Physiological Effects of Labor on a Mother.

Pregnancy plays a very crucial role in womanhood. It is said that when a woman gets pregnant, she is likely
putting her life at stake. During the labor delivery process, due to the intensity, the mother’s body undergoes through a lot
of changes and these changes can have a systemic physiologic effect both on the mother and the fetus.

A. Cardiovascular System
Labor involves strenuous work and effort and requires a response from the cardiovascular system.

Cardiac Output.

- During contractions, the amount of blood flow decreases as the uterine wall applies pressure on the uterine
arteries. With this an increase amount of blood will remain in a woman’s general circulation, leading to an
increase in peripheral resistance, resulting to an increased systolic and diastolic blood pressure. Cardiac
output may rise as much as 40% TO 50% above the pre-labor level.
- Having an increased blood volume during pregnancy, an average blood loss of 300mL to 500mL is an
advantageous role in decreasing blood volume. Immediately after birth, with the weight and pressure removed
from the pelvis, blood from the peripheral circulation floods into the pelvic vasculature, momentarily dropping
blood pressure in the vena cava.

Blood Pressure.

- During labor there will be an increased cardiac output due to the contractions. Systolic pressure increases with an
average of 15 mmHg per contraction. Higher than the average could be a sign of complications.
- The positioning of the mother while giving birth also affects the blood pressure. In a supine position during the
second stage of labor could decrease the blood pressure and may cause hypotension. An upright or side-lying
position on the other hand is effective and could avoid such complications.

 Monitor closely for hemorrhage.

 Monitor for signs of pathology with hypertensive episodes.

B. Hemopoietic System
A normal count of white blood cells is at around 5,000 to 10,000 cells/mm 3. Due to the amount of stress and heavy
exertion during labor this creates a major change in the blood system, the development of leukocytosis, this an
increase amount of white blood cells circulating in the body. An amount of 25,000 to 30,000 cells/mm 3 is produced
after labor.
 Continue to monitor for any signs of infection. (anemia, hypotension)

 it could indicate that the body is fighting for an infection (Chorioamnionitis also known as
“amnionitis” or “intra-amniotic infection.” bacterial infection that occurs before or during labor. The
condition occurs when bacteria infect the chorion, amnion, and amniotic fluid around the fetus.)

C. Respiratory System

Increase cardiovascular parameters also means an increase in respiratory rate to supply additional oxygen for the
body. Oxygen consumption increases up to 100% during labor and may result to hyperventilation. Using appropriate
breathing patterns during labor can help avoid severe hyperventilation.
 Monitor for any signs of hyperventilation. If hyperventilation occurs, rebreathing into a paper bag can be
helpful.
 If needed, use appropriately patterned breathing to regulate respiratory rate.

D. Temperature Regulation

A slight change in temperature arises up to 1°F due to the increase muscular activity. Diaphoresis occurs with
evaporation to cool and avoid excessive warming of the body.

Diaphoresis - excessive, abnormal sweating 

When your body temperature rises, your nervous system sends signals to your sweat glands to release salty fluid. As
sweat evaporates, this fluid cools  the surface of your skin and helps reduce your core body temperature.
 Monitor patient and offer cool washcloths for the patient’s forehead for comfort if needed.

E. Fluid Balance
With high respiration rate and diaphoresis occurring, the tendency of increase water loss may happen during labor.
Fluid balance is further affected if a woman eats nothing but sips of fluid or ice cubes or hard candy.
 Although not a concern in usual labor, the combination of increased fluid losses and decreased oral intake may
make intravenous fluid replacement necessary if labor becomes prolonged.

 Encourage women to sip fluid during labor the same as they would if they were exercising to keep
hydrated.
 If a woman is nauseated by labor, encourage sips of fluid, ice chips, or hard candy to supply some extra
fluid

F. Urinary System.

With insensible fluid loss and decrease intake during the labor process, the kidneys begin to concentrate in creating
urine to preserve fluid and electrolytes. As the fetal head descends in the birth canal against the anterior bladder,
reduces the ability of the bladder to sense filling. Therefore, unless the woman is asked to void approximately every 2
hours during labor, overfilling may occur, possibly decreasing bladder tone in the postpartal period.
 Ask the birthing parent to void approximately every 2 hours during labor to avoid overfilling because
overfilling can decrease postpartal bladder tone

G. Musculoskeletal System

During pregnancy, a hormone called relaxin is released by the ovary to soften cartilages in between bones. A week before
labor the coccyx/sacral joints will become movable, allowing the pelvic ring to stretch up to 2 cm to allow fetal passage.
This may cause the mother to experience back pain, irritating or nagging pain in pubis as she is about to go to labor.
 Monitor for appropriate mobility and be mindful of fall risks.

H. Gastrointestinal System
Gastrointestinal system becomes inactive during labor this is because of the shunting of blood to more life sustaining
organs and also because of pressure on the stomach and intestines from the contracting uterus Some women may
experience loose bowel movement as the contractions grow strong similar to what they may experience with
menstrual cramps
 Although many hospital protocols dictate that women who present in labor should not partake of oral
nutrition, there is little evidence to support this restrictive practice

I. Neurologic and Sensory Responses

The neurological responses during labor are pain associated (increased pulse and respiratory rate). In the early stages of
labor, there is pain or discomfort felt by the mother as the uterus contracts and the cervix dilates.

This pain is registered at uterine and cervical nerve plexuses (at the level of the 11th and 12th thoracic nerves).
At the moment of birth, the pain is centered on the perineum as it stretches to allow the fetus to move past it.
Perineal pain is registered at S2 to S4 nerves.

 Where pain registers is important in appreciating why epidural anesthesia is effective. For early labor, the
anesthetic block needs to suppress the lower thoracic synapses; for birth, it needs to block sacral nerves.
 Discuss nonpharmacologic pain techniques if the patient does not desire medication

Hydrotheraphy- water birth therapy

Patterned breathing

Other methods of comfort therapy such as effleurage (light rhythmic stroking of the abdomen), massage,

Immediate Care of the Newborn Using EENC Protocol

EENC – Early Essential Newborn Care
 is a series of time-bound, chronologically ordered standard procedures that a baby receives a birth.
 is the simplest solution to significantly reduce newborn deaths. It focuses on eliminating harmful and
outdated childbirth, newborn and postpartum practices in the first 24 hours of life, replacing them with
evidence-based practices.
EENC INTERVENTIONS:
1. Immediate and thorough drying of the newborn
 prevents hypothermia which is extremely important to newborn survival
 using a clean dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back,
arms and legs
Note: vernix caseosa, Lanugo and other watery, milky fluids
 2. Proper cord clamping and cutting
 Delayed cord clamping until the umbilical cord stops pulsating decreases anemia in one out of
every three premature babies and prevents brain hemorrhage in one out of two. It prevents
anemia in one out of every 7 terms.
 Clamp and cut the cord after the cord pulsations have stopped (1-3 minutes)
 Put ties tightly around the cord at 2 centimeters and 5 centimeters from the newborn’s abdomen
 Cut between ties with sterile instrument.
Note: AVA – artery vein artery
3. Keeping the mother and baby in uninterrupted skin-to-skin contact
 prevents hypothermia, hypoglycemia and sepsis, increases colonization with protective family
bacteria and improves breastfeeding initiation and exclusivity
 Following birth, a newborn is placed on the mother’s abdomen for a period of skin-to-skin
contact to help retain heat.
 If a baby is crying and breathing normally, avoid any manipulation, such as routine suctioning,
that may cause trauma or introduce infection.
 Cover newborn’s back with the blanket and head with a bonnet. Place identification band on
ankle.
 Observe oozing blood
 Do not milk the cord towards the newborn

4. Breastfeeding initiation within the first hour of life

 prevents an estimated 19.1% of all neonatal deaths.
 Allow the mother to begin breastfeeding if she wishes.
 Observe the newborn. Only when the newborn shows feeding cues (e.g., opening of mouth,
tonguing, licking, rooting), make verbal suggestions to the mother to encourage her newborn to
move towards the breast (e.g., nudging)
 Counsel on positioning and attachment
 When the baby is ready, advise the mother to:
a) Make sure the newborn’s neck is neither flexed nor twisted
b) Make sure the newborn is facing the breast, with the newborn’s nose opposite her nipple
and chin touching the breast
c) Hold newborn’s whole body, not just the neck and the shoulders
d) Wait until her newborn’s mouth is opened wide
e) Move her newborn onto her breast, aiming the infant’s lower lip well below the nipple.
f) Look for sign of good attachment and suckling:
- Mouth wide open
- Lower lip turned outward
- Baby’s chin touching breast
- Suckling is slow, deep with some pauses
- If the attachment or suckling is not good, try again and reassess
Note: What and Who is APGAR and its acronym

Other Important Interventions That Needs to be Considered in the Immediate Care of a Newborn:
(Wala ra kaayo ni gipa elaborate ni mam. Ang Eye care ra)

 Identification Banding
 One traditional form of identification used with newborns is a plastic bracelet with a permanent lock
that requires cutting to be removed.
 Number that corresponds to:

 mother’s hospital number; the mother’s name; and the sex, date and time of the infant’s birth are
printed on the band.
  Eye Care
 There are infections that are usually acquired from the mother as the infant passes through the birth
canal
 eryhthromycin ointment- helps prevent gonorrheal and chlamydia conjuctivitis

 Hepatitis B Vaccination
 All newborns born in a hospital or a birthing center receive first vaccination against hepatitis B within
12 hours after birth.
 Second dose will then be administered at 1 month
 Third one at 6 months
 Infants whose mothers are positive for the hepatitis B surface antigen (HBsAg) also receive hepatitis B
immune globulin (HBIG) at birth.

 Vitamin K Administration
 Newborns are at risk for bleeding disorders during the first week of life because their gastrointestinal
tract is sterile at birth and therefore unable to produce
 A single dose of 0.5 to 11.0 mg of vitamin K administered intramuscularly within the first hour of life
helps prevent such problems.
 Vitamin K is also available in an oral form but it is not the preferred form because newborn absorption
may still be immature and vomiting can dilute the dose.

 Physical Assessment
 A complete physical exam is an important part of newborn care
 Each body system is carefully checked for signs of health and normal function
 The nurse also looks for any signs if illness or birth defects
 Physical exam of a newborn often includes assessment of the following:
Vital Signs:
 Temperature: Able to maintain stable body temperature of 97.0 degrees Fahrenheit in normal room
environment
 Heart rate: Normally 120-160bpm. It may be much slower when an infant sleeps
 Respiratory rate: Normally 30-60bpm
 Blood pressure: normally an upper number (systolic) of 60 and a lower number (diastolic) of 40.
60/40mmHg
 Oxygen saturation: normally 95%-100% on room air