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NCM 107 Lesson 10
NCM 107 Lesson 10
Care of the Mother and Fetus during the Perinatal Period (Preparing a Family for
Childbirth and Parenting)
SPECIFIC OBJECTIVES:
1. Describe common preparations for childbirth and parenting, including common settings
for birth.
2. Describe breathing and relaxation techniques used for each stage of labor.
3. Identify non-pharmacologic strategies to enhance relaxation and decrease discomfort
during labor.
4. Identify alternative birth setting such as freestanding clinic or their home.
LESSON PROPER:
TYPES OF EXERCISES
TAILOR SITTING
• To stretch the thighs and perineal muscles without occluding blood vessels of the lower
legs
• Avoid putting one ankle on top of the another
• Sits in this position gently push on her knees towards the floor until she feels perineum
stretch
• Hold this position in increased amount each time performed, 15 minutes everyday
• By the end of pregnancy her knees will almost touch the floor if pushed
SQUATTING
• Stretches perineal muscles and can be used for 2nd stage of labor, for about 15mins/day
• For the pelvic muscles to stretch, keep feet flat on the floor
• Done 15mins/day
• Ex. Picking up toys on the floor reduces amount of time a woman must devote to daily
exercises
PELVIC ROCKING
• Helps relieve backache making the lumbar spine more flexible
• Positions: Hands and knees, lying down, sitting, standing
• Arch the back, trying to lengthen or stretch her spine, holds the position for 1 minute, then
hollows her back, thrust back outward with buttocks tucked under
• Hold 3 secs. and release 5x/day to relieve back pain and make herself more comfortable
for the night
SEXUALITY IN PREGNANCY
• Be aware of the physiologic changes
• Discuss responses to pregnancy with your partner
> Alternative behavior (mutual masturbation, foot massage, cuddling)
> Alternative position (female superior, side-lying)
• Intercourse is safe as long as it is not uncomfortable
Precautions:
Abstain from intercourse if you have experience uterine cramping/ vaginal bleeding
Abstain from intercourse if you have history of cervical incompetence (activity that
results in orgasms)
• Continue to use safer sex behaviors. Encourage use of condoms
PAIN PATHWAY
Endings of the small peripheral nerve fibers detect a stimulus
Transmit to the cells in the dorsal horn of the spinal cord
Impulses pass through a dense, interfacing network of cells in the spinal cord (substantia
gelatinosa)
A synapse occurs that returns the transmission to the peripheral sit through motor nerve
Impulse then continues in the spinal cord to reach the hypothalamus and cortex of the brain
Impulse is interpreted and perceived as pain
METHODS FOR PAIN MANAGEMENT
A. GATE CONTROL MECHANISMS – involves halting an impulse at the level of the spinal
cord so the impulse is never perceived at the brain level as pain – a process similar to closing
a gate occurs
Cutaneous stimulation- ability of the small nerve fibers at the injury site to transmit pain
impulses appears decrease if the large peripheral nerves next to the injury site are
stimulated.
Ex. Rubbing a large area around the injured part; heat/cold; effleurage
Distraction – if the cells of the brain stem that register an impulses as pain are pre-occupied
with other stimuli, a pain impulse will not register.
Ex. Breathing techniques – increases oxygenation– decreasing pain
Relaxation Techniques
1. Conscious relaxation – relax the body so woman does not remain tense and unnecessary muscle
strain and fatigue during labor.
2. Cleansing breath – woman breathes deeply and then exhales deeply
3. Consciously controlled breathing
Level 1: slow chest breathing (comfortable but full respirations 6 -12 bpm)
Level 2: breathing lighter than level 1. rib cage expands lightly the diaphragm barely
moves. RR up to 40 – good for contractions when cervical dilation is 4 & 6 cm.
Level 3: Breathing is shallow mostly at the sternum, rate 50 – 70 bpm. Keep the tip of
the tongue against the roof of her mouth.
Level 4: uses “pant-blow pattern”- 3-4 quick breaths then a forceful exhalation. “choo-
choo” “hee-hee-hee-hoo”
Level 5: chest panting is continuous, very shallow 60 bpm. Prevents pushing before
dilation
4. Focusing/Imagery – sensate focus like photograph of her husband/children, a graphic design, or
something appeals to them
Second-stage breathing – do not hold breath on the second stage of labor. Teaching woman to
breathe out while pushing may be helpful.
1. Hospital birth:
Birthing bed – woman assumes supine recumbent position, which reduces tension on
the perineum and may result in fewer perineal tears than with a lithotomy position.
2. Birthing Chair
Comfortable reclining chairs with a slide away seat that allows a woman to assume a
comfortable position during labor and also furnish perineal exposure so as birth
attendant can assist with the birth
Woman is encouraged to express her own needs and wishes during labor, she can
choose a birth position, bring her own music or distraction objects and partner can
perform such tasks such as cutting the cord, woman remains 4 to 24 hours after birth.
4. Home Birth:
It allows for family integrity, puts the responsibility on the woman to prepare the
house and take of the infant after birth.
A. Leboyer – (from a warm, fluid filled intrauterine environment to a noisy, air filled
brightly lit birth room creates major shock.) The birthing room is darkened so there
is no sudden contrast in light, keep pleasantly warm-water birth.
REFERENCES/ADDITIONAL RESOURCES/READINGS:
Pillitteri, Adele (2018). Maternal and Child Health Nursing, Care of the Childbearing and
Childrearing Family, 8th edition.
Ricci, Susan (2007). Essentials of Maternity, Newborn and Women’s Health Nursing, Lippincott
Williams & Wilkins
Wong, Donna, et.al.(2009). Maternal Child Nursing Care, 3rd edition, Elsevier (Singapore) Pte Ltd.