INTRAPARTUM Labor and Birth MaternalNewborn and Child Nursing

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 n Critical Factors in Labor n n n The birth passage The fetus The relationship between the passage and the fetus Primary forces of labor Psychosocial considerations n Table 15 -1: p 310

The Birth Passage n Implications of Pelvic types for Labor and Delivery n Table 15 -2, p 310

The Fetus n Head

The Fetus n n n Attitude Lie Presentation Top: Fetal Attitude flexion, fetal lie longitudinal Bottom: Fetal Attitude flexion, fetal lie transverse

Relationship between the passage and the fetus n n n Engagement Station Fetal position

The Forces of Labor n n n Primary Secondary Phases of Contractions n n Increment Acme Decrement Characteristics of contractions n n n Frequency Duration Intensity

Psychosocial Considerations n Motivation for pregnancy Support Preparation Trust in staff Maintaining control Cultural influences n Table 15 -3 n n n

Physiology of Labor n Premonitory signs of labor n n n n Lightening or quickening Braxton Hicks Contractions Cervical changes Bloody show Rupture of membranes Sudden burst of energy Other: diarrhea, nausea, etc True vs False Labor Table 15 -4: p 321

Stages of Labor and Birth n First stage n n Latent Active Transition Second stage n n Crowning Positional changes of the fetus Table 15 -5: Characteristics of Labor, p 323

Stages: n Third stage n n n cont’d Placental separation Placental delivery Fourth stage n 1 -4 hours

Stages: cont’d n Maternal responses to labor n n n Cardio, B/P Respiratory Renal, GI Immune/blood Pain n n Causes Fetal responses

Intrapartal Nursing Assessment Chapter 16 n n n Admission assessment Data Collection Assessments n Assessment Guide, pp 335 - 339

Intrapartal Nursing Assessment, cont’d n Evaluating labor progress n n Leopold’s Maneuvers FHR and Pattern n n Accelerations Decelerations Early Late Variable

Evaluations of FHR Tracings

Intrapartal Nursing Assessment cont’d n Contractions n n Frequency Intensity Duration Vaginal exam

The Family in Childbirth: Needs and Care, Chapter 17 n Nursing management n n The admission process The first stage of labor Family expectations Cultural beliefs n n n Pain, modesty Promotion of comfort Clinical Pathways pp 355 - 357

The Family in Childbirth: Needs and Care, cont’d n Nursing management n Second stage n n comfort Third stage n Initial care of newborn n n Apgar Umbilical cord Warmth Newborn identification

The Family in Childbirth: Needs and Care, cont’d n Nursing management n Fourth stage n n Delivery of placenta Enhancing attachment