LABOR & DELIVERYLABOR & DELIVERY

DEFINITION OF TERMSDEFINITION OF TERMS

LABOR - is the process of moving the fetus, placenta and membranes out of the uterus and through the birth canal. Synonymous with childbirth and parturition.

Delivery – is the actual birth of baby

TRUE LABOR FALSE LABOR

CONTRACTION

Regular increasing frequency, duration & intensityShortening of interval

IrregularNo change in frequency, duration & intensity

DISCOMFORT

Radiates from back around the abdomen

Pain at abdomen

REST /ACTIVITY

Contraction does not decrease with rest or activity/ walking

Contraction may lessen with activity or rest

CERVIX

Progressive effacement and dilatation of cervix

Cervical changes does not occur yet

pening cervical OS - Dilatation

oftening of the cervix

Escent of fetus into pelvic inlet - Lightening

ontraction of uterus that are progressive & regular

upture of BOW

ffacement – progressive thinning & shortening of cervix

pprehension

Ucus plug expulsion – bloody show

A. First Stage A. First Stage

- Stage of dilatation- Begins with true labor pain and

ends with complete dilatation of the cervix

PHASES DILITATION DURATION/INTERVAL

INTENSITY

LATENT 0-3 CM 10-30 sec, 5-30 mins.

Mild to moderate

ACTIVE 4-7 CM 30-40 sec.3-5 mins

Moderate to strong

TRANSITION 8-10 CM 45-90 sec.2-3 min

Strong

Duration – from the beginning of one contraction to the end of same contraction(A-B)Interval – from the end of one contraction to the beginning of the next contraction (B-C)Frequency – from the beginning of contraction to the beginning of next contraction (A-C)Intensity – strengths of contraction

Nursing CareNursing Care

A. Hospital admission – provides privacy and reassurance from the very start.Personal data – name, age, address, civil statusObstetrical data – determine EDC, obstetrical score, amount & character of SHOW, whether BOW have ruptured or not

2. General physical 2. General physical examination, internal exam examination, internal exam and leopold’s are done to and leopold’s are done to determine:determine:EFFACEMENT AND DILATATION

STATIONPRESENTATIONPRESENTING PARTPOSITION

3. Monitoring and evaluating 3. Monitoring and evaluating Uterine contractionBlood PressureFetal Heart Rate

4. Emotional Support is 4. Emotional Support is providedprovided

5. Health teachings5. Health teachings

B. Second StageB. Second Stage

Stage of ExpulsionBegin with complete dilatation of

the cervix and ends delivery of babyContractions change from the

characteristic crescendo-decrescendo pattern to overwhelming uncontrollable urge to push or bear down with each contraction as if to move her bowels

Woman perspire and the blood vessels in her neck may become distended

Crowning takes placeThe need to push become

intense and the woman cannot stop herself

6 Cardinal Movements of the 6 Cardinal Movements of the Mechanism of labor ED FIRE Mechanism of labor ED FIRE EREEREEngagement – presenting fetal part

at station or below

Descent – downward movement of the biparietal diameter of the fetal head to within the pelvic inlet◦full descent occurs and the fetal head

extrudes beyond the dilated cervix and touches the posterior vaginal floor

Flexion – the head bends forward onto the chest, making the smallest anteroposterior diameter

Internal Rotation – the occiput rotates until it is superior, or just below the symphysis pubis, bringing the head into the best relationship to the outlet of the pelvis

Extension – as the occiput is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head, the face and chin are born.

External Rotation – almost immediately after the head of the infant is born, the head rotates (from the anteroposterior position it assumed to enter the outlet) back to the diagonal or transverse position of the early part of labor

Expulsion – the rest of the baby is born easily and smoothly because of its smaller part size. The end of the pelvic division of labor.

Nursing Care:Nursing Care:

Put both legs at the same time when positioning to the lithotomy position

Instruct mother to push as fetal head crowns. If hyperventilation occurs, let patient breathe into a brown paper or a cupped hand.

C. Stage 3 C. Stage 3   Placental Stage – begins from the

delivery of the baby up to the delivery of the placenta

2 Phases:

a. Placental SeparationSigns:◦Lengthening of the cord◦Sudden gush of blood◦Change of shape of the uterus

 

Types of Placental Types of Placental PresentationPresentation

Schultze’s – appearing shiny and glittering from the fetal membranes

Duncan – it looks raw, dirty, meaty, red and irregular(maternal surface)

b. Placental Expulsion- Brandt Andrew’s Maneuver – tract the cord slowly, winding it around the clamp until placenta spontaneously comes out rotating it slowly so that no membranes are left

Nursing Care:Nursing Care:Don’t hurry the expulsion of the

placenta, just watch for the signs of placental separation

Take note of the time of placental delivery

Inspect for the completeness of the placenta

Palpate the uterus to determine degree of contraction. If relaxed, massage gently and apply ice cap

Inspect for lacerations

Stage 4Stage 4(Puerperium Stage)– first 4 hours after delivery of placenta Degrees of Perineal Lacerations:

1. First Degree – skin and superficial to muscle

2. Second Degree – muscles of the perineum

3. Third Degree – continues to anal sphincter

4. Fourth Degree – involves the anterior anal wall

Episiotomy – incision made to the perineum to enlarge the vaginal opening for easy delivery

Types:a. Midline/Medianb. Mediolateralc. Lateral

Advantages:

1. Enlarging of the vaginal opening2. Shortening of the second stage

of labor3. Minimizing the stretching of the

perineal muscle 4. Preventing perineal tearing

POST PARTUM POST PARTUM ASSESSMENTASSESSMENT