Labor & Delivery

• Labor


  the process by which a fetus and placenta leave the uterus, this can be either by vaginal delivery or Cesarean section
• Labor


  continuous progressive contractions that help to open the cervix by dilation and effacement and passage of the fetus and placenta through birth canal
• Normal delivery

  • is the birth of 1 baby after a pregnancy of 270-290 days
  • the birth takes between 3-18 hours
  • Water breaks during 1st stage of labor
  • Blood loss in normal delivery is <500 ml
• Stages of labor

  • 1st stage: onset of regular contraction to full dilatation (10 cm)
  • 2nd stage: full dilatation to delivery of the fetus
  • 3rd stage: delivery of fetus to delivery of the placenta
  • 4th stage: 1 hour after delivery of placenta or recovery of mother
• Labor contractions


  the periodic lightening and relaxing of the uterine muscle
• Uterine muscle


  the largest muscle in a woman's body
• Contractions


  often described as a cramping or lightening sensation that starts in the back and moves around to the front in a wave-like manner, the abdomen becomes hard to the touch
• During labor the nurse assess the following:

  • Vital signs - every 4 hours (if membranes have ruptured for many hours before labor onset or if there is a borderline Temperature elevation, the temp. is checked hourly)
  • contraction pattern (intensity, frequency, interval, duration)
  • intactness of membrane through vaginal exam, and fetal well-being through fetal heart rate, characteristics of amniotic fluid, and contractions.
• Sign of placental separation:


  • Lengthening of umbilical cord
  • Sudden gush of vaginal blood
  • Change in the shape of uterus (globular)
  • Firm uterine contractions
  • Appearance of placenta in vaginal opening
• Amniotomy


  artificial rupture of the membranes
• Reasons to monitor the baby's heart rate can include:

  1. If there are health concerns for the monitor during late pregnancy

  • Bleeding
  • high blood pressure
  • premature labor
  • diabetes

  1. If there are health concerns for the baby

  • small for dates
  • abnormality of the baby
  • pregnancy is overdue
• Cardiotocography is used to monitor different measures:


  • Uterine contraction
  • Four fetal heart rate features
  • Baseline heart rate
  • Variability
  • Acceleration
  • Deceleration
• Uterine contractions


  they are quantifies as the number of contractions in a 10 minute period and averaged over 30 min.

  • Normal: < 5 contractions in 10 min.
  • Abnormal: > 5 contractions in 10 min (tachysystole)
• Baseline heart rate


  • Normal: 120-160 bpm
  • Abnormal: <100 bpm or >180 bpm
• Variability


  Fluctuations in the fetal heart rate

  • Normal: 6-25 bpm
  • Abnormal: >25bpm
• Accelerations


  • increases in fetal heart rate from the baseline by at least 15 beats per minute, lasting for at least 15 seconds and should be 2 accelerations every 20 minutes lasting no longer than 2 minutes
  • usually in response to fetal movement or contractions
• Decelerations


  decreases in fetal heart rate from the baseline by at least 15 bpm, lasting for at least 15 seconds
• Cardinal movements

  • Engagement
  • Descents
  • Flexion
  • Internal rotation
  • Extension
  • Restitution/External rotation
  • Expulsion
• A perineal wash before delivery involves cleaning the perineum with a mild antiseptic solution. The purpose of this wash is to reduce the risk of infections and promote a hygienic environment for delivery.
• Methergine ( Methylergonovine)


  Decreases the amount of breast milk, and serum prolactin. Side effects: increases BP, fast irregular heart beat, allergies.
• How many units of oxytocin are administered?

  10 units
• Crowning


  suress sign of delivery
• Normal color of amniotic fluid


  cloudy because of the vernix caseosa
• Main objectives of perineal care


  1. Reduce infection risk
  2. Prepare for delivery
  3. Promote hygiene
  4. Support wound healing
  5. Facilitate a smooth delivery
• Materials needed for perineal care:

  1. Antiseptic solution
  2. Sterile gloves
  3. Sterile gauze or sponges
  4. Pick-up forceps
  5. Sterile water or saline
  6. Kelly pad
  7. Clean, disposable container
• Cardiotocography


  a technical means of recording the fetal heartbeat and the uterine contractions during pregnancy, typically in the 3rd trimester.
• Cardiotocograph or Electronic featl monitor


  the machine used to perform the monitoring
• Tocodynamometer


  a pressure-sensitive devise that is placed on the mother's abdomen over the area of strongest contractions to measure the length, frequency,a nd strength of uterine contraction.
• Tocodynamometer


  a device for monitoring and recording uterine contractions before and during labor
• Transducer


  is placed over the fundus area of the uterus using a belt

  • Pink - contraction
  • Blue - fetus