NURSING CARE OF A FAMILY DURING LABOR AND BIRTH (10/19/17)

LABOR – series of events by which uterine contractions and abdominal pressure expel a fetus and
placenta from a woman’s body

DILATATION – enlargement or widening of the cervical canal

THEORIES OF LABOR ONSET:

 UTERINE MUSCLE STRETCHING – release of prostaglandins
 PRESSURE ON THE CERVIX – stimulates release of oxytocin from the posterior pituitary
 OXYTOCIN STIMULATION – with prostaglandins to initiate contraction
 CHANGE IN THE RATIO OF ESTROGEN TO PROGESTERONE
 PLACENTAL AGE – triggers contractions at a set point
 RISING FETAL CORTISOL LEVEL - progesterone prostaglandin
 FETAL MEMBRANE PRODUCTION OF PROSTAGLANDIN – initiate contraction

SIGNS OF LABOR
PRELIMINARY SIGNS OF LABOR:
 LIGHTENING
 descend of the fetal presenting part into the pelvis
 10-14 days before labor begins
 Gives a woman relief from the diaphragmatic pressure and shortness of breath
 Primipara: occurs early because of tight abdominal muscles
 Multipara: occurs on the day of labor or even after labor has begun
 As the fetus sinks lower into the pelvis = shooting leg pains
= pressure sciatic nerve
= vaginal discharge
= urinary frequency
 FETAL DESCEND – changes a woman’s abdominal contour
- positions the uterus lower and more anterior in the abdomen
 LEVEL OF ACTIVITY
 Epinephrine , progesterone
 Prepares a woman’s body for the work of labor ahead
 SLIGHT LOSS OF WEIGHT
 progesterone = body fluid is excreted more easily
 1-3 pound loss
 BRAXTON HICKS CONTRACTION
 May experience this in the last week or days before labor begins
 RIPENING OF CERVIX
 Internal sign seen only on pelvic examination
 Internal announcement that labor is very close at hand
 GOODELL’S SIGN: throughout pregnancy, the cervix feels softer than normal to
palpation. At term, the cervix becomes still softer (“butter-coft”)

SIGNS OF TRUE LABOR – involve uterine and cervical changes

 UTERINE CONTRACTION
 Surest sign that labor labor has begun
 Helping a woman appreciate that she can predict when her next one will occur and
therefore can control the degree of discomfort she feels by using breathing exercise
offers her a sense of well-being.
 LABOR WATCH
1. VS every 2 or 4 hours
2. FHT
3. MONITOR THE CONTRACTIONS
 INTENSITY – subjective; scale of 1-10
 FREQUENCY – beginning of contraction A to end of contraction B
 DURATION - beginning to end of contraction A
 INTERVAL – end of contraction A to start of contraction B
 No IE, if there is active bleeding
- Indicative of placenta previa
- Massive bleeding which can lead to death
  SHOW OR BLOODY SHOW
 Operculum or the mucus plug is expelled
 RUPTURE OF THE MEMBRANES
 Sudden gush or as scanty, slow seeping of clear fluid from the vagina.
 Two risks:
1. INTRAUTERINE INFECTION
2. PROLAPSE OF THE UMBILICAL CORD (cut off O2 supply to the fetus)
 If labor has not spontaneously occurred by 24 hours after membrane rupture and
the pregnancy is at term, labor will be induced to help reduce these risks
 PRM or PREMATURE RUPTURE OF MEMBRANCE
- Let the client lie on right side
- Don’t let her walk = prolapsed of umbilical cord
- Inject oxytocin to induce labor if:
o no uterine contraction yet
o amniotic fluid is released
After an hour because 1. Check FHT ( FHT = compromised blood flow to the fetus)
infection takes time 2. Check temperature of the mother = intrauterine contraction

FALSE CONTRACTIONS TRUE CONTRACTIONS

Begin and remain irregular
Felt first abdominally and remain confined to the
abdomen and groin
Often disappear with ambulation or sleep
Do not increase in duration, frequency, or intensity
Do not achieve cervical dilation
Begin irregularly but become regular and
predictable
Felt first in lower back and sweep around to the
abdomen in a wave
Continue no matter what the woman’s level of
activity
Increase in duration, frequency, and intensity
Achieve cervical dilation

COMPONENTS OF LABOR
 PASSAGE
 route a fetus must travel from the uterus through the cervix and vagina to the external
perineum. And pelvic ring.
 Two pelvic measurements:
1. DIAGONAL CONJUGATE (anteroposterior diameter of the inlet)
2. TRANSVERSE DIAMETER OF THE OUTLET
 PELVIS GYNECOID – most ideal to childbirth
 CPD or CEPHALOPELVIC DISPROPORTION – disproportion between fetus and pelvis
 PASSENGER - Fetus
 STRUCTURE OF FETAL SKULL
 CRANIUM - uppermost portion of the skull; composed of 8 bones
 4 SUPERIOR BONES : (important in childbirth)
 FRONTAL
 2 PARIETAL
 OCCIPITAL
 4 other bones of the skull (little significance in child birth; never the presenting part)
 SPHENOID
 ETHMOID
 2 TEMPORAL
 MENTUM – chin
 SUTURE LINES - membranous interspaces allow cranial bones to move and overlap
- Molding or diminishing the size of the skull so that it can pass through the birth canal

 SAGITTAL SUTURE – joins 2 parietal bones

 CORONAL SUTURE – joins frontal bones and 2 parietal bones
 LAMBOID SUTURE – joins occipital bone and 2 parietal bones
 FONTANELLES – @ the junction of the main suture lines
- Depressed fontanel & sunken eyeball = dehydration
(children 2yrsold below)
 ANTERIOR FONTANELLE OR BREGMA
- junction of the coronal and sagittal suture
- shaped
- closes at 12 – 18 months of age
- anteroposterior diameter 3 -4 cm
 - transverse diameter 2 -3 cm
 POSTERIOR FONTANELLE
- junction of the lamboid and sagittal suture
- shaped
- Smaller than anterior fontanelle
- Closes at 2 months of age
- About 2cm across its widest part
 VERTEX – space between the 2 fontanelles
 SINCIPUT – area over the frontal bone
 OCCIPUT - area over the occipital bone
 CAPUT SUCCEDANEUM – edema of the scalp at the presenting part of the head
due to the pressure of the birth canal
 CSF = hydrocephalus – big head in children
=Persistent headache in adult

 DIAMETERS OF FETAL SKULL

 SUBOCCIPITOBREGMATIC DIAMETER (good attitude)
- most ideal
- narrowest; approx. 9.5cm
- from the inferior aspect of the occiput to the center of the anterior
fontanelle
 OCCIPITOFRONTAL DIAMETER (moderate attitude or “military position”)
- approx. 12 cm
- from occipital prominence to the bridge of the nose
 OCCIPITOMENTAL DIAMETER or BROW (poor attitude/ partial extention)
- approx. 13.5cm
- widest anteroposterior diameter
- from the posterior fontanelle to the chin
 ANTEROPOSTERIOR DIAMETER OF PELVIS - 9.5 -12.5cm
- Narrowest diameter at the pelvic inlet
 ENGAGEMENT – settling of the fetal head into the pelvis
 MOLDING
– change in the shape of the fetal skull produced by the force of uterine contractions
pressing the vertex of the head against the not-yet-dilated cervix
-last for only a day or two after birth
-No skull molding when a fetus is breech
 FETAL PRESENTATION AND POSITION
 ATTITUDE – degree of flexion a fetus assumes during labor or the relation of the
fetal parts to each other
 COMPLETE FLEXION (good attitude)
- Spinal column is bowed forward
- Head is flexed forward so much that the chin touches the sternum
- Arms are flexed and folded on the chest
- Thighs are flexed onto the abdomen
- Calves are pressed against the posterior aspect of the thighs
- Advantageous for birth because:
o Helps a fetus present the smallest anteroposterior diameter of the
skull to the pelvis
o Puts the whole body into an ovoid shape, occupying the smallest
space possible

 MODERATE FELXION (“millitary position”)

- Chin is not touching the chest
- Causes the next widest anteroposterior diameter
 PARTIAL EXTENTION
- Presents the brow of the head to the birth canal
- Olihydramnios = complete extenstion
-reflect a neurologic abnormality = spasticity
- “dipping” – one that is descending but has not yet reached the ischial
spines
- “floating” – a presenting that is not engaged
 STATION – relationship of the presenting part of a fetus to the level of ischial spines
stations Indications
-3 Floating
-2 (presenting part is above
-1 the spines)
0 Engaged
+1 Crowning
+2 (presenting part is @ the
perineum & can be seen if
+3
the vulva is separated)

 FETAL LIE – relationship between the long axis of the fetal and a woman’s body
 HORIZONTAL or TRANVERSE POSITION
 VERTICAL or LONGITUDINAL POSITION
- breech or cephalic
 FETAL PRESENTATION – denotes body part that will first contact the cervix
 1. CEPHALIC PRESENTATION - occur as often as 95%
Type Lie Attitude Description
Head is sharply flexed
VERTEX Longitudinal Good (full flexion) Most common presentation
Allows suboccipitobregmatic
diameter to present to the
cervix
BROW Longitudinal Moderate (military) Brow or sinciput is the
presenting part
FACE Longitudinal Poor Face is the presenting part
Xtreme edema and distortion
of the face may occur
MENTUM Longitudinal Very Poor Complete hyperextension of
head to present the chin
Fetus cannot enter the pelvis

 2. BREECH PRESENTATION –either buttocks or feet occur 3% of births

Type Lie Attitude Description
Thighs tightly flexed
COMPLETE Longitudinal Good (full on the abdomen
flexion) both buttocks and
tightly flexed feet
presentto the cervix
FRANK Longitudinal Moderate Hips are flexed
(military) Knees are extended to
the rest on the chest
Buttocks present on
cervix
FOOTLING Longitudinal Poor Neither thighs nor
o Single-footling lower legs are flexed
o Double-footling

 3. SHOULDER PRESENTATION – about 1%

- In a transverse lie, a fetus lies horizontally in the pelvis so that the
longest fetal axis is perpendicular to that of the mother
- Causes:
o Relaxed abdominal walls
o Pelvic contraction
o Placenta previa
 FETAL POSITION
–relationship of the presenting part to a specific quadrant of woman’s
pelvis
- How to determine?
1. Combined abdominal inspection and palpation
(leopold’s maneuver)
2. Vaginal examination
3. Auscultation of FHT
4. Ultrasound
- 4 quadrants of maternal pelvis:
right anterior, left anterior,
right posterior, right posterior
- 4 parts of fetus as landmarks to describe the relationship of the
presenting part to one of the pelvic quadrants:
Vertex presentation – occiput
Face presentation – chin
Breech presentation - sacrum
Shoulder presentation – scapula or acromion process
POSSIBLE FETAL POSITION
Vertex Presentation (occiput)
LOA Left occipitoanterior
LOP Left occipitoposterior
LOT Left occipitotransverse
ROA Right occipitoanterior
ROP Right occipitoposterior
ROT Right occipitotransverse
Breech Presentation (sacrum)
LSaA Left sacroanterior
LSaP Left sacroposterior
LSaT Left sacrotransverse
RSaA Right sacroanterior
RSaP Right sacroposterior
RSaT Right sacrotransverse
Face Presentation (mentum)
LMA Left mentoanterior
LMP Left mentoposterior
LMT Left mentotransverse
RMA Right mentoanterior
RMP Right mentoposterior
RMT Right mentotransverse
Shoulder presentation (acromion process)
LAA Left scapuloanterior
LAP Left scapuloposterior
RAA Right scapuloanterior
RAP Right scapuloposterior

 CARDINAL MOVEMENTS
 DESCEND
- Downward movement of the biparietal diameter of the fetal head
to within the pelvic inlet
 FLEXION
- Fetal head bends forward onto the chest, making the smallest
anteroposterior diameter present to the birth canal
 INTERNAL ROTATION
- Occiput rotates to bring the head into the best relationship to the
outlet of the pelvis.
- This movement brings the shoulders, coming next, into the optimal
position to enter the inlet, putting the widest diameter of the
shoulders in line with the wide transverse diameter of the inlet
 EXTENSION
- The head extends, and the foremost parts of the head, the face and
chin are born
-
  EXTERNAL ROTATION
- After the head of the infant is born, the head rotates back to the
diagonal or transverse position of the early part of the labor
 EXPULSION
- Once the shoulders are born, the rest of the baby is born easily ad
smoothly
 POWER OF LABOR – the force supplied by the fundus of the uterus
 UTERINE CONTRACTIONS
 ORIGINS – “PACEMAKER” POINT LOCATED IN THE UTERINE MYOMETRIUM
NEAR ONE OF THE UTEROTUBAL JUNCTIONS
 PHASES :
o INCREMENT - intensity of contraction increases
o ACME – contraction is strongest
o DECREMENT – intensity decreases
 Between contractions, uterus relaxes
 As labor progresses, relaxation from 10 mins 2-3 mins
Duration of contractions 20-30 secs 60-90 secs
 CONTOUR CHANGES

UTERUS upper portion: thicker and active

(KUNUHAY. HAHA)

boundary: PHYSIOLOGIC RETRACTION RING

lower portion: thin walled, supple, passive

 PATHOLOGIC RETRACTION RING or BANDL’S RING

- A danger sign that signifies impending rupture of the lower uterine
segment if the obstruction to labor is not relieved
 CERVICAL CHANGES
 EFFACEMENT
- Shortening and thinning of cervical canal
Normal : 1-2cm long
 DILATION
- Enlargement or widening of the cervical canal from an opening a
few millimeters wide to one large enough (approx. 10cm) to permit
passage of a fetus
- Reasons:
1. uterine contraction gradually increase the diameter of the
cervical canal lumen by pulling the cervix up over the presenting
part of the fetus
2. fluid filled membranes press against the cervix

P R I E D - PRImipara Effacement Dilation

M U D E – MUltipara Dilation Effacement

 PSYCHOLOGICAL OUTLOOK – psychological state or feelings that a woman brings into labor
 Woman who manage best in labor are those who have string sense of self
esteem and a meaningful support person with them
 Women without adequate support can have a experience so frightening and
stressful they can develop a posttraumatic stress syndrome

STAGES OF LABOR
 1ST STAGE – from initiation of true labor contraction to full cervix dilation
 2ND STAGE – from full dilation until infant is born
 3RD STAGE (placental stage)– from infant is born to delivery of placenta
 4TH STAGE – first 4 hours after placenta is delivered

STAGES HAPPENINGS
Begin: at onset of regularly perceived uterine contractions
End: rapid cervical dilation begins
Contractions: 20-40 seconds
 Cervical dilation: 0-3cm
ST
1 LATENT Multipara: lasts for 4.5hours
Nullipara: lasts for 6 hours
Cervical effacement occurs.
No analgesia (bc it can prolong this phase).
If prolonged, indicative of CPD.
Allow her to be active and give alternativemethods of pain
relief such as distractions

ACTIVE Contractions: 40-60 seconds every 3-5 minutes that grow

4-7cm strong, last longer and begin to cause true discomfort
Multipara: lasts for 2 hours
Nullipara: lasts for 3 hours
Show and spontaneous rupture of membranes occur
Encourage her to remain active
TRANSITION Contractions 60-90 seconds every 2-3 minutes (peak)
8-10cm Cervical dilation: 8-10cm (maximum)
Full dilation (10cm)
Complete cervical effacement
Feeling of loss of contral, anxiety, panic or irritability
With nausea and vomiting
Begin: full dilation and cervical effacement
End: birth of infant
2ND (PELVIC STAGE) w/o complications, this takes only an hour
crowning will occur
All her energy, thoughts, being are directed toward giving birth
Blood vessels in her neck may become distended
Begin: birth of infant
End: delivery of the placenta
3RD 5mins after birth of infant, placenta will follow
Uterus is in discoid shape
Normal blood loss: 300-500mL
Signs:
 Lengthening of the umbilical cord
 Sudden gush of vaginal blood
 Change in shape of the uterus
 Firm contraction of the uterus
Placental separation  Appearance of the placenta at the vaginal opening

o SCHULTZE PRESENTATION (“shiny”)

–appearing shiny and glistening from the fetal membranes
-if the placenta separates frist at its centerand last at its
edges, it tends to fold onto itself like an umbrella and
presents at the vaginal opening with fetal surface evident
-approx 80%of placenta separate and present this way

o DUNCAN PRESENTATION (“dirty”)

-looks raw, red, & irregular, with the ridges or cotelydons
that separate blood collection spaces showing
-if placenta separates first at its edges, it slides along the
uterine surface and presents at the vagina with the
maternal surface evident

Placental expulsion 2 ways:

o Natural bringing-down effort of the mother
o Crede’s maneuver, exerting gentle pressure on the
contracted uterine fundus
4TH First 4 hours after placenta is delivered
MATERNAL AND FETAL RESPONSES TO LABOR
 PHYSIOLOGIC EFFECTS OF LABOR ON A WOMAN
o CARDIOVASCULAR SYSTEM
 CARDIAC OUTPUT
- By as much as 40% to 50% above prelabor level caused by the work of
pushing during labor
- About 80% above prelabor level during sending a a heavy bolus of
blood to the heart
- PERIPHERAL RESISTANCE, SYSTOLIC DIASTOLIC
 BLOOD PRESSURE
- Cardiac output = systolic blood pressure average of 15mmHg each
contraction
- Hypotension when woman lies in a supine position and pushes during
the 2nd stage of labor because the pressure of the uterus on the vena
cava causes her blood pressure to drop
o HEMAPOIETIC SYSTEM
- Normal WBC count 5,000 – 10,000 cells/mm3
- At end of labor, average WBC count 25,000 – 30,000 cells/mm3
- Leukocytosis – sharp of WBC as a result of stress and heavy exertion
-the major change in the blood-forming system that occurs during labor
o RESPIRATORY SYSTEM
- cardiovascular parameters = respiratory rat
- Total O2 consumption by 100%
o TEMPERATURE REGULATION
- muscular activity = temperature by 1®F
o FLUID BALANCE
- Insensible H2O loss = diaphoresis and rate and depth of respiration
o URINARY SYSTEM
- Specific gravity 1.020 – 1.030
- Presence of PROTEIN in urine trace to 1+
- Full bladder can impede fetus and inhibit full and effective uterine contraction
o MUSCULOSKELETAL SYSTEM
- During pregnancy relaxin acted to soften the cartilage bewee bones
- Week before labor, considerable additional softening causes the symphysis
pubis and sacral/coccyx joints to be more relaxed and movable, allowing them
to stretch apart to size of pelvic ring
o GASTROINTESTINAL SYSTEM
- Fairly inactive due to the shunting of blood to more life sustaining organs and
pressure on the stomach and intestines from the contracting uterus

o NEUROLOGIC AND SENSORY RESPONSES

- Pain is registered at uterine and cervical nerve plexus (@ 11 th and 12th thoracic
nerves)
- At the moment of birth, perineal pain is registered at S2 and S4 nerves

What causes pain?

1. Uterine anoxia
2. Compression of nerve ganglia
3. Stretching of cervix
4. Contraction and displacement of perineum
5. Pressure in the uterus & bladder
6. Distention of lower uterine segment

 PSYCHOLOGICAL RESPONSES OF A WOMAN TO LABOR

o FATIGUE -Generally tired from burden of carrying so much extra weight
o FEAR

 PHYSIOLOGIC EFFECTS OF LABOR ON A WOMAN

o NEUROLOGIC SYSTEM
- intracranial pressure due to pressure from uterine contractions
 - FHR by 5bpm
o CARDIOVASCULAR SYSTEM
- intracranial pressure = keep circulation from falling below normal
o INTEGUMENTARY SYSTEM
- The pressure involved in the birth process is often reflected in minimal
petechiae or ecchymotic areas on a fetus
o MUSCULOSKELETAL SYSTEM
- The force of uterine contravtions tends to push a fetus into a position of full
flexion, the most advantageous position for birth
o RESPIRATORY SYSTEM
- The process of labor appears to aid in the maturation of SURFACTANT
production by alveoli in the fetal lung

DANGER SIGNS OF LABOR

 MATERNAL DANGER SIGNS
o HIGH OR LOW BLOOD PRESSURE
- Report these:
 Systolic pressure> 140mmHg
 Diastolic pressure> 90mmHg
 Systolic pressure > 30mmHg The basic criteria for
pregnancy induced
 Diastolic pressure > 15mmHg hypertension

o ABNORMAL PULSE
- Normal pulse rate 70 -80 bpm
- Maternal pulse rate >100bpm indication of hemorrhage should be reported
o INADEQUATE OR PROLONGED CONTRACTIONS
- Uterine Exhaustion if uterine contraction is less frequent, less intense or shorter
in duration
- Uterine contraction >70seconds should be reported because this may
compromise fetal well-being by interfering w/ adequate artery filling
o PATHOLOGIC RETRACTION RING
- An indentation across a woman’s abdomen, where the upper and lower
segments of the uterus join, may be sign of extreme uterine stress and
impending uterine rupture
o ABNORMAL LOWER ABDOMINAL CONTOUR
- If a woman has a full bladder during labor, a round bulge on her lower anterior
abdomen may appear
-danger signals for two reasons:
 Bladder may be injured
 May not allow fetal head to descend
- Every 2 hours women should void during labor to avoid full bladder
o INCREASING APPREHENSION
- A sign of O2 deprivation or internal hemorrhage

 FETAL DANGER SIGNS

o HIGH OR LOW FETAL HEART RATE
- Possible sign of fetal distress:
 FETAL TACHYCARDIA : FHR > 160bpm
 FETAL BRADYCARDIA : FHR < 110bpm
o MECONIUM STAINING
- A green color amniotic fluid
- Indicative of HYPOXIA = stimulates vagal reflex = bowel motility
- Normal in breech presentation
o HYPERACTIVITY
- a sign of HYPOXIA because FRANTIC MOTION is a common reaction to the need
of O2
o OXYGEN SATURATION
- Normal : 40 – 70%
 - FETAL ACIDOSIS
 Blood pH < 7.2
 O2 saturation (under 40%)

MATERNAL AND FETAL ASSESSMENT DURING LABOR

 IMMEDIATE ASSESSMENT OF A WOMAN IN STAGE 1
o Initial interview & Physical examination
 DETAILED ASSESSMENT DURING THE 1ST STAGE OF LABOR
o HISTORY
- Current pregnancy history
- Past pregnancy history
- Past health history
- Family medical history
o PHYSICAL EXAMINATION
o ABDOMINAL ASSESSMENT
o LEOPOLD’S MANEUVER – a systematic method of observation and palpation to
determine fetal position and presentation
o RUPTURE OF MEMBRANES
- NITRAZINE PAPER TEST to test if the fluid is an amniotic fluid or urine
- Vaginal secretion – acidic
- Amniotic fluid – alkalinic
- YELLOW-STAINED FLUID indicative of BLOOD INCOMPATIBILITY between mother
and fetus
- GREEN FLUID indicate MECONIUM STAINING
- FETAL ANOXIA if there’s meconium staining in a vertex presentation
o VAGINAL EXAMINATION
- Necessary to determine the extent of cervical effacement and dilation and to
confirm the fetal presentation, position, and degree of descent
- May be done between contractions or during contractions
- No vaginal examination if there’s a presence of fresh bleeding
-indicative of placenta previa
o ASSESSMENT OF PELVIC ADEQUACY
- Important to know if it has cephalopelvic disproportion
o ULTRASOUND
- Used at term to determine the diameters of the fetal skull, presentation,
presenting part, position, flexion & degree of descent of a fetus
o VITAL SIGNS
- TEMPERATURE
 Obtained every 4hours
 >37.2®C (99®F) indicative of infection & should be reported
 Every 2 hours check temperature after rupture of membrane
- PULSE AND RESPIRATION
 Obtained every 4hours
 Normal pulse rate at range of 70 -80bpm
 Pulse rate >100bpm indicative of tachycardia from dehydration &
hemorrhage
 Normal Respiratory rate 18 -20 breaths per minute
 Rebreathing into a paper bag to stop prolonged hyperventilation which
causes dizziness and tingling of hands and feet
- BLOOD PRESSURE
 Obtained every 4hours
 BP tend to rise 5 – 15 mmHg during labor
 BP = pregnancy0induced hypertension
 BP or Pulse pressure = hemorrhage
 Check BP every 15 minutes after administration of analgesic to a
hypotensive mother to see if extreme hypotension is not occurring

oLABORATORY ANALYSIS
- BLOOD
- URINE
CARE OF A WOMAN DURING 1ST STAGE OF LABOR
 o 6 MAJOR CONCEPTS TO MAKE LABOR & BIRTH AS NATURAL AS POSSIBLE:
1. Labor should begin on its own, not be artificially induced
2. Women should be able to move about freely throughout labor, not confined in
bed.
3. Women should receive continuous support during labor
4. No interventions such as IV fluid should be used routinely
5. Women should be allowed to assume a nonsupine
6. Mother and baby should be together after the birth, with unlimited opportunity
for breastfeeding
o RESPECT CONTRACTION TIME
o PROMOTE CHANGE POSITION
o PROMOTE VOIDING AND PROVIDE BLADDER CARE
- Voiding every 2 – 4 hours
- Catherization using a small straight catheter no.12F-14F inserted between
contractions
o RESPECT AND PROMOTE THE SUPPORT PERSONS
o SUPPORT A WOMAN’S PAIN MANAGEMENT NEEDS
o AMNIOTOMY – artificial rupturing of membranes
- Can be done if the cervix has dilated at least 3cm
- In dorsal recumbent position

CARE OF A WOMAN DURING 2nd STAGE OF LABOR

o PREPARING THE PLACE OF BIRTH
o POSITIONING FOR BIRTH
o PROMOTING EFFECTIVE 2ND STAGE PUSHING
o PERINEAL CLEANING
o EPISIOTOMY
- A surgical incision of the perineum that is made both to prevent tearing of the
perineum and to release pressure onto the fetal head with birth
- Mediolateral episiotomy (right of the mother)– less danger of complication
from rectal
- Midline episiotomy 6 hours after birth baby should be bathe
o BIRTH
o CUTTING AND CLAPPING CORD 90 minutes baby should be placed above the chest of
- About 2cm the mother “UNANG YAKAP”. Skin to skin contact but
o INTRODUCING THE INFANT baby has a bonnet to prevent hypothermia
RD TH
CARE OF A WOMAN DURING THE 3 AND 4 STAGE
o PLACENTA DELIVERY
o OXYTOCIN
o PERINEAL REPAIR
o IMMEDIATE POSTPARTUM ASSESSMENT AND NURSING CARE
o AFTERCARE
UNIQUE CONCERNS OF A WOMAN IN LABOR
o A WOMAN W/O A SUPPORT SYSTEM
o A WOMAN WHO WILL BE PLACING HER BABY FOR ADOPTION
o VAGINAL BIRTH AFTER CESAREAN BIRTH