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? ? ? ?
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