Labor and delivery Objectives n Distinguish the differences

Labor and delivery

Objectives n Distinguish the differences of the 4 stages of labor. n Describe the 5 P’s of normal delivery. n Diagram and explain the three types of decelerations on a fetal monitor during labor. n Analyze the different types of pain relief available for laboring women.

Having my Baby…… Signs of labor n Stage one n Stage two n Stage three n Stage four

Signs of Labor n Preliminary signs of labor Lightening Increase in level of activity Braxton Hicks contractions Ripening of the cervix

Passenger n Passenger Structure of fetal skull Diameters of fetal skull Molding

Passenger n Fetal presentation and position Attitude Engagement Station Fetal lie

Passenger n Types of fetal presentation n Cephalic Breech Shoulder

passenger Position Relation of the presenting part to a specific quadrant of a woman’s pelvis n Right anterior n Left anterior n Right posterior n Left posterior

n Mechanisms of Labor n n n Descent Flexion Internal rotation Extension External rotation Expulsion Passage way of Labor

Powers of Labor n Powers of Labor Cervical changes - SVE Effacement Dilatation Normal Vaginal Birth with Cervical Effacement and Dilatation (Dilation) - Medical Animation

Stages of Labor n First Stage n n n Latent phase Active phase Transition phase

Maternal and Fetal Assessment Nurse Role n Assessment of stage one History Check urine Physical exam Leopold’s maneuvers Rupture of membranes? Vaginal exam Pelvic adequacy

Nursing Care: First Stage n Respect contraction time n Change positions n Voiding and bladder care n Support n Pain management

Nursing Care: Promoting Comfort n Reducing anxiety n Coping strategies n Comfort measures n Positioning n Childbirth method n Pharmacologic pain relief

Deceleration Patterns A. Early decelerations caused by head compression B. Late decelerations caused by uteroplacental insufficiency C. Variable decelerations caused by cord compression

Comfort and Pain Relief of labor n Support from doula or coach n Alternative therapies Relaxation Focusing and imagery Breathing Herbal preparations Be culturally sensitive

Pain relief for laboring clients Injection of local anesthesia to block specific nerve pathways n Epidural Nursing care –consent and make that call! Vitals and observation during administration n Spinal n IV meds Stadol Nubain pg 369

Nursing Care: Second Stage n Preparing for birth n Positioning for birth n Pushing n Perineal cleaning n Episiotomy n Birth n Cutting and clamping the cord

End of Second Stage of Labor n Second stage Period from full dilatation and cervical effacement to birth of the infant n Third Stage n Placental separation n Placental expulsion n

Nursing Care: Third and Fourth Stage n Oxytocin n Placental delivery n Perineal repair n Assessment n Aftercare

End of Third Stage Labor

What is the fourth stage?

C Section

C section

n Questions? ? ? ?