INTRAPARTAL STAGE

Be aware that pharmacologic agents used during labor and birth may
pose risk to the mother and fetus/neonate.

When considering use of pharmacologic intervention, the benefit to

the woman and the fetus must outweigh the risk of medication use.

a. Auscultation of fetal heart sounds

Determine the FHR:
every 30 minutes during beginning labor,
every 15 minutes during active labor
every 5 minutes during the second stage of labor.

b. External Electronic Monitoring

Contractions are monitored by means of a pressure transducer
Place the transducer over the uterine fundus
The transducer converts the pressure registered by the tocodynamometer
contraction into an electronic signal that is recorded on graph paper.
The FHR is monitored with the use of an ultrasonic sensor or a -
monitor also strapped against a woman’s abdomen at the level Pan
of the fetal chest
Variability ;
" a difference between the highest and lowest rates shown on a strip
is one of the most reliable indications of fetal well being
Variability is recorded as:
Absent- ho amplitude range is detected.

Minimal- amplitude range is detectable but is 5 beats per iii

minutes or fewer. a 7
 Moderate (normal)- amplitude range is 6 to 25 beats per
minute. Pa NT Oa

Marked — amplitude range is greater than 25 beats/min,

Periodic Changes
* fluctuations in FHR occur in response to contractions and fetal movement.
a. Accelerations
at 32 weeks AOG and beyond, acceleration has a peak of 15 beats per minute or more above baseline with a
duration of 15 ' seconds but less than 2 minutes from onset to return.
Before 32 weeks AOG, an acceleration has a peak of 10 SEAT beats/min or more above baseline , with a
duration of 10 seconds or more but less than 2 minutes from onset to return.
« Late deceleration suggest uteroplacental insufficiency or decreased :
blood flow through the intervillous spaces of the uterus during uterine contraction
Immediately change the position from supine if she is lying down to lateral to relieve pressure on the vena cava
and supply more blood to the uterus and fetus.
Intravenous fluid or oxygen may be prescribed. Prepare for a prompt cesarean birth of the infant if the late
deceleration persist or if FHR variability becomes abnormal (absent or decreased)
Variable deceleration refers to a deceleration that occur unpredictable times in relation to contractions
May indicate compression of the cord— may be occurring because of prolapsed cord, but is most often occurs
because the fetus is simply lying on the cord
Change the woman’s position from supine to lateral if she is not lying - on her side
If prolapsed cord is diagnosed as the cause of variable decelerations, oxygen will be prescribed as well as
changing her position to a knee to chest to help relieve pressure on the cord.

ASSESSMENT OF POST PARTUM

Involution- rapid reduction in size of uterus and return to pregnant state

Subinvolution-failure to descent
Uterus is at level of umbilicus w/in 6-12 hrs after child birth- decreases by one finger breadth per day.
Exfoliation- allows for healing of placenta site and is important part of involution, may take up to 6 weeks
LOCHIA

- Uterus rids itself of debris remaining after birth through discharge

 Lochia changes:

- Bright red (at birth)

- Rubra (dark red 2-3 days after delivery)
- Serosa(pink 3-10 days after delivery)
- Alba (white) 10days-6 weeks

Puerperal Diuresis- leads to rapid filling of bladder urinary stasis increases chance of uti
Foremilk- high water content, vitamins, proteins
Hindmilk- higher fat content

4 common breastfeeding position

a. Football hold
b. Lying down
c. Cradling
d. Across the lap
Cesarean birth- major abdominal surgery

1. Genetics: a family history of diseases may be inherited by unique genes that are linked to specific disorders;
chromosomes carry genes that determine physical characteristics, intellectual potential, and personality
2. Nutrition: the greatest influence on physical growth and intellectual development ; adequate nutrition
provides essentials for physiologic needs, which promote health and prevent illness
3. Prenatal and environmental factors: beginning with the nutrition from the mother to  exposures in utero
such as alcohol, smoking, infections, drugs, environmental exposures, such as radiation and chemicals,
influence growth and development of the developing child
4. Family and community: a stimulating environment from the family helps a child reach his or her
potential; family structure and community support services influence the environment in the process of
growth and development of the child
5. Cultural factors: customs, traditions, and attitudes of cultural groups in influence the child’s growth and
development regarding physical health, social interaction, and assumed roles

Stages
A. Prenatal Stage Conception to birth 
B. Infancy Stage
   Neonatal Birth to 28 days
   Infancy I month  to 12 months
C. Early Childhood Stage
   Toddler 1 to 3 years
   Preschool 3 to 5 years
D. Middle Childhood Stage
   School age 6 to 12 years
E. Later Childhood
  Prepubertal 10-13 years
  Adolescent 13 to 21 years