Prof.Carole A. Devine RN.MSN. 1

The Process of Birth

Prof.Carole A. Devine RN.MSN. 2

Assessment And Responsibilities During Labor and BirthGoal of Care: To provide for a safe

labor and birth of a healthy baby and to promote maternal comfort in the process…..

1. Comfort Measures: 2. Physical Needs: 3. When to call the Physician Responsibilities of the

Attendants at the Birth

Prof.Carole A. Devine RN.MSN. 3

Immediate Care of the Newborn

Assessments: Vital Signs /Color of Infant Apgar Scores Check Cord Assess Infant Weight Assess U/A and G.I. Systems

Prof.Carole A. Devine RN.MSN. 4

Assessments (Cont.)

Protect against infection

Identification of Infant

Prevent hypothermia

Promote parental attachment

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Managing the Pain of Labor and Delivery

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Labor Pain-Introduction Historical Perspective

Management Strategies:

1.Non- Pharmaceutical Measures 2. Pharmaceutical Choices

The Challenge to Nurses!

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What Exactly is Labor

Pain ????

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Factors Affecting The Factors Affecting The Woman in LaborWoman in Labor1.Parity& Age2.Racial/Cultural3.Coping

Strategies4.Relaxation

Measures5.Emotional/

Attitude6.Knowledge base

7.Confidence level8.Support Systems9. Environment10.Fatigue/length

of labor11.N/V & Diarrhea12. Maternal &

Fetal Positions13.Pain Level

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Non-Pharmacologic Methods of Pain Relief

Hydrotherapy Application of heat

/cold Acupressure Imagery/Visualization Effleurage Comfort Measures Distraction Breathing

Techniques

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Pharmacological Methods of Pain Relief

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Goal of Administering Systemic Medication:

Three Factors to be Considered in the use of Systemic Medication

1.Effect on The Mother

2. Effect on the Fetus

3. Effect on Labor contractions

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Analgesia/Anesthesia

Analgesics: (Opioids,Tranquilizers &Sedatives) Common Ones: Demerol Stadol Nubain Fentanyl Morphine

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Demerol (Meperidine) Action: Usual dose: Pros : Cons: Maternal Cons: Neonatal

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Stadol (Butorphanal) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

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Nubain (Nalbuphine) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

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Fentanyl (Sublimaze) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

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Morphine (Duromorph) Usual dose: Action: Pros : Cons: Maternal Cons: Neonatal

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Nursing Considerations with Opioids:

Opioid Antagonist NALOXONE (Narcan) Reverses opioid induced

Resp.Depression Dose: Neonate: 0.01mg/Kg IV,IM

or SC q 2-3min. Mother: 0.1-0.2mg IVQ 2-3min Have Crash Cart Handy!!!!

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Anesthesia 1. Local Infiltration:

2.Regional:

Pudendal Block

Epidural Block Goal Procedure Complications 1. Maternal

2 .Neonatal

Nursing Considerations

Advantages vs Disadvantages

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Spinal Block (Subarachnoid)

Intrathecal)

Goal Procedure Pros: Complications: Nursing

Responsibilities/Considerations

General Anesthesia

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Fetal Response to Labor Intrapartal Fetal Assessment:

Electric Fetal Monitor ( EFM) Purpose Factors that Impact Fetal Oxygenation

1. Maternal Bld. O2 Saturation 2. Normal flow of oxygenated bld. thru the Placenta3. Normal Utero-Placental exchange4. Patent umbilical cord vessels (AVA)5. Normal Fetal circulation and oxygen-carrying

function

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Types of Intrapartal Fetal Assessments 1. Low -Tech Approach 2. EFM a. Equipment: 1. External ( Indirect)Uses two Transducers: Pressure and

ultrasound 2. Internal (Direct )Uses a Fetal Scalp Electrode

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Evaluating Fetal Monitoring Strips Fetal Heart Rate: Baseline Tachycardia Causes: Bradycardia Causes: Variability Presence of Periodic Changes: Accelerations? Decelerations?

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Decelerations/Types: Early,Late or VariableEarly

Decelerations: Characteristics: Pattern: Cause: Rx:

Late Decelerations: Characteristics: Pattern: Cause: Rx:

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Variable Decelerations: Characteristics: Pattern: Cause Treatment: AN OMINOUS SIGN- LATE DECELERATION and

DECREASED VARIABILITY OF FETAL HEART RATE!!!!

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Significance of Fetal Heart Patterns:”Reasssuring”vs. “Non-Reassuring” Reassuring Patterns of FHR 1. Show signs of fetal well being 2. Fetus is compensating Non-Reassuring Patterns of FHR 1. Associated with Hypoxia and

Acidosis 2. Suggest some level of Fetal

compromise !

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THE END

GOOD LUCK To All Of YOU !!!!!