CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌

   ‌
ADOLESCENT,‌‌AND‌‌FAMILY‌‌    ‌
IDIANALE‌‌BATCH‌‌2024‌  ‌
ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌  ‌
 ‌
TOPIC‌‌8:‌‌LABOR‌‌&‌‌BIRTH‌  ‌
 ‌
 ‌ ● T‌‌-‌‌term‌‌delivery‌  ‌
  ‌ ● P‌‌-‌‌pre-term‌‌delivery‌  ‌
  ‌ ● A‌‌-‌‌bortion‌  ‌
  ‌ ● L‌‌-‌‌#‌‌of‌‌living‌‌children‌  ‌
 ‌
  ‌
● TPAL‌  ‌
● T‌‌-‌‌term‌  ‌
 ‌
● P‌‌-‌‌preterm‌  ‌
 ‌ ● A‌‌-‌‌abortion‌  ‌
● L‌‌-‌‌living‌‌children‌  ‌
 ‌  ‌
● G-P‌  ‌
 ‌
● G‌‌-‌‌gravida‌‌(#‌‌of‌‌pregnancy)‌  ‌
 ‌ ● P‌‌-‌‌parity‌‌(#‌‌of‌‌delivery)‌  ‌
 ‌
 ‌ INITIAL‌‌LABOR‌‌ASSESSMENT‌  ‌
● amniotic‌‌membrane‌‌status‌  ‌
LABOR‌‌AND‌‌BIRTH‌  ‌ ● onset‌‌and‌‌f requency‌‌of‌‌contractions‌  ‌
● birth‌  ‌process‌  ‌is‌  ‌coordinated‌  ‌effort‌‌   ● description‌‌of‌‌vaginal‌‌bleeding‌  ‌
depending‌‌on‌‌5‌‌interrelated‌‌factors‌  ‌ ● location‌‌and‌‌description‌‌of‌‌discomforts‌  ‌
● abnormalities‌  ‌in‌  ‌any‌  ‌of‌  ‌5 ‌ ‌can‌  ‌alter‌  ‌or‌‌
  ● time‌‌last‌‌fetal‌‌movement‌  ‌
prevent‌  ‌labor‌  ‌progress‌  ‌putting‌  ‌mother‌  ‌or‌‌    ‌
baby‌‌at‌‌risk‌  ‌ THEORIES‌‌OF‌‌LABOR‌‌ONSET‌  ‌
  ‌ ● Progesterone‌  ‌withdrawal‌  ‌- ‌ ‌anti-progestin‌‌  
Nursing‌‌Responsibilities‌  ‌ at‌‌
  term‌‌ inhibits‌‌
 relaxant‌‌  effect‌‌
 and‌‌ enables‌‌  
● allay‌‌fear‌‌and‌‌anxieties‌‌of‌‌client‌‌and‌‌family‌  ‌ estrogen‌‌to‌‌stimulate‌‌contractions‌  ‌
● obtain‌‌complete‌‌OB‌‌history‌  ‌ ● Prostaglandin‌  ‌synthesis‌  ‌- ‌ ‌used‌  ‌to‌  ‌“ripen”‌‌
 
cervix‌‌for‌‌induction‌  ‌
● Observations‌‌on‌‌maternal‌‌and‌‌fetal‌‌status‌  ‌
● Corticotrophin-releasing‌  ‌hormone‌  ‌(CRH)‌  ‌- ‌‌
● keep‌  ‌attending‌  ‌physician‌  ‌informed‌  ‌of‌‌   stimulates‌‌   synthesis‌‌
  of‌‌
  prostaglandins‌‌  and‌‌
 
progress‌‌of‌‌labor‌  ‌ by‌‌the‌‌amnion‌‌cells‌  ‌
  ‌ ● Oxytocin‌  ‌Stimulation‌  ‌- ‌ ‌working‌  ‌together‌‌  
Initial‌‌Personal‌‌Data‌  ‌ with‌‌prostaglandin‌‌to‌‌initiate‌‌contractions‌  ‌
● Name,‌‌age,‌‌ethnicity‌  ‌  ‌
● Obstetric‌‌care‌‌provider‌  ‌ PREMONITORY‌‌SIGNS‌‌OF‌‌LABOR‌  ‌
● Presenting‌‌complaint‌  ‌ ● Lightening‌  ‌
● Braxton‌‌Hicks‌‌contractions‌  ‌
● LMP‌  ‌
● Ripening‌‌of‌‌the‌‌cervix‌  ‌
● Estimated‌‌date‌‌of‌‌birth‌  ‌ ● Bloody‌‌show‌  ‌
● OB‌‌SCORE‌  ‌ ● Backache‌  ‌
● Current‌‌medications‌‌(Rx,‌‌OTC,‌‌herbal0‌  ‌ ● ROM‌  ‌
● Allergy‌‌history‌  ‌ ● 1-3‌‌lbs.‌‌wt.‌‌loss‌  ‌
 ‌ ● Sudden‌‌burst‌‌of‌‌energy‌  ‌
OB‌‌SCORES‌  ‌ ● Flu-like‌‌symptoms‌  ‌
● GTPAL‌  ‌   ‌
● G‌‌-‌‌of‌‌pregnancy‌  ‌ True‌‌Labor‌  ‌
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PROPERTY‌‌OF‌‌ODLID‌  ‌
35‌  ‌
 ‌
CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌
   ‌
ADOLESCENT,‌‌AND‌‌FAMILY‌‌    ‌
IDIANALE‌‌BATCH‌‌2024‌  ‌
ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌  ‌
 ‌
● progressive‌  ‌cervical‌  ‌change‌  ‌and‌  ‌fetal‌‌   ● Sinciput‌‌-‌‌anterior‌‌area‌‌(brow)‌  ‌
descent‌  ‌ ● Bregma‌‌-‌‌anterior‌‌fontanel‌  ‌
● regular‌‌intervals‌  ‌ ● LAmbda‌‌-‌‌posterior‌‌fontanel‌  ‌
● intervals‌  ‌between‌  ‌contractions‌  ‌gradually‌‌   ● Vertex‌  ‌- ‌ ‌area‌  ‌between‌  ‌anterior‌  ‌and‌‌  
shorten‌  ‌ posterior‌‌fontanelles‌  ‌
● contractions‌  ‌increase‌  ‌in‌  ‌duration‌  ‌and‌‌   ● Occiput‌  ‌- ‌ ‌area‌  ‌occupied‌  ‌by‌  ‌the‌  ‌occipital‌‌
 
intensity‌  ‌ bone,‌‌beneath‌‌the‌‌posterior‌‌fontanel‌  ‌
● discomfort‌  ‌begins‌  ‌in‌  ‌back‌  ‌and‌  ‌radiates‌‌   ● Molding‌‌-‌‌overlapping‌‌of‌‌cranial‌‌bones‌  ‌
around‌‌to‌‌abdomen‌  ‌ ● Sutures‌  ‌- ‌ ‌membranous‌  ‌spaces‌  ‌between‌‌  
● intensity‌‌usually‌‌increases‌‌with‌‌walking‌  ‌ the‌‌cranial‌‌bones‌  ‌
● cervical‌  ‌dilation‌  ‌and‌  ‌effacement‌  ‌are‌‌   ● Fontanelles‌‌-‌‌intersections‌‌of‌‌the‌‌sutures‌  ‌
progressive‌  ‌
● contractions‌  ‌do‌  ‌not‌  ‌decrease‌  ‌with‌  ‌rest‌  ‌or‌‌
 
warm‌‌tub‌‌bath‌  ‌
 ‌
False‌‌Labor‌  ‌
● less‌  ‌regular‌  ‌and‌  ‌contractions‌  ‌do‌  ‌not‌‌  
progressively‌‌increase‌  ‌
● contractions‌‌are‌‌irregular‌  ‌
● usually‌  ‌no‌  ‌change‌  ‌in‌  ‌contractions‌‌
  interval‌‌
 
and‌‌duration‌‌and‌‌intensity‌  ‌
● discomfort‌‌is‌‌usually‌‌in‌‌abdomen‌  ‌
● walking‌  ‌has‌  ‌no‌  ‌effect‌  ‌on‌  ‌or‌  ‌lessens‌‌ 
contractions‌  ‌
● no‌‌change‌‌in‌‌cervical‌‌dilation‌  ‌
● rest‌  ‌and‌  ‌warm‌  ‌tub‌  ‌baths‌  ‌lessen‌‌    ‌
contractions‌  ‌
COMPONENTS‌‌OF‌‌LABOR‌  ‌
Passenger‌  ‌
● fetus‌‌and‌‌placenta‌  ‌
Passageway‌  ‌
● pelvis,‌‌uterus,‌‌and‌‌vagina‌  ‌
Powers‌  ‌
● contractions‌‌and‌‌pushing‌  ‌
Position‌  ‌
● of‌‌the‌‌laboring‌‌mother‌  ‌
Psychological‌‌Response‌  ‌
● culture,‌‌experiences,‌‌preparedness‌  ‌  ‌
 ‌
PASSENGER‌  ‌
Fetal‌‌Skull‌  ‌
● Mentum‌‌-‌‌fetal‌‌chin‌  ‌

 ‌
PROPERTY‌‌OF‌‌ODLID‌  ‌
36‌  ‌
 ‌
CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌
   ‌
ADOLESCENT,‌‌AND‌‌FAMILY‌‌    ‌
IDIANALE‌‌BATCH‌‌2024‌  ‌
ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌  ‌
 ‌

 ‌

 ‌
Fetal‌‌Presentations‌  ‌
● Cephalic‌‌-‌‌fetal‌‌head‌‌first‌  ‌
 ‌ ● Breech‌‌-‌‌fetal‌‌buttocks,‌‌feet‌‌or‌‌knees‌‌first‌  ‌
Fetal‌‌Lie‌  ‌ ● Shoulder‌‌-‌‌transverse‌‌lie‌  ‌
● relationship‌‌   of‌‌
  the‌‌
  long‌‌
  axis‌‌
  of‌‌
  the‌‌
  baby‌‌
  to‌‌
 
the‌‌long‌‌axis‌‌of‌‌the‌‌mother‌  ‌
○ horizontal‌  ‌
○ longitudinal‌‌(normal)‌  ‌
Fetal‌‌Attitude‌  ‌
● relationship‌‌of‌‌the‌‌fetal‌‌parts‌‌to‌‌each‌‌other‌  ‌
● Universal‌‌flexion‌  ‌

 ‌
Fetal‌‌Positions‌  ‌
● relationship‌  ‌of‌  ‌fetal‌  ‌landmarks‌‌  
denominators‌‌to‌‌the‌‌maternal‌‌pelvis‌  ‌
● Occiput‌‌-‌‌head‌‌flexed‌  ‌
● Mentum‌  ‌- ‌ ‌head‌  ‌extended‌  ‌(face‌‌
 
presentation)‌  ‌
● Brow‌‌-‌‌head‌‌partially‌‌extended‌  ‌
● Sacrum‌‌-‌‌breech‌  ‌
● Acromion‌‌process‌‌-‌‌shoulder‌  ‌

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PROPERTY‌‌OF‌‌ODLID‌  ‌
37‌  ‌
 ‌
CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌
   ‌
ADOLESCENT,‌‌AND‌‌FAMILY‌‌    ‌
IDIANALE‌‌BATCH‌‌2024‌  ‌
ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌  ‌
 ‌

 ‌

 ‌

 ‌

 ‌

 ‌

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 ‌
PROPERTY‌‌OF‌‌ODLID‌  ‌
38‌  ‌
 ‌
CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌
   ‌
ADOLESCENT,‌‌AND‌‌FAMILY‌‌    ‌
IDIANALE‌‌BATCH‌‌2024‌  ‌
ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌  ‌
 ‌

 ‌
 ‌
 ‌
 ‌
● Placenta‌‌Accreta‌  ‌
 ‌ ● Abruptio‌‌placenta‌  ‌
Stations‌‌and‌‌Engagement‌  ‌ ○ premature‌  ‌separation‌  ‌of‌  ‌the‌‌
 
● Station‌  ‌- ‌ ‌relationship‌  ‌of‌  ‌the‌  ‌biparietal‌‌   placenta‌‌f rom‌‌the‌‌uterus‌  ‌
diameter‌‌   of‌‌
  the‌‌   infant‌‌  to‌‌
  the‌‌
  ischial‌‌   spines‌‌
 
of‌‌the‌‌mother‌  ‌
● Engagement‌‌   - ‌‌when‌‌   the‌‌  head‌‌   of‌‌
  the‌‌ fetus‌‌
 
is‌‌at‌‌Station‌‌0 ‌ ‌
DETERMINATION‌‌OF‌‌POSITION,‌‌PRESENTATION,‌‌  
LIE,‌‌ATTITUDE,‌‌STATION,‌‌AND‌‌ENGAGEMENT‌  ‌
● Ultrasound‌‌examination‌  ‌
● Leopold’s‌‌maneuvers‌  ‌
● vaginal‌‌exam‌  ‌
● Location‌‌of‌‌fetal‌‌heart‌‌sounds‌  ‌
 ‌
Placenta‌  ‌
● Normal‌‌placental‌‌separation‌  ‌
● Placenta‌‌previa‌  ‌ PASSAGEWAY‌  ‌
○ implantation‌  ‌of‌  ‌the‌  ‌placenta‌  ‌at‌‌   Pelvis‌  ‌
least‌‌partially‌‌covering‌‌the‌‌cervix‌  ‌
● support‌‌and‌‌protect‌‌the‌‌pelvic‌‌contents‌  ‌
● form‌  ‌the‌  ‌relatively‌  ‌fixed‌  ‌axis‌  ‌of‌  ‌the‌  ‌birth‌‌
 
passage‌  ‌
● measurements‌  ‌
● parts‌  ‌
○ inlet‌  ‌
○ pelvic‌‌cavity‌  ‌
○ outlet‌  ‌

 ‌

 ‌
PROPERTY‌‌OF‌‌ODLID‌  ‌
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 ‌
CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌
   ‌
ADOLESCENT,‌‌AND‌‌FAMILY‌‌    ‌
IDIANALE‌‌BATCH‌‌2024‌  ‌
ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌  ‌
 ‌
○ not‌‌favorable‌‌for‌‌vaginal‌‌birth‌  ‌
○ fetal‌  ‌head‌  ‌engages‌  ‌in‌  ‌transverse‌‌ 
position‌  ‌
○ difficult‌‌descent‌‌through‌‌midpelvis‌  ‌
○ frequent‌‌   delay‌‌
  of‌‌
  progress‌‌  at‌‌
 outlet‌‌
 
of‌‌pelvis‌  ‌
Cervix‌  ‌
● Cervical‌‌dilation‌ 
○ from‌  ‌size‌  ‌of‌  ‌fingertip‌  ‌to‌  ‌10‌  ‌cm‌‌
 
(progressive)‌  ‌
● CErvical‌‌effacement‌  ‌
○ thinning‌‌of‌‌cervix‌‌(%)‌‌(progressive)‌  ‌

 ‌
● Gynecoid‌‌   ‌
○ inlet‌  ‌rounded‌  ‌with‌  ‌all‌  ‌inlet‌‌  
diameters‌‌adequate.‌‌    ‌
○ Midpelvis‌  ‌diameters‌‌   adequate‌‌   with‌‌
 
parallel‌‌side‌‌walls.‌‌   ‌
○ Outlet‌‌adequate.‌‌    ‌
○ Favorable‌‌for‌‌vaginal‌‌birth‌  ‌  ‌
● Android‌‌
   ‌ POWERS‌  ‌
○ inlet‌  ‌heart-shaped‌  ‌with‌  ‌short‌‌   Primary‌‌powers‌  ‌
posterior‌‌sagittal‌‌diameter.‌‌    ‌ ● Uterine‌‌contractions‌‌
   ‌
○ Midpelvis‌‌diameters‌‌reduced.‌‌    ‌ ○ frequency‌  ‌
○ Outlet‌‌capacity‌‌reduced.‌‌    ‌ ○ regularity‌  ‌
○ Not‌‌favorable‌‌for‌‌vaginal‌‌birth.‌  ‌ ○ duration‌  ‌
○ Descent‌‌into‌‌pelvis‌‌is‌‌slow‌  ‌ ○ intensity‌  ‌
○ fetal‌  ‌head‌  ‌enters‌  ‌pelvis‌  ‌in‌‌   Secondary‌‌powers‌  ‌
transverse‌  ‌or‌  ‌posteriori‌  ‌position‌‌   ● maternal‌‌bearing‌‌down‌‌pushing‌  ‌
with‌‌arrest‌‌of‌‌labor‌‌f requent‌  ‌ Uterine‌‌Contraction‌  ‌
● Anthropoid‌  ‌
● contraction‌  ‌wave‌  ‌starts‌  ‌in‌  ‌pacemaker‌  ‌at‌‌
 
○ inlet‌  ‌oval‌  ‌in‌  ‌shape‌  ‌with‌  ‌long‌‌  
the‌‌
  cornual‌‌
 ends‌‌
 of‌‌
 the‌‌
 fallopian‌‌  tubes‌‌
 and‌‌
 
anteroposterior‌‌diameter.‌‌M ‌ ‌
descends‌  ‌down‌  ‌into‌  ‌the‌  ‌lower‌  ‌uterine‌‌
 
○ idpelvis‌‌diameters‌‌adequate‌  ‌
segment‌  ‌
○ outlet‌‌adequate‌  ‌
MATERNAL‌‌POSITIONS‌  ‌
○ favorable‌‌for‌‌vaginal‌‌birth‌  ‌
● upright‌‌position‌‌or‌‌standing‌  ‌
● Platypelloid‌  ‌
● lithotomy‌‌position‌  ‌
○ inlet‌  ‌oval‌  ‌in‌  ‌shape‌  ‌with‌  ‌long‌‌  
● side-lying‌  ‌
transverse‌‌diameters‌  ‌
● squatting‌  ‌
○ midpelvis‌‌diameters‌‌reduced‌  ‌
● semi-recumbent‌‌position‌  ‌
○ Outlet‌‌capacity‌‌inadequate‌  ‌

 ‌
PROPERTY‌‌OF‌‌ODLID‌  ‌
40‌  ‌
 ‌
CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌
   ‌
ADOLESCENT,‌‌AND‌‌FAMILY‌‌    ‌
IDIANALE‌‌BATCH‌‌2024‌  ‌
ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌  ‌
 ‌
● hands‌‌and‌‌knees‌  ‌ ● fertility‌  ‌
● birthing‌‌chair‌  ‌ SYSTEMIC‌‌EFFECTS‌‌OF‌‌LABOR‌  ‌
● increased‌‌cardiac‌‌output‌‌and‌‌BP‌  ‌
○ never‌  ‌leave‌  ‌a ‌ ‌laboring‌  ‌woman‌‌  
supine‌  ‌
● increased‌  ‌oxygen‌  ‌demand‌  ‌and‌‌ 
consumption‌  ‌
● acid-base‌‌alterations‌  ‌
● stimulation‌‌of‌‌renal‌‌secretions‌  ‌
● slowed‌‌GI‌‌motility‌‌and‌‌gastric‌‌emptying‌  ‌
● Immune‌  ‌response‌  ‌including‌  ‌increased‌‌  
WBCS‌  ‌
 ‌
● Decreased‌  ‌blood‌  ‌glucose‌  ‌and‌  ‌insulin‌‌ 
requirements‌  ‌
● Pain‌‌f rom‌‌varied‌‌causes‌  ‌
 ‌

 ‌

 ‌
PSYCHOLOGICAL‌‌RESPONSE‌  ‌
● maternal‌‌past‌‌experience‌  ‌
● preparedness‌  ‌
● support‌  ‌
● financial‌‌stability‌  ‌
● impact‌‌of‌‌another‌‌child‌  ‌
● other‌‌children‌‌to‌‌care‌‌for‌  ‌
● cultural‌‌meaning‌‌of‌‌children‌  ‌

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PROPERTY‌‌OF‌‌ODLID‌  ‌
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