partner

Teach partner how labor pains affect the woman’s behavior/attitude

Teach partner how to adapt responses to the woman’s behavior

Teach partner what to expect in his/her own emotional responses

Teach partner the effects of epidural analgesia

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Stages and Phases of LaborStages and Phases of Labor

First stage—dilation and effacement (4 to 6 hours) Second stage—expulsion of fetus (30 minutes to

2 hours) Third stage—expulsion of placenta (5 to 30 minutes) Fourth stage—recovery

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Nursing Responsibilities During Birth

Nursing Responsibilities During Birth

Preparing the delivery instruments and infant equipment

Perineal scrub Administering medications Providing initial care to the

infant

Assessing Apgar score Assessing infant for

obvious abnormalities Examining the placenta Identifying mother and

infant Promoting parent-infant

bonding

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Immediate Postpartum Period: The Third and Fourth Stages of Labor

Immediate Postpartum Period: The Third and Fourth Stages of Labor

Third stage—Expulsion of placenta Schultze’s or Duncan’s

Fourth stage—Nursing cares include: Identifying and preventing hemorrhage Evaluating and intervening for pain Observing bladder function and urine output Evaluating recovery from anesthesia Providing initial care to the newborn infant Promoting bonding and attachment between the infant and

family

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Nursing Care Immediately After Birth

Nursing Care Immediately After Birth

Care of the mother Observing for hemorrhage Promoting comfort

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Nursing Care Immediately After Birth (continued)

Nursing Care Immediately After Birth (continued)

Care of the infant Phase 1

• From birth to 1 hour (usually in delivery room) Phase 2

• From 1 to 3 hours (usually in transition nursery or postpartum unit)

Phase 3

• From 2 to 12 hours (usually in postpartum unit if rooming-in with the mother)

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Phase 1: Care of the NewbornPhase 1: Care of the Newborn

Initial care includes: Maintaining thermoregulation Maintaining cardiorespiratory function Observing for urination and/or passage of

meconium Identifying the mother, father, and newborn Performing a brief assessment for major

anomalies Encouraging bonding/breastfeeding

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Care of the Newborn (Continued) Care of the Newborn (Continued)

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Apgar ScoringApgar Scoring

Heart rate Respiratory effort Muscle tone Reflex response to suction or gentle stimulation on

the soles of the feet Skin color

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Administering Medications to the Newborn

Administering Medications to the Newborn

Eye care Vitamin K (AquaMEPHYTON)

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Umbilical Cord Blood BankingUmbilical Cord Blood Banking

This type of blood is capable of regenerating stem cells that are able to replace diseased cells

Informed consent is essential Collect blood after cord has been clamped Blood must be transported to blood banking facility

within 48 hours of collection

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Question for ReviewQuestion for Review

State the primary fetal risk during the first and second stage of labor and the primary maternal risk during the fourth stage of labor.

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ReviewReview

Objectives Key Terms Key Points Online Resources Critical Thinking Questions Review Questions