Labor and Delivery

• Intrapartum Period

  Onset of regular contractions and lasts until the placenta delivers.
• Labor triggers: Maternal & Fetal Factors

  Release of prostaglandins

  Increased estrogen

  Decreased progesterone

  Increased oxytocin

  Aging of the placenta

  Fetal cortisone production: decreases progesterone and increases prostaglandins
• Signs that labor may be starting

  Lightening (fetus drops down into pelvis)

  Braxton-Hicks contractions increasing

  Cervical changes

  GI changes/weight loss

  Backache

  Bloody show

  SROM occasionally occurs
• True Labor

  Contractions:

  Regular, increase in frequency & intensity, increase intensity & duration with walking, felt in lower back, radiate to lower portion of abdomen

  Dilation & effacement

  May have bloody show

  Fetus usually engaged
• False Labor

  Contractions:

  Irregular, decrease or no change in intensity with walking, felt in abdomen above umbilicus, Braxton-hicks and hydration or sedation slows/stops contractions

  No change in cervix

  Fetus ballotable
• Powers of Labor

  Involuntary contractions in the beginning of labor move the baby down the birth canal.

  At birth combined with voluntary pushing or bearing down.

  Uterine contractions are responsible for dilation (opening) and effacement (thinning) of the cervix in the 1st stage of labor.
• Intensity types

  Mild= tip of nose

  Moderate= finger to chin

  Strong= touch forehead
• Passage

  The hormone relaxin helps to soften the cartilage and allows some movement of the pelvis.

  Positive= going down

  Negative= going up
• Fetal Attitude/Posture

  Relationship of fetal parts to one another
• Fetal Lie

  Relationship of long axis of fetus (spine) to long axis of mother (spine)
• Assessing A Woman in Labor

  Check prenatal record -> risk factors

  ROM: Speculum exam (SVE): Ferning, Nitrazine, Amnisure

  GBS Status

  Vital signs: including pain

  I&O/Need for IV/Labwork

  Assessment

  Fetal surveillance: FHR

  Family support

  Ambulate
• Stage I, Latent (early) phase

  Cervical dilation: 0-6 cm

  Contractions q 5-15 minutes

  Duration 10-30 sec

  Mild intensity

  Mother talkative and eager

  May be anxious
• Stage I, Latent (early) Phase Nursing Interventions:

  Check UC's Q 30 minutes

  FHR q 30 minutes

  Vital signs q 1-2 hours

  If membranes are ruptures, check temp every hour

  Encourage voiding q 1-2 hours
• Stage I Active Phase

  Cervical dilation: 6-8 cm

  Uterine contractions every 3-5 minutes

  30-45 (may be 60) seconds in duration

  Moderate-strong intensity

  Mother may experience feelings of helplessness, pain, restlessness, anxiety, serious and more inward
• Stage I Active Phase Nursing Interventions

  Position changes

  Provide quiet environment

  Ice chips/sips of fluid, chapstick
• Stage I Transition Phase

  Cervical dilation: 8-10 cm

  Strong intensity

  Mother tired, irritable, restless, and feels out of control, panic

  May have nausea/vomiting, leg cramps
• Stage I Transition Phase Nursing Interventions

  Encourage rest between contractions

  Ice chips

  Comfort measures

  Encouragement
• Stage 2: Pushing

  Cervical dilation is complete= 10 cm, effacement 100%

  Intensity strong

  Increase in bloody show

  Mother feels urge to bear down (Ferguson's reflex)

  Perineal burning/stretching
• Stage II: Evidence Based Nursing Interventions

  Delay pushing until the women has the urge to push (laboring down)

  Encourage open glottis pushing for 4-6 seconds

  Position women as upright as possible (HOB at least 45)
• Stage 3: Delivery of the placenta

  Contractions occur until placenta is delivered

  Expulsion of placenta occurs within 1-30 minutes of delivery

  Lengthening of cord, spurt of blood, fundus rises in abdomen
• Active management of the Third Stage of Labor:

  Administer oxytocin IV after the delivery of the anterior shoulder

  Controlled cord traction and late cord clamping

  Uterine massage after the placenta is delivered
• Stage IV nursing interventions

  Provide warm blankets (shivering common)

  Apply ice to perineum

  Massage uterus if needed