Professional Documents
Culture Documents
Intrapartum NCM 101
Intrapartum NCM 101
Intrapartum NCM 101
6. YOGA
teaching relaxation, concentration and “complete breathing”
combination of chest and abdominal breathing
7. Hypnosis
NURSING IMPLEMENTATION
1. Reduce the couple’s anxiety and fears related to pregnancy and child
birth
Maintain an open non judgmental atmosphere
Promote realistic goals and expectation regarding the entire childbirth
experience
2. Provide family teaching; childbirth preparation course
3. Promote prenatal care compliance in the pregnant woman and her
partner
Stress the importance of prenatal care
Address the couple’s questions and concerns honestly and promptly
Encourage attendance at childbirth education program
4. Integrate the partner into preparation for childbirth
How to coach the mother during labor and delivery
Importance of helping the mother keep antepartum
appointments
How to participate in preparing the home for the newborn
Preparing sibling for the newborn
INTRAPARTUM CARE
• 1. period extends from the beginning of contractions that cause
cervical dilatation to the first 1 to 4 hours after delivery of the new
born and placenta
• 2. refers to the medical and nursing care given to pregnant woman
and her family during labor and delivery.
GOAL OF INTRAPARTUM CARE
• 1. to promote physical and emotional well being in the mother and
fetus
• 2. to incorporate family-centered care concepts into the labor and
delivery experience
FACTORES AFFECTING THE INTRAPARTUM
1. Previous experience with pregnancy
2. Prepregnant health and biophysical preparedness for
childbearing
3. motivation for childbearing
4. socioeconomic readiness
5. age of mother
6. cultural and personal expectations
• a) touch- may or may not be acceptable in the labouring
woman’s culture. N. I. determine early in the labor process
whether therapeutic touch ( back rub, effleurage) is an
acceptable comfort measure
• b) pain response – may be stoic and nonverbal; may scream or
actively verbalized her discomfort, may moan softly; may thrash
about; N.I. Assess facial expression, body posture and tension, activity
level, and verbalization of pain to determine the level of discomfort
• c) support person- may be the husband, mother, sister, relatives or
friends; N.I. respect the woman’s choice of support person.
• d) language – may not speak or understand English: N.I. provide
interpreter
• e) placenta – may ask to have the placenta to take home, some
culture may bury it to ensure the child’s health; N.I. respect the
client’s request; observe standard precaution when supplying the
mother with the placenta
PROCESS OF LABOR AND DELIVERY
• ONSET OF LABOR
LABOR – The process by which the fetus and products of conception are
expelled as the result of regular, progressive, frequent, and strong uterine
contractions.
An involuntary physiologic process whereby the contents of the gravid uterus
are expelled through the birth canal into the external environment
THEORIES OF LABOR
MATERNAL FACTOR THEORIES
• Uterine muscles stretch, causing release of prostaglandin
• Pressure on the cervical stimulates nerve plexus, causing release off
oxytocin by maternal posterior pituitary gland. This is known as the
FERGUSON REFLEX
• Oxytocin stimulation in circulating blood increases slowly during
pregnancy, rises dramatically during labor, and peaks during second
stage. Oxytocin and prostaglandin work together to inhibit calcium and
thus activating contractions.
• Estrogen/ progesterone ratio shift – estrogen excites the uterine
response, and progesterone quiets the uterine response. A decrease of
progesterone allows estrogen to stimulate the contractile response of the
uterus.
• FETAL FACTOR THEORIES
• Placental aging and deterioration triggers initiation of
contractions
• Fetal cortisol, produced by the fetal adrenal glands, rises and
acts on the placenta to reduce progesterone formation and
increase prostaglandin
• Prostaglandin produced by fetal membranes(amnion and
chorion) and the decidua stimulates contractions. When
arachidonic acid stored in fetal membranes is released at
term, it is converted to prostaglandin
• Uterine Stretch Theory – a hollow organ such as the
uterus when full, will empty
• Oxytocin Theory – oxytocin released by the posterior
pituitary gland initiates labor.
• Progesterone Deprivation Theory – contractions are
initiated when progesterone levels are decreased as
such at the end of pregnancy
• Prostaglandin Cascade Theory – labor is initiated due
to the production of prostaglandin as a result of the
interplay between adrenal, fetus, and uterus.
FACTORS AFFECTING LABOR/FIVE ESSENTIAL
COMPONENTS OF LABOR
•PASSAGEWAY
•PASSENGER
•POWER
•POSITION OF THE WOMAN
•PSYCHE
PASSAGEWAY - refers to the adequacy of the pelvis
and birth canal in allowing fetal descent.
Includes :
• 1.Pelvic Shape
Gynecoid – classic female type
Android – resembling male pelvis
Anthropoid - resembling anthropoid apes
Platypelloid – flat pelvis
•A gynecoid pelvis is oval at the inlet, has a
generous capacity and wide subpubic arch.
This is the classical female pelvis.
• A platypelloid pelvis is flattened at the inlet and
has a prominent sacrum. The subpubic arch is
generally wide but the ischial spines are
prominent. This pelvis favors transverse
presentations.
• An anthropoid pelvis is, like the gynecoid pelvis,
basically oval at the inlet, but the long axis is oriented
vertically rather than side to side.Subpubic arch may
be slightly narrowed. This pelvis favors occiput
posterior presentations
• An android pelvis is more triangular in shape at
the inlet, with a narrowed subpubic arch. Larger
babies have difficulty traversing this pelvis as the
normal areas for fetal rotation and extension are
blocked by boney prominences. Smaller babies
still squeeze through
2.Structure of pelvis
True Pelvis – or lesser pelvis contains the
pelvic inlet and is short, curved canal, deeper on
its posterior than on its anterior wall
False Pelvis – or greater pelvis; part of the
abdominal cavity
Pelvic Dimensions – estimates the true pelvis.
Obstetric conjugate
Diagonal Conjugate
4. Soft Tissues – cervix & vagina
Effacement – shortening and thinning of
the cervical canal
Dilatation – enlargement or widening of
the cervical canal
•2. PASSENGER
• 2 parietal bones
• 1 occipital bone
• Suture lines = sagittal, coronal, lambdoidal, and frontal
membranous interspaces that allow the cranial bones to
move and overlap to pass the birth canal readily
• Sutures allow the bones to move during the birth process.
• They act like an expansion joint, allowing the bone to enlarge
evenly as the brain grows and the skull expands, resulting in
a symmetrically shaped head.
• if ever any of the sutures close too early (fuse prematurely),
there may be no growth in that area. This may force growth
to occur in another area or direction, resulting in an
abnormal head shape.
The major sutures of the skull include the following:
• Metopic suture. This extends from the top of the head down the
middle of the forehead, toward the nose. The 2 frontal bone plates
meet at the metopic suture.
• Coronal suture. This extends from ear to ear. Each frontal bone plate
meets with a parietal bone plate at the coronal suture.
• Sagittal suture. This extends from the front of the head to the back,
down the middle of the top of the head. The 2 parietal bone plates
meet at the sagittal suture.
• Lambdoid suture. This extends across the back of the head. Each
parietal bone plate meets the occipital bone plate at the lambdoid
suture.
• Fontanelles = anterior; larger - 3by 2cm, lies at frontal,
coronal and sagittal sutures. It closes by 18 months after
birth.
• = posterior; 1cm-2cm, lies at the junction of the
sutures of 2 parietal bones and the occipital bone, is
triangular. It closes 6-8 weeks after birth.
• Diameter of the fetal head should be small enough to allow
the head to travel through the bony maternal pelvis.
• Molding – a process that reduces the diameter of the head;
elongation of the fetal skull. Molding can be extensive but
the heads of most newborns assume their normal shape
within 3 days after birth.
• Size of the fetal shoulders may affect passage, their position can be
altered relatively easily during labor, so that one shoulder may occupy
a lower level than the other.
• This creates a shoulder diameter that is smaller than the skull,
facilitating passage through the birth canal. The circumference of the
fetal hips is usually small enough not to create problems.
• Fetal Lie- describes the long axis of the fetus in relation to
the long axis of the pregnant woman.
• Longitudinal/ vertical – the long axis of the fetus is parallel with
the long axis of the mother. It is either cephalic or breech
presentation, depending on the fetal structure that first enters the
mother’s pelvis.
• Transverse/horizontal/oblique – the long axis of the fetus is at a
right angle diagonal to the long axis of the mother.
• Fetal Presentation- the foremost part of the fetus that enters the
pelvic inlet.
• a) Cephalic- head
• b) Breech- feet or buttocks
• c) Shoulder- shoulder
• Fetal Position – relationship of the presenting part to a specific
quadrant of a woman’s pelvis.
• MATERNAL PELVIS:
• Right anterior
• Left anterior
• Right posterior
• Left posterior
FETUS:
• Vertex- occiput
• Face- chin (mentum)
• Breech – sacrum
• Shoulder – scapula or acromiom
• Sinciput - forehead
To document fetal position:
• The side of the maternal pelvis in which the presenting part is found : Right
(R), Left (L)
• Reference point on the presenting part (Fetal Landmark)
• O- occiput
• M- Mentum or chin
• Sa- Sacrum
• A- acromiom process
• A- Anterior ( front of pelvis)
• P- Posterior ( back)
• T- transverse (side)
• Ex. ROA (right occiput anterior) - Vertex presentation, facing the right
anterior quadrant of the pelvis.
• Fetal Attitude- the relation of the fetal parts to each other.
• Good/ Well flexed Attitude- General flexion that is advantageous
during birth
• The fetus assumes a characteristic posture in utero partly because
the way the fetus conforms to the shape of the uterine cavity.
• The fetus becomes folded/bent upon itself in such a manner that the
back becomes markedly convex
• The head is sharply flexed so that the chin is almost in contact with
the chest.
• Normally, the back of the fetus is rounded so that the chin is
flexed on the chest, the thighs are flexed on the abdomen, and
the legs are flexed on the knees.
• The arms are crossed over the thorax, and the umbilical cord lies
between the arms and legs.
• Engagement- refers to the settling of the presenting part of a fetus far
enough to the pelvis to be at the level of the ischial spines, a midpoint
of the pelvis. It is corresponding to station 0.
• It often occurs in the weeks just before labor begins in nulliparas;
and may occur during labor in multiparas.
• Fetal Station- the relationship of the presenting part to the ischial spines.
• Recorded as: 0 (zero)- presenting part is at the level of the ischial spines.
- (1-4)- above the ischial spines
+(1-4) – below the ischial spines
Minus 4 or above – floating & unengaged
Zero (0) – engaged
+4 – head is at outlet
3. POWER
• - The involuntary and voluntary powers combine to expel the
fetus and the placenta from the uterus.
• Refers to the frequency, duration, and strength of uterine
contractions to cause complete cervical effacement and dilatation
• - Primary power - supplied by involuntary muscle contractions of the
fundus of the uterus causing DILATION AND EFFACEMENT
(shortening and thinning of the cervix during the first stage of
labor.)
• Secondary power - voluntary muscle contractions of the maternal
abdomen during the second stage of labor; the bearing-down efforts
to aid in the expulsion of the fetus as she contracts her diaphragm
and abdominal muscles and pushes
Phases of uterine contractions:
a. Increment- longest; building up of the contraction
b. acme – peak or highest intensity
c. Decrement – letting –up phase; descent or relaxation of the
uterine muscle fiber
Descriptors of Contractions:
a. Frequency- number of contractions, the time from the beginning of
one contraction to the beginning of the next contraction.
b. Duration – interval from the beginning to end; length of contraction
c. Intensity - strength of the contraction; mild, moderate or strong
Terms used to describe what is felt on palpation:
• Epidural
• Spinal
• Pudendal
• Local Infiltration
Oxytocics
Inverted Uterus
•Uterus turns inside out, usually during
delivery or after delivery of the placenta
Prolapsed Cord
Episiotomy
Incision into perineum to facilitate birth & prevent
lacerations & overstretching of the pelvic floor