INTRAPARTUM: Labor and Birth

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INTRAPARTUM: Labor and Birth. Maternal-Newborn and Child Nursing London, Ladewig, Ball, & Bindler Prepared by Mary Ann Gagen, Professor of Nursing. “Pa…I think it’s time to go!”. Process and Stages of Labor and Birth: Chapter 15. Critical Factors in Labor The birth passage The fetus - PowerPoint PPT Presentation

Text of INTRAPARTUM: Labor and Birth

  • INTRAPARTUM:Labor and BirthMaternal-Newborn and Child NursingLondon, Ladewig, Ball, & Bindler

    Prepared by Mary Ann Gagen, Professor of Nursing

  • PaI think its time to go!

  • Process and Stages of Labor and Birth: Chapter 15Critical Factors in LaborThe birth passageThe fetusThe relationship between the passage and the fetusPrimary forces of laborPsychosocial considerationsTable 15-1: p 310

  • The Birth PassageImplications of Pelvic types for Labor and Delivery Table 15-2, p 310

  • The FetusHead

  • The FetusAttitudeLiePresentationTop: Fetal Attitude flexion, fetal lie longitudinalBottom: Fetal Attitude flexion, fetal lie transverse

  • Relationship between the passage and the fetusEngagementStationFetal position

  • The Forces of LaborPrimarySecondaryPhases of ContractionsIncrementAcmeDecrementCharacteristics of contractionsFrequencyDurationIntensity

  • Psychosocial ConsiderationsMotivation for pregnancySupportPreparationTrust in staffMaintaining controlCultural influencesTable 15-3

  • Physiology of LaborPremonitory signs of laborLightening or quickeningBraxton Hicks ContractionsCervical changesBloody showRupture of membranesSudden burst of energyOther: diarrhea, nausea, etcTrue vs False LaborTable 15-4: p 321

  • Stages of Labor and BirthFirst stageLatentActiveTransition Second stageCrowningPositional changes of the fetus

    Table 15-5: Characteristics of Labor, p 323

  • Stages: contdThird stagePlacental separationPlacental delivery

    Fourth stage1-4 hours

  • Stages: contdMaternal responses to laborCardio, B/PRespiratoryRenal, GIImmune/bloodPainCausesFetal responses

  • Intrapartal Nursing AssessmentChapter 16Admission assessmentData CollectionAssessmentsAssessment Guide, pp 335 - 339

  • Intrapartal Nursing Assessment, contdEvaluating labor progressLeopolds ManeuversFHR and PatternAccelerationsDecelerationsEarlyLateVariable

  • Evaluations of FHR Tracings

  • Intrapartal Nursing AssessmentcontdContractionsFrequencyIntensityDuration

    Vaginal exam

  • The Family in Childbirth:Needs and Care, Chapter 17Nursing management The admission processThe first stage of laborFamily expectationsCultural beliefsPain, modestyPromotion of comfortClinical Pathways pp355 - 357

  • The Family in Childbirth: Needs and Care, contd Nursing managementSecond stagecomfortThird stageInitial care of newbornApgarUmbilical cordWarmthNewborn identification

  • The Family in Childbirth: Needs and Care, contd Nursing management

    Fourth stageDelivery of placentaEnhancing attachment

    Labor is the bridge between pregnancy & motherhood. For the woman in labor, this is the most intense experience of pregnancy.

    The process begins between 38 and 40th week. The exact cause of onset is not understood. There are several hypothesis: Progesterone withdrawal relaxation of the myometrium, whereas estrogen stimulates myometrial contractions and production of prostaglandins. As you will learn later, prostaglandin E is used to induce labor. During labor, prostagIandin the connective tissue in the cervix to soften, thin out, and open during labor. Oxytocin, a hormone produced by the pituitary, plays a major role in the onset and maintenance of contractions during the labor process. Corticotropin-releasing hormone makes the uterus more sensitive to oxytocin and the prostaglandins. Different theories for one of the most emotional experiences.

    Start on Chapter 15. Well cover parts Chapters 15 through 20. Each chapter has Key Terms at the beginning and Chapter Highlights as summaries. Final weeks of pregnancy: mother/baby prepare for birth. Five important factors : the passage, the fetus, the relationship between the passage and the fetus, the forces of labor, and psychosocial considerations.Often called the 5 Ps of Labor:Passageway, Passenger, Powers, Position, and Psychologic responses PASSAGE : Birth passage 3 sections of true pelvis inlet, pelvic cavity (midpelvis), & outlet. Four classifications : gynecoid , android, anthropoid, & platypelloid.

    See Table 15-2: Implications of Pelvic Type for Labor & Birth p 310

    The Caldwell-Moloy (1933) classification of pelvises is widely used to differentiate bony pelvis types. See Figure 15-1 , p 311

    Gynecoid is most common, with diameters favorable to vaginal delivery.PASSENGER: Fetal head: Considerations: face, base of skull, & vault of cranium (roof). Bones in face fused but vault has movable bones; overlap under pressure molding.Sutures membranous spaces between bones; intersections fontanelles (soft spot)Landmarks: mentum chin; sinciput brow; vertex space between fontanelles; occiput occipital bone

    Fetal attidude relationship of fetal parts to one another: norm: mod flexion of head, flexion of arms unto chest, & flexion of legs to abdomen

    Fetal lie relationship of cephalocaudal axis (spinal column) of fetus to c. a. of motherlongitudinal: parallel transverse: fetal c.a. is 90 to womans spine

    Fetal Presentation determined by fetal lie and by the body part that enters the pelvic passage first. The portion of the fetus is referred to as the presenting part. Fetal presentation may be cephalic, breech, or shoulder.Presentation: Fetal presentation may be cephalic, breech, or shoulder. Cephalic (head) occurs 97%. Breech (feet) & shoulder may be difficult called malpresentations.

    Cephalic presentation, head is completely flexed onto chest; smallest diameter (suboccipitobregmatic) presents. The occiput is the presenting part.

    In your book: Figure 15-6: Military- top of head Fig B ; brow head is partially extended largest diameter ; face (D).Engagement when largest diameter of presenting part reaches or passes through pelvic inlet.Figure 15-7, p 314The biparietal diameter (BPD) of fetal head settles into inlet of pelvis. In most instances, the occiput is at the level of the ishial spines () station.

    Station refers to the relationshio of presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis. If the presenting part is higher than the ischial spines, the station has a negative #, referring to centimeters above 0 station..Minus 5 is at the pelvic inlet. Positive #s = presenting part has passed the ischial spines. Positive (+) 4 is at the outlet. See Figure 15-8, p 315

    Fetal position relationship of the designated landmark of fetal presenting part to the left or right side of the maternal pelvis. The designated landmarks are vertex: the occiput; in face presentation: the mentum. In breech: the sacrum; for shoulder: the acromion process of the scapula. If directed to side, it is designated as transverse. The landmark on the fetal presenting part r/t four imaginary quadrants: left anterior, right anterior, left posterior, and right posterior, meaning: Is the presenting part directed toward the front, back, left or right of the passage? Three notations: Right or left (L) side of maternal pelvisThe landmark of fetal presenting part: occiput (O); mentum (M), sacrum (S), or acromion process (A).Anterior (A), posterior (P), or transverse (T ) Figure 15-9 p 316.Click back to slide 7

    Power: Primary forces: is the uterine contraction complete effacement and dilation of the cervix.Secondary forces: use of abdominal muscles to push during the 2nd stage of labor. Pushing force adds to the primary force after the cervix is fully dilated.

    Contractions have a rhythmic pattern, with periods of relaxation between, allowing the woman to rest. This resting period allows for restoration of placental circulation: important to uterine muscles but also for the babys oxygenation.Increment: the building up and longest; acme peak; and decrement or letting up.

    Characteristics: frequency: time between beginning of one contraction to the beginning of the next. Duration: beginning to completion of a single contraction. Intensity strength of contraction. Experienced nurse can estimate by palpating the fundus (top) during the contraction. Mild: the uterine wall can be indented; strong, it cannot be indented. Intensity can be measured directly with an intrauterine probe. Look at Figure 15-10, p 317

    Power of forces

    Transition to new role couple; permanent change in lifestyle, relationships, & self-image.; differences between primi and multi: losing it being out of control; fear of pain; birthing plan: will it be honored?

    Most primigravidas and many multigravidas experience the following S & Sx of labor:Lightening the fetus settles into pelvic outlet (review: engagement); leg cramps, pelvic pressure, leg edema, vaginal secretionsBraxton Hicks contractions (irregular, intermittent contractions or Practice throughout pregnancy, like menstrual cramps. Strong woman in false laborCervical changes rigid, firm cervix softens or ripens Bloody show mucus plug is expelled exposed cervical capillaries pink-tinged secretionsRupture of membranes ROM (not range of motion). 12% before labor begins. Then 80% go into labor within 24 hrs. Watch carefully: if fetus not engaged, cord can prolapse with fluid gush. Inc risk for infection Sudden burst of energy 24 48 hrs /a deliveryOther: weight loss 1-3 lbs, N&V, diarrhea

    True Vs False labor: contractions of TRUE labor progressive dilatation & effacement of cervix; regular & inc in frequency, duration, & intensity; pain starts in back & radiates to abdomen. Walking intensifies pain.False labor doesnt; woman feels foolish (tell story of VICKY).Table 15-4: Comparison of True & False, p 321Four stages of labor: First stage: the longest stage occurs between onset of true labor and th