NORBELISA CADUNGGAN, BSN4-C

MATERNAL AND CHILD NURSING

Pregnancy, process and series of changes that take

place in a woman’s organs and tissues as a result of
developing fetus. The entire process from fertilization
to birth takes an avergage of 266- 270 days or about
nine months.

INITIATION OF PREGNANCY

A new individual is created when the elements of a

potent sperm merge with those of a fertile ovum or egg.
Before this union both spermatozoon and the ovum have
migrated for considerable distances in order to achieve
union. Anumber of actively motile spermatozoa are
deposited in the vagina, pass through the uterus and invade
the uterine (fallopian) tube, where they surround the ovum.
The ovum has arrived there after extrusion from its follicle ,
or capsule in the ovary. After it enters the tube, the ovum loses its outer layer of cells as a tubal
wall. Loss of the outer layer of cells as result of action by substances in the spermatozoa and from
the lining of the tubal wall. Loss of the outer layer of the ovum allows number of spermatozoa to
penetrate the eggs surface. Only one spermatozoon however, normally becomes the fertilizing
organism. Once it has entered the substance of the ovum, the nuclear head of this spermatozoa
separated from its tail. As it travels toward the nucleus of the ovum ( at this stage called the
female pronucleus), the head enlarges and becomes the male pronucleus. The two pronuclei meet
NORBELISA CADUNGGAN, BSN4-C

in the centre of the ovum, where their threadlike chromatin material organizes into
chromosomes.

STAGES OF LABOR

STAGE 1:CERVICAL DILATION

The first stage is the longest part of the labor
and can last up to 20 hours. It begins when the
cervix starts to open (dilate) and ends when it is
completely open (fully dilated) at 10 cm.

PHASES:
EARLY OR LATENT LABOR
Th early or latent phase is when the labor
begins. It has mild contractions that are 15- 20
minutes apart and last 60- 90 seconds. The
contractions will become more regular until they
are less than 5 minutes apart. The contractions cause cervix to dilate and efface, which means it
gets shorter and thinner, and more ready for delivery. During this early phase, cervix dilated
from 0-6 cm and contractions get stronger as time goes on. During this phase , may have
discharge from the vagina that clear to slightly bloody.

This part of labor could take hours or even days. Here are some things you can do to help the
process along:

•Take a walk.
•Change positions often.
•Continue practicing breathing and relaxation techniques.
•Soak in a warm tub or take a warm shower. If the water has broken, talk to doctor
before soaking in a tub.
•Rest if can.
•Drink plenty of liquids and have something light to eat.
NORBELISA CADUNGGAN, BSN4-C

ACTIVE PHASE

While the cervix dilates from 6 to 8 centimeters (called the Active Phase), contractions get
stronger and are about 3 minutes apart, lasting about 45 seconds. May have a backache and
increased bleeding from called the "bloody show". If the amniotic membrane ruptures or "water
breaks" at this point, the contractions may get much stronger.

This part usually lasts about 4 to 8 hours. Mood may become more serious as focus on
managing the contractions. Depends more on support person. It’s usually during the active
phase of labor that go to the hospital or birthing center. Pulse, blood pressure, and temperature
will be checked. A monitor will be placed on abdomen for a short time, or continuously, to check
for uterine contractions and assess the baby's heart rate. The health care provider will also
examine the cervix during a pelvic exam to determine how far labor has progressed.
An intravenous (IV) line may be placed into a vein in arm to deliver fluids and
medications if necessary. The doctor may have limit what you eat and drink at this time if they
think it’s possible, need a C-section with general anesthesia.

Some tips to help through the active phase of labor:

•Encourage walking between contractions.
•Emptying bladder often to make more room for the baby’s head in pelvis.
•Continue practicing breathing and relaxation techniques.
•Listening to soothing music.
•Focus on taking one contraction at a time. Remember that each one brings closer to
holding the baby.

•Try changing position.

TRANSITION PHASE

The transition phase is short, but also intense and painful. It usually takes from 15
minutes to an hour for the cervix to dilate from 8 to 10 centimeters. Contractions are 2 to 3
minutes apart and last about 1 minute. May feel pressure on the rectum and backache may feel
worse. Bleeding from the vagina will be heavier. May feel the urge to push. Pushing before
cervix is fully dilated may cause it to swell and slow down the process.
NORBELISA CADUNGGAN, BSN4-C

SECOND STAGE: DELIVERY

The second stage of labor begins when cervix is fully dilated at

10 centimeters. This stage continues until the baby passes through the
birth canal, vagina, and is born. This stage may last 2 hours or longer.

Contractions may feel different from the first stage of labor, they will
slow to 2 to 5 minutes apart and last from about 60 to 90 seconds. May
feel a strong urge to push within contractions. The patient may try to
rest as much as possible between intervals of pushing, and only push
when the health care provider says.
Management;

• Tell the patient to try several positions, squatting, lying in side

with legs up or resting patients hands and knees.

• Instruct the patient to take deep breaths in and out before and after contraction.

• Encourage the patient to curl into the push as much as possible, this allows muscles to
work.

THIRD STAGE OF LABOR: PLACENTAL EXPULSION

NORBELISA CADUNGGAN, BSN4-C

The third stage of labor begins after the baby is born and ends when the placenta
separates from the wall of the uterus and is passed through the vagina. This stage is often called
delivery of the "afterbirth" and is the shortest stage of labor. It may last from a few minutes to 20
minutes. May feel contractions but they will be less painful.

Management:

• After the birth, palpate the mother's abdomen to be sure she is not carrying twins.
Administration of 5 or 10 IU oxytocin slow IV or IM immediately after the birth (after the
birth of the last infant in a multiple pregnancy) AND before delivery of the placenta
accelerates separation of the placenta, facilitates its delivery and helps prevent PPH .

• Then, after clamping and cutting the cord, deliver the placenta with controlled cord
traction (during a contraction with counter pressure to the uterus, with a hand placed on
the abdomen). Uncontrolled traction on the cord (i.e., done without a contraction or
counterpressure) is contra-indicated, as it can cause tearing of the placenta and,
afterwards, retention of placental fragments with risk of bleeding and infection.

• Monitoring of heart rate, blood pressure, the amount of blood loss, while waiting for the
placenta to deliver and after placental expulsion (every 15 minutes for the first hour, then
every 30 minutes for the next hour) as the risk of PPH persists.

• Monitor for placental separation, press down on the abdomen just above the pubic bone.
If the cord does not retract when pressure is applied, the placenta has separated.To
facilitate expulsion from the vagina if it seems to be going slowly after the separation,
apply moderate pressure to the uterine fundus, directed toward the vagina.

•Monitor if uterus retracts and remains retracted.

•Examine the placenta to verify that it has been completely expelled. The uterus can only
retract properly if it is empty. Sooner or later, retained debris will lead to hemorrhage or
infection.
•Regular, bright red cotyledons. Any holes, roughened or depressed areas, or any deep cuts
that fail to line up when the cotyledons are brought together may suggest retained placenta,
requiring uterine exploration.
NORBELISA CADUNGGAN, BSN4-C