Republic of the Philippines

CAVITE STATE UNIVERSITY

Don Severino de las Alas Campus
Indang, Cavite

COLLEGE OF NURSING

INTRAPARTAL CARE
NURS 08

K.L. RINT
C. LINTAO
P.B.ROMEN
G.L.N-CAMAYANG
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PREFACE

The World Health Organization (WHO) has designated 2020 as the “International Year
of the Nurse and the Midwife,” in honor of the 200th anniversary of Florence Nightingale’s birth
(WHO, 2020). The many roles of the nurses are exemplified especially now during this
pandemic season. However, one of the vital responsibilities of a nurse in the nursing discipline
is to focus on the care for child bearing and childrearing families. In order to have healthy
adults and children.
Promoting the health of the childbearing woman is a significant consideration to produce
healthy children. Ensuring the health of children from birth to adulthood will yield positive
result. More forth, highlighting both preconceptual and prenatal care are essential
contributions to the health of a woman and fetus and to a family’s emotional preparation for
childbearing and childrearing.
As children mature and grow, consistent health supervision and support for the family is
needed. As children reach maturity and plan for their own families, a new cycle is expected to
begin and new type of support becomes necessary. The nurse’s role in all these phases
focuses on promoting healthy growth and development of the child and family in health and in
illness. Although the field of nursing typically divides its concerns for families during
childbearing and childrearing into two separate entities, maternity care and child health care,
the full scope of nursing practice in this area is not two separate entities, but one: maternal
and child health nursing.
This module is designed to provide an overview and discuss the standards and
philosophies of maternal-child health care and how these standards and philosophies affect
care.

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ABOUT THE AUTHOR

GLAIZALYN NOVEN0-
CAMAYANG,
MAN,RN,RM

Background

Contact
 Instructor I for 3 years at Cavite
State University under the College Cavite State University
of Nursing. Indang Cavite, Philippines, 4122
 Teaches both nursing/ midwifery
subjects like Maternal and Child
Nursing, Pharmacology and
Clinical Practicum. glaizalyn.camayang@cvsu.edu.ph
 Former Staff Nurse-Midwife for 9 rgcariacourtney@gmail.com
years at Gen. Emilio Aguinaldo
Memorial Hospital (GEAMH)

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TABLE OF CONTENTS
Page
Cover Page……………………………………………………………………………………… 1
Title page………………………………………………………………………………………… 2
Preface…………………………………………………………………………………………… 3
About the author………………………………………………………………………………… 4
Table of contents………………………………………………………………………………... 5
Learning Outcomes……………………………………………………………………………... 6
Objectives………………………………………………………………………………………... 6
Methods/Instructional Technique……………………………………………………………… 6
Materials………………………………………………………………………………………….. 6
Module Instruction………………………………………………………………………………. 6
Pre-Test………………………………………………………………………………………….. 7
Topic 1. Measuring Progress of Labor……………………………………………………. 9
Topic 2. Maternal and Fetal Danger Signs of Labor…………………………………….. 15
Partograph …………………………………………………………………………………. 15
Topic 3. Maternal and Fetal Assessment During Labor………………………………… 17
Topic 4. Managing Labor Pain ……………………………………………………………… 18
Activity I…………………………………………………………………………………….. 21
Post Test…………………………………………………………………………………………. 22
Assignment………………………………………………………………………………………. 24
Key to corrections……………………………………………………………………………….. 24
Glossary………………………………………………………………………………………… 25
Suggested links………………………………………………………………………………….. 26
References………………………………………………………………………………………. 26

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Learning Outcomes:
After mastering the contents of this module, the student will be able to:
1. Understand the process of labor and delivery.
2. Gain knowledge and understanding regarding intrapartum care to mother and fetus.
3. Assess accurately the maternal and fetal condition during labor.
4. Identify nursing action and consideration in every step during labor and delivery.

Objectives:
This module aims to discuss the standards and philosophical underpinnings of maternal and
child health care. With the help of this module the students are expected to:
1. To demonstrate the principles of good care in caring of the woman in labor and
delivery.
2. To identify the steps in providing intrapartal care.
3. To be knowledgeable in handling clients during labor and delivery.
4. To describe factors influencing labor and delivery.

Methods/Instructional Technique
Interactive lecture discussion
Oral Questioning
Listening
Reflective journal and analysis
Self-Evaluation
Supply Type of Test

Materials
Open educational resources
Printed copy/ soft copy of handout
Book reference
Power point presentation
LMS Platform

Module Instruction: This module will serve as supplemental learning material to Second Year
Nursing students of Cavite State University enrolled in NURS 08. Use this as a guide during
interactive online discussion as well as when complying with assigned requirements and
activities.

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Mind Memos: Pre-test

Read the questions carefully. Read the options and pick the one that you believe is the
BEST answers. Write the answer before the number. No erasures please! GOODLUCK!!!

1. In assessing pregnant client during labor, partograph is very important. When assessing
the (AF) amniotic fluid, you put a remark “M”, which of the following explains your
observation?
A. The mother must be transferred immediately because she is showing signs of
ruptured uterus
B. That the FHR must be taken immediately because it is a sign of imminent delivery
C. It signifies that the fetus is in distressed and needs to be delivered in a CEMONC
facility
D. The fetus is in danger of asphyxia or stillbirth
2. A client is admitted to the labor and delivery unit complaining of vaginal bleeding with very
little discomfort. What should be the RN’s first action to consider?
A. Assess fetal heart tones
B. Check for cervical dilatation
C. Check for firmness of the uterus
D. Obtained detail history
3. If the mother upon admission at 9am, her cervix is 6cm dilated. When is she expected to
deliver?
A. 1am of the same day
B. 1pm of the same day
C. 3pm of the next day
D. 3pm of the following day
4. These are the interventions the RN can perform once the partograph shows the cervix
(‘X’) moves to the right side of the graph and passes the alert line.
1. Rehydrate the mother thru IVF
2. Empty the bladder
3. Ask the mother to move around
4. Alert transport services
A. 1, 2 & 3
B. 2, 3,& 4
C. 1, 3,& 4
D. 1, 2,& 3
5. A woman in your clinic suddenly has her bag ruptured. She is 35 weeks pregnant. What
would be your management?
1. Put her on left side-lying position ASAP
2. Elevate her buttocks and prepare for transport
3. Take the FHR to check distress
4. Allow her to be on strict bedrest
A. 1 & 2
B. 2 & 3
C. 3 & 4
D. 1 & 4
6. When the woman presents the following signs: Fever- 39 C, foul smelling vaginal
discharge, ruptured of membranes at less than 8 months AOG, How will the RN consider the
following assessment?
A. a vaginal infection
B. possible STD
C. endometritis
D. strong likelihood of uterine and fetal infection

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7. At the Labor room, you notice that one of you client experiencing prolonged labor. Upon
assessment, the FHT ranges 170bpm and sometimes 180bpm and you conclude that it is
fetal distress. As a nurse, what will you do first?
A. Take the BP of the mother
B. Apply oxygen cannula
C. position the mother on left lateral
D. refer to physician
8. Which among the following are purpose of vaginal examination?
1. determine if the BOW is intact
2. to evaluate capacity of the pelvis
3. to determine station of the presenting part
4. to determine the age of the fetus thru the size of the fetal head
A. 1,2,3 B. 2,3,4 C. 1,2,4 D. 4 only
9. When the RN identify fetal distress, the following measures are indicated:
1. Change maternal position from lying on her back to lying on her left side
2. Give oxygen by inhalation
3. Correct hypotension by infusing intravenous fluid
4. Record the findings in the partograph and closely monitor the fetus and
mother 5. Bring the client to the hospital
A. 1,2,3,5 are incorrect
B. 1,2,3,4 are correct
C. 1,2,3,5 are correct
D. 1,2,3,5 are unnecessary
10. A woman is in active labor. She is now telling the RN to relieve her pain. The RN tries
non-
pharmacological methods that include:
1. Change of position
2. Ask companion to massage the woman’s back and hold the woman’s hand.
3. Give Meperdine HCI or Nalbuphine per order.
4. Encourage deep breathing techniques.
A. 1 & 2
B. 2 & 3
C. 3 & 4
D. All Except 3

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MODULE V-B
INTRAPARTAL CARE

TOPIC 1:

MEASURING PROGRESS OF LABOR

The purpose of monitoring the progress of labor is to recognize incipient problems, so
that their progression to serious problems may be prevented. Prolonged labor can lead to
adverse outcomes for both mother and baby, including maternal exhaustion, perinatal
asphyxia, and even death.
INITIAL EVALUATION IN LABOR AND DELIVERY
The clinician’s initial evaluation and documentation in Labor and Delivery shall include, at a
minimum:
 reviewing the patient’s prior pregnancy(s)
 reviewing and summarizing the antenatal course;
 physical exam (including an estimated fetal weight);
 evaluation of status of labor, including a description of uterine activity, cervical dilation
and effacement, and fetal station and presentation, unless vaginal exam deferred;
 evaluation of fetal status, including interpretation of auscultation or electronic fetal
monitoring strips, if generated; and
 the plan for delivery.
First Stage of Labor After Initial Evaluation
Fetal heart rate (and variability—if electronically monitored) should be evaluated and
recorded at least every 15–30 minutes, depending on the risk status of the patient, during the
active phase of labor). The FHR should be evaluated as soon as is feasible after spontaneous
rupture, or immediately after artificial rupture of the membranes.
Continuous fetal heart rate monitoring should be done for patients with any of these indicators:

 history of an abnormal antepartum FHR or rhythm,

 breech presentation,
 history of prior cesarean delivery,
 multiple gestation,
 nonreassuring fetal assessment,
 significant maternal illness,
 use of oxytocin,
 abnormality of active or second stage labor,
 thick meconium, or
 heavy vaginal bleeding.
Evaluation During First Stage Labor
The patient shall be evaluated by the responsible clinician or designee during labor at
appropriate intervals. Each evaluation should include:

 assessment of maternal status;

 description of uterine activity;
 assessment of fetal status;

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 description of findings on vaginal exam, if performed, including cervical dilation and

effacement, fetal station, change in status of membranes, and progress since last
exam;
 summary of maternal and fetal status; and
 plan, including plans for or performance of clinical interventions and pain management.
Each evaluation should be recorded in the medical record.
Evaluation During Second Stage Labor
The monitoring clinician should document in the medical record at the time of
identification of second stage, after two hours of second stage, and hourly thereafter. This
documentation, which should be dated and timed, should include, at a minimum:

 assessment of maternal status;

 assessment of fetal status;
 description of uterine activity;
 fetal station and, if known, position; and
 assessment of progression and a plan for delivery.

A partograph is a tool used to monitor labor

and prevent prolonged and obstructed labor
focusing on observations related to maternal,
fetal condition and labor progress.
It is a graphical presentation of the progress of
labour, and of fetal and maternal condition
during labour. It is the best tool to help you
detect whether labour is progressing normally or
abnormally, and to warn you as soon as
possible if there are signs of fetal distress or if
the mother’s vital signs deviate from the normal
range.
Objectives:
 Early detection of abnormal progress of labor.
 Prevention of prolonged labor.
 Recognize cephalopelvic disproportion long before obstructed labor.
 Assist in early detection on transfer, augmentation, or termination of labor.
 Increase the quality and regularity of all observation of mother and fetus.
 Early recognition of maternal or fetal problems.
 Highly effective in reducing complications from prolonged labor of mother
(postpartum hemorrhage, sepsis, uterine rupture and its sequelae) and for the
newborn (death, anoxia, infections, etc).
 Reduce incidence of CS rate.
 Facilitates handover procedure.

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COMPONENTS:
Part I: Patient Identification Part III: Progress of Labor
Part II. Fetal Condition Part IV: Maternal Condition
Part I: Patient Identification
 Name
 Gravida
 Para
 Hospital Number
 Date and Time of Admission
 Time of ruptured membranes
PART II. Fetal Condition
Monitor and assess fetal condition
◦ 1. Fetal Heart Rate
◦ 2. Liquor
◦ 3. Moulding the fetal skull bones
FETAL HEART RATE:
 Monitor every 30 mins in latent phase
 Every 15mins in active phase
nd
 Every 5mins in 2 stage of labor
 Mark it with an (X) & join the lines
Fetal Heart Rate 120-160 beats/min (normal)
 > 160 beats / min = tachycardia (increase)
 < 110 beats / min = bradycardia (decrease)
 < 100 beats / min = severe bradycard
MEMBRANES AND LIQUOR
Intact membranes……………………………………………I
Ruptured membranes + clear liquor………………………C
Ruptured membranes + meconium- stained liquor……...M
Ruptured membranes + blood –stained liquor…………...B
Ruptured membranes + stained liquor ……………………A

MOULDING THE FETAL SKULL BONES

Moulding is an important indication on how adequately the pelvis can accommodate

the fetal head.

Increasing moulding with the head high in the pelvis is an ominous sign of
cephalopelvic disproportion.

Separated bones, sutures felt easily ………………. O

Bones just touching each other …………………….. +

Overlapping bones (reducible) ……………………….++

Severely overlapping bones (nonreducible) ……. …+++

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Part III: Progress of Labor

 Cervical dilatation
 Descent of fetal head
 Uterine contractions
 Fetal position
o This section of the partograph has its central feature a graph with a vertical
scale on the left, number in the ascending order from 0-10 (Cervical dilatation
in cms).
o In same vertical scale- descent of the fetal head as assess by abdominal
examination.
o At the right in the descending order denotes the station of the fetal presenting
part.
o Horizontal scale represents hours spent in labor
o Points are entered as a cross (x) for cervical dilatation & station by dot (●)
o Each observation is joined to the preceding one by a straight line.
o The “S” shaped dilatational curve is divided into a latent phase and an active
phase
LATENT PHASE:
 It starts form onset of labor until the cervix reaches 3cm dilatation
 Once 4cm dilatation is reached, labor enters the active phase
 At least 2/10 min contractions.
 Each lasting > 20 secs.
ACTIVE PHASE:
 Contractions at least 3/ 10 mins
 Each lasting > 40 secs
 The cervix should dilate at rate of 1cm / hour or faster

ALERT LINE (PINK)

o The alert line drawn from 4cm
dilatation represents the rate of
dilatation of 1cm/ hour.
o In a normal labor, cervical should be
either on the alert line or to the left of
it.
o Moving to the right of the alert line
means it falls on zone 2, it is
abnormal & needs to be critically
assessed.
Part IV: Maternal Condition

Assess maternal condition regularly by monitoring:

o Oxytocin
o Drugs
o Pulse- every 15 mins
o Blood pressure

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o Temperature
o Urine volume, analysis for protein and acetone

 Latent phase is less than 8 hours

 Progress in active phase remains on or to the left of the alert line.
 Do not augment with oxytocin if latent and active phase go normally.
Between alert & action lines
 In health center, the women must be transferred to a hospital with facilities for CS,
unless the cervix is almost fully dilated.
 Observe labor progress for short period before transfer.
 Continue routine observations.
At or beyond action line
 Conduct full medical assessment
 Consider intravenous infusion/ bladder catheterization/ analgesia
 Options
◦ Delivery by CS if fetal distress or obstructed labor.
◦ Augment with oxytocin by IV infusion if there is no contraindications

Factors or causes of prolonged labor

PROLONGED LATENT PHASE
 It is prolonged when its duration exceeds 20 hours in Primi & 14 hours in Multi
 According to WHO partograph, a latent phase is “Cervix not dilated beyond 4cmsafter
8 hours from admission & with any changes in cervical effacement or dilatation”.
PROLONGED ACTIVE PHASE
 In active phase of labor, plotting of cervical dilatation will normally remain on or to the
left of the alert line.
 Moves to the right of the alert line warns that labor maybe prolonged.
 Happens if the rate of cervical dilatation in active phase of labor is less than 1 cm/ hour
for a minimum of 4 hours.
 At action line, the woman must be carefully re assessed for why labor is not
progressing and a decision made on further management.
PROLONGED DECELERATION PHASE
 Deceleration phase exceeds 3 hours for nulliparas & 1 hour for multiparas
SECONDARY ARREST OF CERVICAL DILATATION
 When the cervical dilatation commences normally but stops or slows significantly for
2 hours or more prior to full dilatation of cervix
SECONDARY ARREST OF HEAD DESCENT
 Abnormal progress of labor may occur with normal progress of descent of the fetal
head then followed by secondary arrest of descent of fetal head.

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POINTS TO REMEMBER!!!
 It is important to realize that the partograph tool for managing labor progress only.
 The partograph does notnhelp to identify other risk factors that may have been before
started.
 Only start a partograph when you have checked that there are no complications of
pregnancy that requires immediate action.
 A partograph chart must only be started when a woman is in labor- be sure that she is
contracting enough to start a partograph
 If progress of labor is satisfactory, the plotting of cervical dilatation will remain at or to
the left of the alert line
 When labor progress well, the dilatation should not move to the right of the alert line.

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TOPIC 2:
MATERNAL AND FETAL DANGER SIGNS OF LABOR

Most women, including women with disabilities, give birth safely. But when
something goes wrong during labor and birth, it is very important for a woman to get the
care she needs to save her life.
 Waters break but labor does not start within 24 hours
Go to a health center or hospital. When the waters have broken, the risk is much
higher to the mother or to the baby could get a serious infection. It may need to
get fluids or medicines in the vein (intravenous, IV).
 Baby lying sideways
Go to a hospital. Do not try to change the position of the baby once labor has
started. This can tear the womb or separate the placenta from the womb wall. A
baby lying sideways cannot be born without an operation.
 Bleeding before the baby is born
Go to the hospital right away. If there is bleeding bright red blood, it could mean
the placenta is separating from the womb wall or is covering the opening of the
womb. This is very dangerous.
 Fever
Fever is usually a sign of infection. If fever is not very strong, it may just need fluids.
Drink plenty of water, tea, or juice, and try to pass urine every few hours.
If fever is very high and with chills, go to a health center or hospital. It may need
antibiotic medicines right away.
 Too long labor
Go to a health center or hospital. When labor lasts longer than 1 day and 1 night, or if
pushing hard for more than 2 hours, it may need medicines or an operation for the
baby to be born.
 Green or brown waters
If it is still early labor, or if the mother has not started pushing, it is best for this
baby to be born in a hospital. When the bag of water breaks, the water should be
clear or a little pink. Brown or green waters mean the baby has probably passed
stool inside the womb and could be in trouble.
If the mother is far along in her labor and the baby is going to be born soon, have the
mother push as hard as she can and get the baby out quickly. As soon as the baby’s head is
out, and before it takes its first breath, ask the mother to stop pushing. Wipe the baby’s
mouth and nose with a finger wrapped in a clean cloth, or use a suction bulb to suck out the
mucus. Once the nose and mouth have been cleaned out, the mother can push the rest of
the baby’s body out.
 Pre-Eclampsia (Toxemia of Pregnancy)
Pre-eclampsia can lead to seizures and even death. If the mother has any of these
danger signs, go to a hospital right away:
 strong headache
 blurred or double vision
 sudden, steady severe pain at the top of the belly, just below the high
point between the ribs
 overactive reflexes
 high blood pressure
 protein in the urine

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Fetal distress is an emergency pregnancy, labor, and delivery complication in which a

baby experiences oxygen deprivation (birth asphyxia). This may include changes in the baby’s
heart rate (as seen on a fetal heart rate monitor), decreased fetal movement, and meconium
in the amniotic fluid, among other signs. Medical professionals must immediately address and
manage fetal distress to avoid serious complications, such as hypoxic-ischemic
encephalopathy (HIE), cerebral palsy (CP), and other birth injuries. Expectant mothers aren’t
always with their physician when signs of fetal distress occur, so it is important to know the
following signs that indicate a baby is in trouble. Often, the only way to stop fetal distress is to
deliver a baby, allowing doctors and nurses to administer medical care. This is usually
accomplished by C-section delivery.

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TOPIC 3:

MATERNAL AND FETAL ASSESSMENTS DURING LABOR

EVALUATION DURING FIRST STAGE LABOR

The patient shall be evaluated by the responsible nurse, midwife or ob-gyne during
labor at appropriate intervals.
Each evaluation should include:
 assessment of maternal status;
 description of uterine activity;
 assessment of fetal status;
 description of findings on vaginal exam, if performed, including cervical dilation
and effacement, fetal station, change in status of membranes, and progress
since last exam;
 summary of maternal and fetal status; and
 plan, including plans for or performance of clinical interventions and pain
management. Each evaluation should be recorded in the medical record.

EVALUATION DURING SECOND STAGE LABOR

The monitoring clinician should document in the medical record at the time of
identification of second stage, after two hours of second stage, and hourly thereafter.
This documentation, which should be dated and timed, should include, at a minimum:
 assessment of maternal status;
 assessment of fetal status;
 description of uterine activity;
 fetal station and, if known, position; and
 assessment of progression and a plan for delivery.

Fetal heart rate should be evaluated and recorded at least every 5–15 minutes,
depending on the risk status of the patient
No later than the end of the second hour of the second stage of labor, and every hour
thereafter, the attending physician or midwife should personally evaluate the patient and
document in the medical record the minimum as noted above. Additionally, the providers
involved (which may include the attending physician, resident, nurse midwife, RN, and/or
charge nurse) shall discuss the patient’s progress and plan of care at each hourly interval. By
the end of the third hour of the second stage of labor, the attending obstetrician should
personally evaluate and examine the patient, immediately document details of this evaluation,
and be involved in continued planning.

DELIVERY
If a patient is moved to another room for delivery, fetal monitoring should be
established in that room unless delivery is reasonably expected to occur imminently. For
patients about to undergo cesarean delivery, monitoring should continue as is feasible until
abdominal preparation for surgery is begun.

AFTER DELIVERY
Following delivery, the clinician must record in the medical record all the events relating
to the delivery in a reasonable period of time after the patient’s needs have been fully attended
to, using forms, notation, and/or dictation as appropriate to the case. The clinician should be
readily available to return to the unit until the immediate (30 minute) postpartum period is
complete and the patient is stable.

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TOPIC 4:

MANAGING LABOR PAIN

What are pain relief options during labor?

An epidural block (sometimes referred to as “an epidural”) is the most common type
of pain relief used for childbirth in the United States. In an epidural block, medication is given
through a tube placed in the lower back. For labor and vaginal delivery, a combination of
analgesics and anesthetics may be used.
MEDICAL PAIN RELIEF OPTIONS FOR CHILDBIRTH
The three main medical pain-relieving options for labor include:
 Nitrous oxide
 Pethidine
 Epidural anesthesia.
Nitrous oxide
Nitrous oxide, known as ‘laughing gas’, is mixed with oxygen and administered to the
mother through a face mask or a tube held in the mouth. The gas takes a few seconds to work,
so it is important to breathe from the mask as soon as a contraction starts.
Nitrous oxide doesn’t stop the pain entirely, but takes the ‘edge’ off the intensity of
each contraction. Many women prefer nitrous oxide because it allows them direct control, the
mother can hold the mask herself and take deep breaths whenever she feel the need.
Possible problems with using nitrous oxide include:
 Nausea and vomiting
 Confusion and disorientation
 Claustrophobic sensations from the face mask
 Lack of pain relief – in some cases, nitrous oxide doesn’t offer any pain relief at all (this
applies to around one-third of women).
Pethidine
Pethidine is a strong pain reliever (related to morphine and heroin), usually injected
directly into a muscle in the buttock. It may also be administered intravenously (directly into a
vein). Depending on various factors, the effect of pethidine can last anywhere from two to four
hours.
Possible problems with pethidine for the mother include:
 Giddiness and nausea
 Disorientation and altered perception
 Respiratory depression (reduced breathing)
 Lack of pain relief, in some cases.
Possible problems with pethidine for the baby include:
 The unborn baby is exposed to the drug via the umbilical cord and may experience
respiratory depression at birth, particularly if several doses are given or the baby
delivers soon after a pethidine injection. This effect can be reversed by an injection
given to the baby.

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 The baby’s sucking reflex may also be depressed, as well as other normal reflexes.
Debate persists over the effects of pethidine on newborns.
Epidural anesthesia
Epidural injections are the most effective pain relief available. They are used for vaginal
births and also for caesarean sections, because they allow the mother to stay awake and alert
during the baby’s birth.
Anesthetic is injected into the lining of the spinal cord through the back, which makes
the mother feel numb from the waist down.
Possible side effects and complications of epidural anesthesia include:
 The anesthesia may not be complete and you may still experience some pain. This
may require the procedure to be repeated.
 After the epidural has been inserted, your blood pressure may drop, causing you to
feel faint and nauseated. This may also cause stress to your baby. This is treated by
giving intravenous fluid.
 An epidural often causes some muscle weakness in the legs, so women who have had
an epidural anesthetic may be confined to bed.
 The lack of sensation in the lower body means that you will not be able to tell when
you need to urinate. A urinary catheter will be inserted in most cases.
 Epidurals can lengthen the second stage of labor.
 The likelihood of having a normal vaginal delivery is reduced.
 If you are unable to push effectively, due to altered sensation and reduced muscle
strength, the baby may have to be delivered by forceps or vacuum cup.
 Around one per cent of women experience headache immediately following the
procedure.
 Some women experience itchiness after having an epidural. This can usually be
effectively treated using antihistamines.
 Some women experience pain or tenderness where the epidural was injected.
 Around one in 550 women experience ongoing patches of numbness on the back near
the injection site.
 Very rare complications include infection, blood clots and difficulty breathing.
NON-MEDICAL PAIN RELIEF
Active birth
Staying active is one of the most helpful things you can do to manage the pain of labor
and birth. Moving freely and rocking your pelvis can help you to cope with the contractions.
Massage and heat
Massage and hot packs can ease your pain in labor. Massage helps distract you from
the pain. Heat packs can help your body release its natural painkillers — endorphins.
Water immersion
Most hospitals and birthing centers will have facilities that allow to have a bath or
shower during the first stage of labor.
Many women find that being in a warm bath is relaxing and helps them to cope with
the contractions. Having a shower can help with any back pain you might be experiencing.

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Having a bath or shower to ease pain during labor is not the same as having a water
birth. Not all hospitals are equipped for water birth. Midwife and doctor need to be specially
trained and they need to be able to get out quickly if there is a problem with the birth.
Relaxation
There are different relaxation techniques to ease pain. Some people like music, some
like meditation, some like incense. Generally, relaxation techniques help ease pain in labor.
Just check that the hospital or birth center can cope with your plans.
Aromatherapy
Essential oils are used with massage or heated over a burner. There is no evidence
aromatherapy provides pain relief, but some women find it pleasant. If they thinking of using
aromatherapy, check that your hospital or birth center allow it.
Acupuncture
Acupuncture can reduce pain in labor and reduce the need to use forceps. It is not
clear how it works. There are no known side effects of acupuncture for mother or baby.
Only a trained person should perform acupuncture. Not all hospitals have an
acupuncture therapist on staff. They need to discuss arranging your own practitioner.
TENS
A TENS machine uses two electrodes stuck in the skin. They are usually attached to
the lower back. The machine sends a small electric current through the body. It is generally
safe for mother and baby.
While there is no harm is using a TENS machine, there is not a lot of evidence to show
TENS works to reduce pain, but some women find it helpful.
A TENS machine is not suitable for everyone. People with a pacemaker should not
use one, and the use of TENS before 37 weeks’ gestation should be avoided.
Sterile water injections
Sterile water with no medicine in it can be injected under the skin of your lower back
to deal with lower back pain.It may sting but there are no side effects for mother or baby.
Some women have found these injections helpful. It is not clear how they work, or
whether they work very often. You may still need other pain relief.

Things to remember!!!
 Childbirth is usually a painful experience.
 There is a range of options for pain relief in labor including non-medical techniques
and medical pain relief options such as nitrous oxide, pethidine and epidural
anesthesia.
 Particularly if you are having your first baby, consider all options and be flexible.
 If you planned to give birth without using pain relief, but find the labor pains are
overwhelming, don’t be reluctant to ask the doctor, nurse or midwife for pain relief.

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Activity I

Espie is a 30-year old G3 P2 (2002) who arrives at your lying-in at 12 midnight.

• Vital signs: BP- 120/80 mmHg, PR-90/min, T- 37.0°C., FHT-130/min.
• IE cervix is 6 cm. dilated. Uterine contractions are strong and patient is bearing down
involuntarily.
• Repeat IE at 3 am, cervix is fully dilated.
• Patient delivers after 15 mins. Oxytocin is given within 1 min of the baby’s birth. The placenta is
delivered 5 mins after birth of baby.

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Mind Memos: Post-test

Read the questions carefully. Read the options and pick the one that you believe is the
BEST answers. Write the answers before the number. No erasures please!
GOODLUCK!!!

1. At the Labor room, you notice that one of you client experiencing prolonged labor. Upon
assessment, the FHT ranges 170bpm and sometimes 180bpm and you conclude that it is
fetal distress. As a nurse, what will you do first?
A. Take the BP of the mother
B. Apply oxygen cannula
C. position the mother on left lateral
D. refer to physician
2. Which among the following are purpose of vaginal examination?
1. determine if the BOW is intact
2. to evaluate capacity of the pelvis
3. to determine station of the presenting part
4. to determine the age of the fetus thru the size of the fetal head
A. 1,2,3 B. 2,3,4 C. 1,2,4 D. 4 only
3. These are the interventions the RN can perform once the partograph shows the cervix
(‘X’) moves to the right side of the graph and passes the alert line.
1. Rehydrate the mother thru IVF
2. Empty the bladder
3. Ask the mother to move around
4. Alert transport services
A. 1, 2 & 3
B. 2, 3,& 4
C. 1, 3,& 4
D. 1, 2,& 3
4. A woman in your clinic suddenly has her bag ruptured. She is 35 weeks pregnant. What
would be your management?
1. Put her on left side-lying position ASAP
2. Elevate her buttocks and prepare for transport
3. Take the FHR to check distress
4. Allow her to be on strict bedrest
A. 1 & 2
B. 2 & 3
C. 3 & 4
D. 1 & 4
5. In assessing pregnant client during labor, partograph is very important. When assessing
the (AF) amniotic fluid, you put a remark “M”, which of the following explains your
observation?
A. The mother must be transferred immediately because she is showing signs of
ruptured uterus
B. That the FHR must be taken immediately because it is a sign of imminent delivery
C. It signifies that the fetus is in distressed and needs to be delivered in a CEMONC
facility
D. The fetus is in danger of asphyxia or stillbirth
6. A client is admitted to the labor and delivery unit complaining of vaginal bleeding with very
little discomfort. What should be the RN’s first action to consider?
A. Assess fetal heart tones
B. Check for cervical dilatation
C. Check for firmness of the uterus
D. Obtained detail history

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7. When the RN identify fetal distress, the following measures are indicated:
1. Change maternal position from lying on her back to lying on her left side
2. Give oxygen by inhalation
3. Correct hypotension by infusing intravenous fluid
4. Record the findings in the partograph and closely monitor the fetus and
mother 5. Bring the client to the hospital
A. 1,2,3,5 are incorrect
B. 1,2,3,4 are correct
C. 1,2,3,5 are correct
D. 1,2,3,5 are unnecessary
8. A woman is in active labor. She is now telling the RN to relieve her pain. The RN tries
non-pharmacological methods that include:
1. Change of position
2. Ask companion to massage the woman’s back and hold the woman’s hand.
3. Give Meperdine HCI or Nalbuphine per order.
4. Encourage deep breathing techniques.
A. 1 & 2
B. 2 & 3
C. 3 & 4
D. All Except 3
9. If the mother upon admission at 9am, her cervix is 6cm dilated. When is she expected to
deliver?
A. 1am of the same day
B. 1pm of the same day
C. 3pm of the next day
D. 3pm of the following day
10. When the woman presents the following signs: Fever- 39 C, foul smelling vaginal
discharge, ruptured of membranes at less than 8 months AOG, How will the RN consider the
following assessment?
A. a vaginal infection
B. possible STD
C. endometritis
D. strong likelihood of uterine and fetal infection

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Assignment : ESSAY 1 Reading Assignment:

Explain the importance of using partograph in every

 Physiologic and psychological
client during labor and delivery.
changes of the postpartal
(Not more than 300 words) period.
 Development of parental
(50 points, Deadline should be Every Monday)
attachment, bonding, and
positive family relationship
 Nursing care of a mother and
family during first 24 hours after
birth
 Nursing care plan of postpartal
More More More Reading….
discharge Instructions

Please do advance reading on the next topic =)

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Glossary:

Antenatal-before birth; prenatal.

Puerperium the period of about six weeks after childbirth during which the mother's
reproductive organs return to their original non pregnant condition.

Chadwick’s sign (darkening of the cervix, vagina, and vulva).

Goodell’s sign (softening of the vaginal portion of the cervix).

Hegar’s sign (softening of the uterus isthmus).

Areola is the pinkish-brown skin surrounding your nipple. The areola usually gets darker early
in pregnancy.

Colostrum is a fluid rich with protein and antibodies made by the breasts during pregnancy. It is
the pre-milk substance that your newborn needs for nourishment during the first few days after
birth.

Birth plan is a written document that describes what you would like to happen during labor and
delivery. It includes your preferences about pain medication, breastfeeding, the delivery setting,
and who you want present at the birth.

Breech means the baby's buttocks (complete breech) or feet (footling breech) are pointing to the
birth canal. Normally, the baby moves so its head is down near the birth canal for delivery.

Cesarean (C-section) is the surgical delivery of a baby through an incision in the

lower abdomen and uterus.

Normal Spontaneous Vaginal Delivery, expulsion of the baby through vagina.

Full term is the beginning of week 39 to the end of week 40 of pregnancy. A baby born during this
time is full term.

High-risk pregnancy is when you or your baby are at increased risk of a health problem. For
example, if you have high blood pressure or are pregnant with more than one baby, you are a
high-risk pregnancy.

Kegels are exercises you do to strengthen the muscles that surround the vaginal opening. This
helps prevent leaking urine.

Linea negra is the line from the belly button to the pubic hair. Pregnancy hormones often cause
this line to become darker.

Mask of pregnancy is a common skin change during pregnancy in which the skin gets darker
around the eyes, nose, and cheeks. Also called chloasma or melasma, it usually fades after a
baby is born.

Viable means the baby has reached the stage of development that it can survive outside the
womb.

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Suggested links:

http://downloads.lww.com/wolterskluwer_vitalstream_com/samplecontent/9780781777766_Pillitt
eri/samples/Chapter01.pdf

https://www.undp.org › corporate › brochure › SDGs_Booklet_Web_En

http://www.medicotips.com/.../types-of-female-pelvis...

References:

American Nurses Association and Society of Pediatric Nurses. (2003). Scope and standards
of pediatric clinical practice. Washington, D.C.: American Nurses Publishing House;

Association of Women’s Health, Obstetric, and Neonatal Nurses. (1998). Standards for the
nursing care of women and newborns (5th ed.). Washington, D.C.: Author.;

Bissell, G. (2004). The phenomenon of high-level nursing practice within neonatal units: Who
does it? Journal of Neonatal Nursing, 10(1), 21–25.

Carpenito, L. J. (2004). Handbook of nursing diagnosis (10th ed.). Philadelphia: Lippincott

Williams & Wilkins.

Dawley, K. (2003). Origins of nurse-midwifery in the United States and its expansion in the
1940s. Journal of Midwifery and Women’s Health, 48(2), 86–95.

Department of Health and Human Services. (2000). Leading health indicators. Healthy People
2010. Washington, D.C.: DHHS.

Johnson, M., Maas, M., & Moorhead, S. (2000). Nursing outcomes classification (2nd ed.).
St. Louis: Mosby.

McCloskey, J., & Bulechek, G. (2000). Nursing interventions classification (3rd ed.). St.
Louis: Mosby.

Peterson, V. (2004). When quality management meets case management. Case

Management, 9(2), 108–109.
Pillitteri, A. (2010). Maternal & child health nursing: care of the childbearing & childrearing
family Philadelphia,PA -6th ed.: Lippincott Williams & Wilkins,
Ricci, S. S. (2013). Essentials of maternity, newborn &women's health nursing. Philadelphia:
Wolters Kluwer/Lippincott Williams & Wilkins,

UN General Assembly, transforming our world: the 2030 Agenda for Sustainable
Development, 21 October 2015, A/RES/70/1, available at:
https://www.refworld.org/docid/57b6e3e44.html [accessed 14 August 2020]

World Health Organization. Year of the nurse and the midwife 2020.www.who.int/news-
room/campaigns/year-of-the-nurse-and-the-midwife-2020.Accessed August 13, 2020.

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