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Labor & Birth

MAMC exam 9 nursing care during labor & birth

describe traditional setting small functional room for labor moved to delivery area transferred to recovery area to postpartum unit
advantages of traditional safe
disadvantages of traditional impersonal multiple moves uncomfortable for mother disrupts family's time together separate parents & infant
describe labor, delivery, and recovery room (LDR) setting one setting for labor, delivery, recovery remain in LDR for 1-2 hours
advantages of LDR home-like & comfortable healthy infant remains with mother throughout stay
disadvantages of LDR family may regard technologic components as disadvantages
describe LDRP setting similar to LDR not transferred to a postpartum unit after recovery
advantages of LDRP support person encouraged stays with the mother and infant sleeping equipment may be provided
describe birth center setting designed to provide maternity care to low-risk women outside the hospital setting birth often by certified nurse midwife
advantages of birth center less expensive safe and home-like setting for low-risk
disadvantages of birth center not equipped for major obstetric emergencies
advantages of home births keeps family together in own environment
disadvantages of home births long transfer time to hospital in an emergency
guidelines for reporting to a birthing facility contractions ruptured membranes bleeding other than bloody show decreased fetal movement other concerns
contraction guidelines for reporting 5 minutes apart for 1 hour for first labor 10 minutes apart for 1 hour for 2nd & subsequent labors
cultural considerations important for l&d shapes values, their expectations of birth & response to it knowledge provides framework to assess & care for woman & family
traditional practices of Southeast Asia father usually not present stoic response to pain side-lying position preferred
traditional practices of Laos squat for birth prefer female attendants
traditional practices of India natural childbirth methods used female relatives present as caregivers
traditional practices of Iran father not present female caregivers & support people present at birth
traditional practices of Mexico stoic about pain until 2nd stage father & female relatives present
traditional practices of American Indians bury placenta for good luck
maternal physiologic changes during birth cervix thins & dilates supine hypotension depth & resp rate increase, hyperventilation may occur reduced sensation of a full bladder decreased GI motility may result in N/V clotting factors increased even higher
fetal physiologic changes during birth placental circulation - compression by uterine muscle, the maternal supply to placenta decreases cardiovascular - reflect normal labor effects or suggest fetal intolerance pulmonary - lung fluid must be cleared to allow normal breathing after birth
4 Ps: components of the birth process powers passage passenger psyche
powers involuntary uterine contractions which cause the cervix to open and that propel the fetus downward through the birth canal
primary powers responsible for effacement and dilation of the cervix
secondary powers bearing down efforts of the woman which add to the power of the expulsive forces but have no effect on cervical dilation
contractions coordinated uterine contractions are the primary powers of labor during the first stage involuntary
effects of contractions effacement dilation
effacement thinning of the cervix & is described as a percentage of the original length of the cervix
dilation enlargement or widening of the opening of the cervix & the cervical canal. increases from less than 1cm - 10cm
characteristics of contractions frequency duration intensity interval
hypertonic contractions (tachysystole) less than 2 mins apart longer than 90-120 secs intervals shorter incomplete relaxation of the uterus report immediately
maternal pushing when cervix fully dilated the combination of contractions & the maternal pushing propel the baby downward through the pelvis
factors affecting pushing maternal exhaustion epidural anesthesia some women may want to push prematurely due to fetal head causing rectal pressure
the passage bony pelvis and the soft tissue of the pelvis and perineum
bony pelvis false pelvis true pelvis
soft tissues of the passage uterus - upper walls thicken, lower thin cervix vagina perineum
the passenger includes the fetus along with the placenta and membranes
fetal lie relationship o the fetal head & buttocks axis to that of the mother longitudinal transverse
most common fetal lie longitudinal
fetal attitude relationship of fetal body parts to one another
ideal fetal attitude where the back is bowed outward, chin touches sternum, and arms are crossed on the chest with thighs flexed onto the abdomen
the psyche crucial part of childbirth marked anxiety & fear decrease a woman's ability to cope with pain in labor catecholamines inhibit uterine contractions & divert bloodflow from the placenta
contractions of TRUE labor regular close together stronger last longer start in lower back then lower ABD can't be stopped
cervix and fetal changes in true labor cervix softens, effaces, dilates fetus descends into the pelvis
contractions of FALSE labor rarely follow a pattern vary in length & intensity frequently stop with ambulation & position changes & eventually stop with relaxation interventions discomfort in ABD & groin
cervix and fetal changes in false labor cervix doesn't change no significant change in fetal position
focused assessment r/t false labor fetal heart tones maternal VS presence & frequency of contractions
fetal condition fetal HR regular, rhythm normal FHR 110-160 w/ 6-25 beat flutuations presence of accelerations & absence of decelerations
confirm ruptured membranes with nitrazine paper fern test
signs of impending birth sitting on one buttock making grunting sounds bearing down with contractions "the baby's coming" bulging of perineum
what to do if birth imminent don't leave patient, but call for help
process of childbirth descent engagement internal rotation extension external rotation expulsion
stages of labor dilation delivery delivery of placenta stabilization
precipitous labor labor that's completed in less than 3 hours
signs & symptoms in precipitous labor labor begins abruptly & intensifies quickly contractions may be frequent & intense
maternal risks of precipitous labor uterine rupture cervical/vaginal lacerations & hematoma amniotic fluid embolism postpartum hemorrhage abruptio placentae can be associated
fetal risks of precipitous labor hypoxia resulting from decreased periods of uterine relaxation between contractions intracranial hemorrhage nerve damage law apgar scores
external devics for EFM doppler transducer TOCO with a pressure-sensitive button
internal devices for EFM fetal spiral electrode IUPC - 2 types
nursing response to reassuring to monitor patterns accelerations are reassuring & require no intervention early decelerations are caused by head compression & require no intervention other than continued observation
nursing response to variable decelerations caused by cord compression (non-reassuring) repositioning usually first response, may require several changes before pattern improves amnioinfusion may be used to increase the fluid around the fetus & cushion the cord
nursing response to late decelerations caused by placental insufficiency (non-reassuring) initially treated by measures to increase maternal oxygenation & blodd flow to the placenta - repositioning usually first IV fluid bolus of NS or LR per SOP to increase placental perfusion
nursing response to monitor patterns (non-reassuring) O2 at 8-10L/min per SFM stop Pitocin if it's infusing treat hypertonic contractions with terbutaline if ordered notify the doctor of any non-reassuring fetal pattern
Created by: ealongo