Passenger Passageway Powers Position Psychologic response.
Transcript of Passenger Passageway Powers Position Psychologic response.
Labor and the Birth Process
The 5 “Ps” of labor
Passenger Passageway Powers Position Psychologic response
Passenger’s Head
Presentation of the Passenger
What is the fetal presentation?› Cephalic (96%)› Breech (3%)› Shoulder (1%)
Fetal lie
Fetal Attitude
Position of the Passenger
Station & Engagement
Passageway
Passageway Continued
Powers-Primary
We really do not know what causes the primary powers
ContractionFrequency,Duration, andIntensityResult in Effacement and Dilatation
Secondary Powers
Positioning
Pelvic muscles/ligaments
A bit of humor found
http://www.youtube.com/watch?v=ppzV6hoPkIc
Pain Management in Labor
Pain Perception & Expression
Pain thresholds are similar in everyone, the perception of pain is not.
Pain is expressed SensoryEmotionallyPhysiologically
How Does Labor Effect Pain
Pain experienced by mother can result in :› Acidosis of the
fetus › Impaired Uterine
Contraction
Non-Pharmacologic Strategies Position changes
› Walking › Rocking› Labor ball
Breathing› May need to breath
with mother Counter-pressure Application of heat
or cold Showering/Tub
Music Aromatherapy Imagery Focal points Effleurage Therapeutic touch Childbirth Education Hypnosis Biofeedback Empty Bladder
regularly
Pharmacologic
Goal maximum relief with minimal risk to mother and fetus
Pain Control Depends:
Epidural Spinal/Epidural
Nerve Block Local Pudendal Spinal Epidural Combined
Spinal/Epidural(CSE)
Analgesics 1st Stage
Systemic analgesia IM vs IV Narcotics Opioid agonist
› Demerol, Fentanyl, Morphine Opioid agonist-antagonist
› Stadol, Nubain, Narcan Epidural
Naloxone (Narcan)
Opiate antagonist Works immediately-may need to be repeated Used to counteract respiratory depression-
Neonatal dose available at every delivery Adult dose: 0.4-2mg IVP Neonatal dose: 0-1mg/kg of 0.4mg/ml
concentration Do not give to patient with narcotic
dependency-triggers immediate withdrawal and possible seizures
Labor Nerve Block MedsMethod Effects Criteria Care
Local-Lido /Polocaine used with epi
Numbs perineum
Episiotomy or repair of laceration
Normal perineal care
Puedendal Numbs lower vaginal/vulva/perineal area
Epis or vacuum delivery anticipated
May need more direction in pushing
Spinal T-6 to feet C-Section Uterine displacement, VS monitored
Epidural Numbs from T10-S5
Labor /C-section Monitoring line, VS, Positioning of pt
Intrathecals 1.5-3 hours Multip who is progessing fast
Same as Epi/Spinal
Pain Pathway
Epidural Coverage
General Anesthesia
Only used in an emergency prior to infant delivery, if patient has contraindications to a Spinal /Epidural,or demands to be put to sleep.
Kahn Academy
Fetal Circulation
Maternal position Uterine Contractions Blood Pressure Umbilical Blood Flow
Fetal Assessment
Continuously or intermittently
Fetal Monitor Tracing
Monitor placement and Lie
Intrauterine Pressure Catheter-IUPC
IUPC use Montevideo Units (MVU)
› Subtract baseline pressure from peak pressure for each contraction in a 10 min period. 100-250 is optimal
Fetal Heart Rate
Normal FHR Baseline110-160› 10 minute segment with no significant
periodic changes or change in baseline of >25 BPM
Variability› Absent› Minimal› Moderate› Marked (pg 421)
Fetal Heart Rate Tachycardia >160
› Can be early sign of fetal hypoxia› Maternal or fetal infection› Maternal hyperthyroidism or fetal anemia› Response to some drugs-cocaine, Meth,
terbutaline, Vistaril Bradycardia <110
› Heart Block› Viral infections such as CMV
Periodic & Episodic Changes
Periodic-with contractions Episodic-occur without contractions Acceleration 15 x 15 above baseline Deceleration
› Early› Late› Variable
What type of deceleration?
What type of deceleration?
What type of deceleration would this cause
True knot in cord
Variable deceleration
Management of FHR tracing
Basic interventions› Oxygen› Reposition› IV fluid bolus
Specific problem› Correct the problem› If can not…..DELIVER BY CESAREAN
Categories of FHR tracings
Category I-normal Category II-requires interventions and
close monitoring Category III-Deliver
Category I
Normal FHR:110-160 FHRV: Moderate (6-25beats) Accelerations or Early Decelerations: Absent or
present Late or Variable Decelerations: Absent
Category III
FHRV: Absent + Recurrent late decelerations FHRV: Absent + Recurrent variable
decelerations FHRV: Absent + Bradycardia Sinusoidal
Category II
Bradycardia without absent FHRV Tachycardia FHRV: Minimal or Marked FHRV: Absent without recurrent decels Absent accelerations after induced fetal stimulation
(this is only diagnostic-not intervention) Recurrent variable decel + FHRV: Min or moderate Prolonged decel > 2min but <10 min Recurrent late decel + FHRV: Moderate Variable decel with other characteristics: Slow
return to baseline, overshoots, or shoulders
Category II Example
Review
Review
Review
Review
Remember the Psychosocial
Labor is anxiety provoking Is the baby going to be ok? Was this pregnancy planned? Does the patient have adequate
support both at home and in labor? Will she have help at home when goes
home with infant?
Questions