Advanced Women’s Health Nursing

Management of labor

Presenter(s):Dr. Nadia Eltohamy

 Learning Outcomes

• Describe Nursing Management of normal labor.

• Discuses management during the first stage of labor .
• Mention about Nursing management during second stage.
• Recognized Managements of the Third Stage of labor.
• Explain Managements of the Fourth Stage of labor.
Management of normal labor

The labor process is changing of life of

mothers so as a nurse we should be
respectful ,encouraging and
supporting to mothers to have positive
childbirth.
 Nursing Management of labor

Admission Assessments

Nurse is the most first contact &

communicate with the mother in E.R
,delivery room or operating room.
 Admission Assessments

1/maternal health history

➢ Include biographical data such name and age
➢ Antenatal care data :
• Estimated date of birth, to determine if term or
Preterm.
• Fetal movement
• Para, gravida, and previous childbirth experiences
➢ Laboratory results as blood type and RH
➢ List of medication.
➢ Any allergic .
➢ Any dieses or family history .
 Admission Assessments

2-Laboratory tests :
In admission, laboratory tests should be done to stablish a baseline The tests
include:
▪ complete blood count (CBC).
▪ Blood typing and Rh factor analysis
▪ Urinalysis
▪ Other tests hepatitis B & C
 Admission Assessments

3-Physical Examination:
A generalized assessment should be done of the
woman’s body systems, including:
▪ hydration status.
▪ vital signs.
▪ auscultation of heart and lung sounds.
▪ measurement of height and weight.
▪ Fundal height measurement.
 Continue of physical assessments:

▪ Uterine activity, including contraction frequency,

duration, and intensity.
▪ Status of membranes (intact or ruptured)
▪ Cervical dilatation and degree of effacement.
▪ Pain level.
▪ Fetal status, including heart rate, position
 Nursing management during the first
stage of labor

Close observation is important for both mother and fetus . The

nurse should observe :
➢Reaction of the woman to labor
➢Vaginal discharge ,show , amniotic fluid
➢Progress of labor through down of head and cervical dilatation.
➢Monitoring Of V/S.
 Activity

In SGD , Explain the nursing management during the first

stage of labor .

Time : 15 min

Teaching Strategies : SGD

 Nursing management during the first stage of
labor

➢ Monitoring Uterine Contractions

 Nursing management during the first stage
of labor

• Uterine contractions during labor are monitored by palpation and by

electronic monitoring.
 Nursing management during the
first stage of labor

➢Vaginal Examination: If there no vaginal bleeding it is prefer to do

vaginal examination to assess cervical dilation.
➢Fetal Assessment: FHR auscultation can be used to detect
FHR baseline
 Nursing management during
the first stage of labor
➢Leopold’s maneuvers :determining the presentation, position, and lie of the fetus
through the use of four specific steps.
 Nursing management during the first stage of labor

➢Rest and sleep is important in the first stage of labor to :

o Reserve energy ,Prevent anxiety distracting factors ( drive attention away
from labor and pain) .
The midwife or nurse helps the woman to sleep by :
1. Evacuate her bladder .
2. Give her a warm drink.
3. Maintaining a quiet room and a comfortable bed.
o •Ambulation may decrease the need for analgesia ,shorten labor and decrease of
fetal heart rate abnormalities
o •The woman is allowed to ambulate if there are no contraindications like bleeding
,premature rupture of membranes with high head , pregnancy with hypertension ,
cardiac disease.
 Nursing management
during the first stage of labor

➢Nutrition & Hydration:

o During labor , there are excessive fluids loss and increased
dehydration.
o The painful contraction of the uterus during labor need a
continuous supply of glucose.
o If no food is allowed, an intravenous infusion should be
sited to correct the homeostatic imbalance by providing
glucose and fluid
o IV fluids are given to provide energy and prevent
dehydration in case of vomiting & possible use of
anesthesia.
 Nursing management
during the first stage of labor

➢Comfort & Assistance

oProvide mouth wash and sips of water if her
mouth is dry
oMassage the back if she complain of back pain.
oRelieve pain by encouraging deep breathing
during contractions and use of analgesia
oChange the pad frequently if there is excessive
vaginal discharge
 Nursing
management during the first stage of labor
➢Posture of woman in labor
o The nurse should allow the mother to assume any comfortable position , except the
dorsal recumbent which may result in supine hypotension and lead to fetal distress
o The nurse should encourage the woman to walk in the room if she is in active
labor Woman in labor should not be out of bed in the following cases
oMembranes have ruptured , because the risk of cord prolapsed
oWhen she is medicated with any drug which make her dizzy or unsteady .
oRabidly progressive labor or late first stage in multipara or second stage of
labor in primi gravida .
oObstetrical complications sever pre-eclampsia .
 Nursing management during the first stage of labor

➢Pain Management :non-pharmacologic and pharmacologic

 Activity

In SGD , Explain the nursing management during the 2nd

stage of labor .

Time : 20 min

Teaching Strategies : SGD

 SECOND STAGE OF LABOR

The cervix is dilated in 10cm

until the delivery of the baby
and placenta
 Nursing management during second stage

Assessment should include the following:

➢Uterine contractions
➢Maternal physical and emotional status
➢Fetal well being
 Nursing management during second stage

➢ Preparation of the delivery room:

o Delivery room should always be ready . Delivery
trolley and emergency drug tray should be ready
o The delivery room should be worm enough for the
infant
o All equipment needed for infant care is present and
resuscitation trolley should be ready for use at all
times
➢Safety of woman should be ensured .She should
be transferred between contractions and
supported adequately
➢Enough privacy should be provided
➢Strict aseptic technique should be maintained
 Management of second stage of labor

• Continusely provide information support and encouragement to the

women and her companion.
• Encourage active pushing.
• Listen frequently between contraction every 5 min.
• Check the maternal pulse.And v/s
• Observe progressive descent and rotation of presenting part.
• Conduct the delivery with full support of perinium.
• Be ready to augment i/v oxytocin infusion .
• be ready to under take instrumental vaginal delivery if indicated.
Positions used
Positions used
 Management of second stage of labor
• After delivery of the head:
➢Wipe any mucus from the eyelids with separate swabs of sterile
cotton
➢Mouth and nostrils with gauze swab
➢If the umbilical cord is looped round the infant’s neck, slip it over the
head if it loose or clamp and cut it, if it tight
➢Give the woman IM syntometrine, 1ml after delivery of the infant’s
anterior shoulder, or after expulsion of placenta, to stimulate uterine
contractions and prevent bleeding
➢Notes and record the time of birth
 Preparation of the attendance

1-The attendance should wear a head cap and mask

2-Wash and scrub hands

3- Put on a sterile gown and gloves.

 Duties of the scrub nurse

1-Arranges the instruments on the delivery table

2- Assists in draping the woman
3- Handles the instruments and catheter to the doctor as
called for
4- Assists in perineal repair and prepares proper sutures on
proper needles
5- Massages the uterus as needed
6- Assists in holding the newborn
 Duties of the circulating nurse

1-Assists the woman during her transfer from the labor bed
and positions her properly on the delivery table
2- Opens packs
3- Prepares and administers routine medications as ordered
and records its time
4- Prepares resuscitation and emergency equipments.
5- Count and records FHR
 Duties of the circulating nurse

6-Receives the newborn from the doctor and takes care of him
7- Records the time of birth and sex of the infant
8- Observes and records the time of placental expulsion
9- Records the amount of blood loss
10- Observes and records any unusual conditions
11- Prepares and places the identification measure of the infant
12- Assists in giving anesthesia and emergency drugs if needed
 Activity

In SGD , Explain the nursing management during the 3rd

stage of labor .

Time : 20 min

Teaching Strategies : SGD

Managements of the Third Stage of labor

o The normal duration of the

third stage of labor depends on
the method used to deliver the
placenta.
o It usually lasts less than 30
minutes, and mostly only 2 to 5
minutes.
 Managements of the Third Stage of labor

o Immediately after the delivery of the infant,

an abdominal examination is done to
exclude a second twin.
o An oxytocic drug is given if no second twin
is present.
✓WHO recommends oxytocin as the
uterotonic drug of choice for prevention of
PPH during the third stage of labor it is
effective 2–3 minutes after injection, has
minimal side-effects and can be used in all
women
 Managements of the Third Stage of labor

o When the uterus contracts, controlled cord traction must be

applied:​
✓ Keep steady tension on the umbilical cord with one hand.​
✓ Place the other hand just above the symphysis pubis and
push the uterus upwards.
 Managements of the Third Stage of labor

oDelayed umbilical cord clamping (not earlier than 1 minutes after birth )is
recommended for improved maternal and infant health and nutrition
outcome
 Delivery of the placenta

a. The conservative methods:

▪ After delivery of the fetus, the left hand is placed over the fundus to
detect signs of placental separation and descend.
▪ When these signs appear, the uterus is massaged to contract, and the
patient is asked to bear down to deliver the placenta.
▪ This can be helped by gentle traction on the cord and 0.5 mg ergometrin
given I.V or I.M given after placental delivery to diminish bleeding
 Delivery of the placenta

b. The active method:

▪ With delivery of the fetus, ergometrin 0.5 mg is given IV or IM or Syntometrin

vial I.M.
▪ The placenta is then delivered by Brandt-Andrews or Crede's methods .
▪ The advantages of active methods are to avoid postpartum hemorrhage but
ergometrin may cause contraction ring and retained placenta to diminish
bleeding
 Activity

In SGD , Explain the nursing management during the 4th

stage of labor .

Time : 20 min

Teaching Strategies : SGD

Fourth Stage of labor

The fourth stage of labor is

the period from the delivery
of the placenta until the
uterus remains firm on its
own.in the first two or three
hours after birth.
 Managements of the Fourth Stage of labor

• Transfer the patient from the delivery table and Remove the drapes
and soiled Linen.
• Give the mother clean gown.
• Cover the mother with a warm blanket.
• vital signs chart, every 15 minutes for an hour, then every 30 minutes
for an hour, and then every hour as long as the patient is stable.
• Provide care of the perineum, An ice pack may be applied to the
perineum to reduce swelling from episiotomy especially if a fourth-
degree tear
 Managements of the Fourth Stage of labor

• Apply a clean perineal pad between the legs.

• evaluated the fundal height and firmness.
• Assess for ambulatory stability.
• Assessment for perianal hematoma.
• Look for discoloration of the perineum.
• Observe of signs of PPH.
 Managements of the Fourth Stage of labor

• Assessing lochia flow:

✓Keep a pad count and Record the number of
pads soaked with lochia .
✓Character of lochia ( rubra , serosa or alba).
✓Identify lochia amounts as small, moderate,
or heavy.
✓Color and Oder.
✓Document lochia flow when the fundus is
massaged.
 Managements of the Fourth Stage of labor

• Care of episiotomy
• Keep the area clean and dry to prevents further irritation or
infection.
• Always wipe front to back.
• changing pads– every two to four hours .
• Use pain relievers as doctor order.
• Ask the mother to Take a warm, clean bath (wait at least 24 hours
after giving birth).
 Managements of the Fourth Stage of labor

• Apply ice packs immediately after birth.

• Observe if any Discharge or discolored
and/or has a bad odor in the episiotomy.
• Encourage the mother to do Kegel
exercises.
• Prevent constipation by increasing water
and fiber intake.
 Care of breast for postnatal mother

• Hand hygiene before touch the breast.

• Clean the breast before nursing the baby.
• Check the nipple if there is any discharge or
bleeding.
• Breast feeding to avoid breast engorgement.
• Ask the mother to wear a supportive bra
• Change breast pads often.
• Apply warm pack .
• proper positioning and latch-on usually prevents
sore nipples .
 Psychological assessment

o Assess the mother emotion

and behavior and the relationship with
her baby.

o Observe if there is any sign or

symptoms of postpartum depression or
blouse.
 References

World Health Organization. (2019, October 1). Who

recommendations: Intrapartum Care for a positive childbirth
experience. World Health Organization. Retrieved October 6,
2021, from
https://www.who.int/reproductivehealth/publications/intrapar
tum-care-guidelines/en/.
Normal labor and delivery: GLOWM. Global Library of Womens
Medicine. (n.d.). Retrieved October 6, 2021, from
https://www.glowm.com/section-
view/heading/Normal%20Labor%20and%20Delivery/item/127
Nursing management during labor and birth flashcards | Quizlet.
(n.d.). Retrieved October 11, 2021, from
https://quizlet.com/ca/465362798/nursing-management-
during-labor-and-birth-flash-cards/.