Labor and Delivery Alicia A Stone MS RN

Labor and Delivery Alicia A. Stone MS, RN, FNP Molloy College 9/26/202 0 1

“Pa…. I think it’s time to go!” 9/26/2020 2

What is Labor? • Demonstrating progressive cervical changes, in the presence of regular, frequent, painful uterine contractions 9/26/2020 3

9/26/2020 4

Phases of Labor During First Stage • Latency (0 to 3 cm) • Prodromal, early, preliminary • 4 - 24 hours • Active (4 to 7 cm) • 3 to 5 hours • Transition (8 to 10 cm) • ½ to 2 hours 9/26/2020 5

Physiologic Forces of Labor • Frequency of contractions • Effectiveness of pushing 9/26/2020 6

9/26/2020 7

Uterine Contractions • Palpation • Timing • Frequency • Duration • strength 9/26/2020 8

Birth Passage • Size of maternal pelvis • Type of maternal pelvis • Ability of cervix to dilate • Ability of vaginal canal to distend 9/26/2020 9

Dilation and Effacement • 9/26/2020 10

Fetal Head 9/26/2020 11

• Fetal attitude • Fetal lie 9/26/2020 12

9/26/2020 13

9/26/2020 14

9/26/2020 16

Passage • Engagement • Station • Fetal position 9/26/2020 17

9/26/2020 18

Psychosocial considerations • Mental and physical preparation for childbirth • • Sociocultural values Previous experience Support Emotional status 9/26/2020 19

Admission to Labor Suite • • • History Contractions When they last ate Vital signs Ultrasound Examination 9/26/2020 20

Membranes Rupture • • • 600 to 800 cc Color Odor Consistency Nitrazine Paper 9/26/2020 21

Leopold’s Maneuvers 9/26/2020 22

External fetal monitoring • Two belts • Uterine contractions • Fetal heart monitoring • benefits • negatives 9/26/2020 23

Internal fetal monitoring • 9/26/2020 24

Fetal heart variability 9/26/2020 25

Early decelerations • Head compressions 9/26/2020 26

Late decelerations • Uteroplacental insufficiency 9/26/2020 27

Variable decelerations • Cord Compression 9/26/2020 28

Maternal Responses to labor • • • Cardio, B/P Respiratory Renal, GI Immune/blood Pain • causes 9/26/2020 29

Cardinal movements • • Descent Flexion Internal rotation Extension Restitution External rotation Expulsion 9/26/2020 30

Fetus moving through the Pelvis

Placental delivery • • Contraction Globular uterus Cord lengthens Rush of vaginal blood 9/26/2020 32

Pain Management • Narcotic Analgesics • Timing • Effect on labor • Common meds used • Stadol • Nubain 9/26/2020 33

Regional Anesthesia • • Epidural Spinal Pudendal Side effects • Hypotension • Bladder distention 9/26/2020 34

Breathing Methods • Basic principles • Comfortable position • Chest breathing • Focal point • Verbal and non-verbal cues • Cleansing breath • • Rhythmic chest Shallow chest Pant-blow Exhalation pushing 9/26/2020 35