Labor and Delivery Dr Meity Elvina, Mked,SpOG,PGCert 9/12/2019 1

What is Labor? Demonstrating progressive cervical changes, in the presence of regular, frequent, painful uterine contractions 9/12/2019 2

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Phases of Labor During First Stage Latency (0 to 3 cm) Prodromal, early, preliminary hours Active (4 to 7 cm) 3 to 5 hours Transition (8 to 10 cm) ½ to 2 hours 9/12/2019 4

Physiologic Forces of Labor Frequency of contractions Effectiveness of pushing 9/12/2019 5

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Uterine Contractions Palpation Timing Frequency Duration strength 9/12/2019 7

Birth Passage Size of maternal pelvis Type of maternal pelvis Ability of cervix to dilate Ability of vaginal canal to distend 9/12/2019 8

Dilation and Effacement 9/12/

Fetal Head 9/12/

Fetal attitude Fetal lie 9/12/

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Passage Engagement Station Fetal position 9/12/

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Psychosocial considerations Mental and physical preparation for childbirth Sociocultural values Previous experience Support Emotional status 9/12/

Admission to Labor Suite History Contractions When they last ate Vital signs Ultrasound Examination 9/12/

Membranes Rupture 600 to 800 cc Color Odor Consistency Nitrazine Paper 9/12/

Leopold’s Maneuvers 9/12/

External fetal monitoring Two belts Uterine contractions Fetal heart monitoring benefits negatives 9/12/

Internal fetal monitoring 9/12/

Fetal heart variability 9/12/

Early decelerations Head compressions 9/12/

Late decelerations Uteroplacental insufficiency 9/12/

Variable decelerations Cord Compression 9/12/

Maternal Responses to labor Cardio, B/P Respiratory Renal, GI Immune/blood Pain causes 9/12/

Cardinal movements Descent Flexion Internal rotation Extension Restitution External rotation Expulsion 9/12/

Fetus moving through the Pelvis

Placental delivery Contraction Globular uterus Cord lengthens Rush of vaginal blood 9/12/

Causes of Pain in Labor Stage One Stretching of the cervix during dilation & effacement Uterine Anoxia Stretching of the uterine ligaments

Causes of Pain in Labor Stage Two Stage Two Distention of the vagina and Perineum Compression of the nerve ganglia in cervix & lower uterus Pressure on urethra, bladder, rectum during fetal descent Traction on and stretching of the perineum

Factors affecting Mothers Response to Pain in Labor Preparation - Knowledge and confidence gained through childbirth classes Cultural influences on expression of pain Maternal fatigue, anxiety, sleep deprivation Previous experiences with pain Support

Methods of Pain Relief Nonpharmacological Childbirth methods Breathing Techniques Relaxation Techniques Touch Focusing attention on one object Effleurage

Breathing Methods Basic principles Comfortable position Chest breathing Focal point Verbal and non-verbal cues Cleansing breath Rhythmic chest Shallow chest Pant-blow Exhalation pushing 9/12/

Non-Pharmacological Sensory Stimulation Listening to music; subdued lighting Imagery Applying heat and cold Massage (lower back); Counterpressure TENS Position Changes

Pain Management Narcotic Analgesics Timing Effect on labor Common meds used Stadol Nubain 9/12/

Pain Relief in Labor Criteria for administering an analgesic: Needs to be in active phase of labor If give in latent phase – it may slow labor If give in transition phase – can lead to neonatal respiratory depression

Regional Anesthesia Epidural Spinal Pudendal Side effects Hypotension Bladder distention 9/12/

Nursing Care related to an epidural Preparation Assess platelet count – must be normal Empty bladder Assess vital signs for baseline IV fluids Following Assess V/S – especially the B/P because the main side effect is hypotension Rotate position between right and left side-lying Assess bladder and catheterize as needed Assess for other side effects and intervene

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