INTRA PARTUM CARE

PREPARATION FOR LABOR AND DELIVERY

❒ The birth processes

❒ Breathing techniques and relaxation exercises
❒ Creating a birth plan, this includes plans for getting to the birthplace and child care arrangement.
❒ Understanding fetal monitoring.
❒ Hydration during labor.
❒ Analgesia and anesthesia
Preparation for possible cesarean birth, including indications, advantages and disadvantages, risks, partner’s
involvement.

THEORIES OF LABOR ONSET

A number of theories of why labor occurs follow:
1. Uterine Stretch Theory
▪ Any hollow body organ stretched to capacity will contract and empty. By analogy, a uterus stretched to
capacity by a mature fetus may also be “ripe” for emptying. This is an old theory of the cause of labor
onset.

2. Oxytocin Theory
▪ It is well established that Oxytocin administered to a woman at term will initiate labor; if administered
during labor, it acts to strengthen uterine contractions, assisting labor.

3. Progesterone Deprivation Theory

▪ Also known as the estrogen/ progesterone shift, where estrogen excites the uterine response, and
progesterone quiets the uterine response. A decrease of progesterone allows estrogen to stimulate
contractile response of the uterus.

4. Fetal Adrenal Response Theory

▪ Fetal Cortisol, produced by the fetal adrenal glands, rises and acts on the placenta to reduce
progesterone formation and increase prostaglandin.

5. Prostaglandin Initiation Theory

▪ 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.
▪ That prostaglandins can initiate uterine contractions has been established by the usefulness of
prostaglandins in induced abortion.

LABOR
❒ The physiologic and mechanical process in which the baby, placenta, and fetal membranes are propelled
through the pelvis and expelled from the birth canal.
❒ The process by which the fetus and products of conception are expelled as the result of regular,
progressive, frequent, and strong uterine contractions.
FACTORS AFFECTING LABOR & DELIVERY

1. Passage/ Passageway
❒ This refers to the adequacy of the pelvis and birth canal in allowing fetal descent; factors include:

ANATOMY OF THE BONY PELVIS

a. Parts: ischium, ilium, sacrum, coccyx

b. Joints: sacroiliacs, sacrococcygeal, symphysis pubis (all soften during pregnancy).

c. Divisions: False pelvis supports the enlarged uterus in the abdominal cavity. True pelvis is the bony
inner pelvis through which the baby must pass.

d. Diameters: Inlet- true conjugate (anteroposterior diameter, transverse (widest diameter at inlet), right
and left oblique diameters
Outlet- conjugate diagonal (anteroposterior is widest in diameter, transverse (one ischial tuberosity
to the other)

Classification of pelvis:
1. Gynecoid (normal female pelvis)
▪ Normal female pelvis has an ample pubic arch, curved sacrum, curve side walls, blunt ischial spines
and a movable coccyx.
▪ A typical female pelvis with a round inlet.
2. Android (male pelvis)
▪ A normal male pelvis with a heart-shaped inlet
3. Anthropoid
▪ An “apelike” pelvis with an oval inlet
4. Platypelloid
▪ A flat, female-type pelvis with a transverse oval inlet
Note: pelvic size and structural irregularities can alter labor and birth.

e. Ability of the uterine segment to distend, the cervix to dilate, and the vaginal canal and introitus to
distend (expand).

2. Passenger
▪ This refers to the fetus and its ability to move through the passageway, which is based on the
following:
a. Size of the fetal head and capability of the head to mold to the passageway.
b. Fetal presentation- the part of the fetus that enters the maternal pelvis first.
c. Fetal attitude- the relationship of fetal parts to one another
d. Fetal position- the relationship of a particular reference point of the presenting part and the
maternal pelvis, described with a series of three letters.

Determining Fetal Position, presentation and lie:

Four methods can be used to determine if the fetus is in an optimal position for birth:
▪ Determining the place on the woman’s abdomen where fetal heart tones are heard strongest
▪ Abdominal inspection and palpation, called Leopold maneuvers
▪ Vaginal examination
▪ Sonography

LEOPOLD’S MANEUVER
Leopold maneuvers are a systematic method of observation and palpation to determine
fetal presentation and position and are done as part of a physical examination. Preferably performed after 24
weeks gestation when fetal outline can be already palpated.

Preparation:
1. Instruct woman to empty her bladder first.
2. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place
a small pillow under the head for comfort.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions).
6. Use the palm for palpation not the fingers.

Purpose Procedure Findings

First To Using both hands, feel for the Head is more firm, hard and
Maneuver: determine fetal part lying in the fundus. round that moves
Fundal Grip fetal part independently of the body.
lying in the Breech is less well defined that
fundus. moves only in conjunction with
To the body.
determine
presentation
.
Second To identify One hand is used to steady Fetal back is smooth, hard, and
Maneuver: location of the uterus on one side of the resistant surface
Umbilical fetal back. abdomen while the other Knees and elbows of fetus feel
Grip To hand moves slightly on a with a number of angular
determine circular motion from top to nodulation
position. the lower segment of the
uterus to feel for the fetal
back and small fetal parts.
Use gentle but deep
pressure.
Third To Using thumb and finger, The presenting part is not
Maneuver: determine grasp the lower portion of engaged if it is not movable.
Pawlik’s engagement the abdomen above It is not yet engaged if it is still
Grip of presenting symphysis pubis, press in movable.
part. slightly and make gentle
movements from side to side.
Fourth To Facing foot part of the Good attitude – if brow
Maneuver: determine woman, palpate fetal head corresponds to the side (2nd
Pelvic Grip the degree pressing downward about 2 maneuver) that contained the
of flexion of inches above the inguinal elbows and knees.
fetal head. ligament. Poor attitude – if examining
To Use both hands. fingers will meet an obstruction
determine on the same side as fetal back
attitude or (hyperextended head)
habits. Also palpates infant’s
anteroposterior position. If
brow is very easily palpated,
fetus is at posterior position
(occiput pointing towards
woman’s back)
3. Power
▪ This refers to the frequency, duration, and strength of uterine contractions to cause complete cervical
effacement and dilation.
▪ The third important requirement for a successful labor is effective powers of labor. This is the force
supplied by the fundus of the uterus and implemented by uterine contractions, which causes cervical
dilatation and then expulsion of the fetus from the uterus. After full dilatation of the cervix, the
primary power is supplemented by use of a secondary power source, the abdominal muscles. It is
important for women to understand that they should not bear down with their abdominal muscles to
push until the cervix is fully dilated. Doing so impedes the primary force and could cause fetal and
cervical damage.

4. Psyche or a woman’s psychological outlook

▪ Refers to the psychological state or feelings a woman brings into labor. For many women, this is a
feeling of apprehension or fright. For almost everyone, it includes a sense of excitement or awe.
▪ Women who manage best in labor typically are those who have a strong sense of self-esteem and a
meaningful support person with them. These factors allow women to feel in control of sensations and
circumstances they have never experienced before and which may not be what they pictured (Hodnett,
Gates, Hofmeyr, et al., 2013). Women without adequate support can have a labor experience so
 frightening and stressful that they develop symptoms of posttraumatic stress disorder (PTSD) (Beck,
2016).
▪ Encourage women to ask questions at prenatal visits and to attend preparation for childbirth classes so
they are as well prepared for labor as possible. Encourage them after birth to talk about and share
their experience because a “debriefing time” can be an important way to help them appreciate
everything that happened and integrate the experience into their total life.

FUNCTIONAL RELATIONSHIPS OF PRESENTING PARTS

FETAL ATTITUDE
▪ Relationship of fetal parts to each other.
▪ It describes the degree of flexion the fetus assumes.
▪ A fetus in good attitude is in complete flexion: the spinal column is bowed forward; the head is flexed
forward so much that the chin touches the sternum; the arms are flexed and folded on the chest; the
thighs are flexed onto the abdomen; and the calves of the legs are pressed against the posterior aspect of
the thighs. This is the normal “fetal position”.
▪ If a fetus is in poor attitude, the back is arched, the neck is extended, and the occipitomental diameter of
the head is presented to the birth canal. This is an unusual position; it represents too wide a skull diameter
to the birth canal for normal delivery.

ENGAGEMENT
▪ When the presenting part has settled far enough into the pelvis to be at the level of the ischial spines, a midpoint of
the pelvis.
▪ Descent to this point means that the significant diameter of the presenting part of the fetus has passed through the
pelvic inlet or the pelvic inlet is adequate for delivery.

FETAL LIE
▪ Relationship of the long axis of the fetus to the long axis of the mother
▪ Transverse if the fetus is lying in a horizontal position.
▪ Longitudinal (cephalic or breech) if the fetus is lying in a vertical position.
▪ About 99% of fetuses assume a longitudinal lie.

FETAL PRESENTATION
▪ Fetus’ body part that engages in the true pelvis
✔ Cephalic (head): vertex, brow, face, mentum
✔ Breech: frank, complete, single, or double footling
✔ Shoulder: cannot be delivered vaginally

FETAL POSITION
▪ Relationship of presenting parts to four quadrants of the mother’s pelvis (the letters L and R are used for left or
right; A and P for anterior or posterior; O for occiput; M for mentum or face; S for sacrum).
✔ Vertex: occiput, LOA, LOP, ROA, ROP
✔ Face: chin (mentum), LMA, LMP, RMA, RMP
✔ Breech: sacrum, LSA, LSP, RSA, RSP
STATION
▪ Relationship of presenting part to the false and true pelvis
1. Floating: presenting part movable above the true pelvic inlet
2. Engaged: suboccipitobregmatic diameter fixed into the pelvic inlet
3. Station 0: presenting part at level of the ischial spines: levels below spines +1, +2, +3; levels above
spines -1, -2, -3
4. Crowning: it occurs when the fetus’ head or presenting part appears at the vaginal opening.
COMMON SIGNS OF LABOR
Clinical Findings Prior to Labor (Premonitory Signs)
1. Physiologic
A. Lightening
▪ Fetus drops down into the true pelvis
▪ The descent of the fetus and uterus into the pelvic cavity 2 to 3 weeks before onset of labor.

B. Braxton Hicks Contractions

▪ Painless tryout contractions in preparation for true labor
▪ Irregular, intermittent contractions that have occurred throughout the pregnancy, become
uncomfortable, and produce a drawing pain in the abdomen and groin.

C. Increased vaginal secretions

D. Cervical Changes (softening of the cervix)

▪ Include softening, “ripening,” and effacement of the cervix that will cause expulsion of the mucus
plug (bloody show) and increased vaginal discharges.
● Effacement is the shortening and thinning of the cervical canal from its normal length of 1 to 2 cm to a
structure with paper-thin edges in which no canal distinct from the uterus appears to exist.
● Dilatation denotes the enlargement of the cervical canal from an opening a few millimeters wide to
one large enough to permit passage of the fetus (about 10 cm)

E. Rupture of Membranes (ROM)

▪ May occur before the onset of labor.
▪ For confirmation fluid can be tested with nitrazine paper

F. Bloody Show
▪ Softening and effacement of the cervix causes mucus plug to be expelled; this is accompanied by
small blood loss.

G. Weight loss
▪ About 1 to 3 pounds may occur 2 to 3 days before onset of labor.

H. Urinary frequency returns

I. Backache

2. Psychologic: mother shows signs of nesting (increased activity) caused by sudden rise in energy level.

Clinical Findings of True Labor

1. Uterine contractions that increase in frequency, strength, and duration and do not disappear when lying
down or walking around.
2. Effacement and progressive dilation of the cervix.

FALSE LABOR TRUE LABOR

⮚ Contractions may be regular ✔ Regular contractions
⮚ Decrease in frequency and intensity ✔ Progressive frequency and intensity
⮚ Longer intervals between contractions ✔ Shorter intervals between contractions
 ⮚ Discomfort in lower abdomen and groin
⮚ Activity such as walking either has no
effect or decreases contractions
⮚ Contractions disappear while the woman
is sleeping
⮚ Sedation decreases or stops contractions
⮚ Bloody show usually not present
⮚ No appreciable change in the cervix
✔ Discomfort begins in back and radiates to
the abdomen
✔ Activity such as walking increases
contractions
✔ Contractions continue while the woman is
sleeping
✔ Sedation does not stop contractions
✔ Bloody show usually present
✔ Progressive thinning and opening of the
cervix.

MECHANISMS OF LABOR: rotation of vertex presentation through the true pelvis.

The mechanical steps the baby undergoes can be arbitrarily divided, and clinically they are usually broken
down into six or eight steps for ease of discussion. It must be understood, however, that these are arbitrary
distinctions in a natural continuum.

The following seven divisions of labor are easy to use:

1. Engagement.   This occurs at various times before the forces of labor begin.
2. Descent.   This occurs as a result of active forces of labor.
3. Flexion
4. Internal Rotation.   This occurs as a result of impingement of the presenting part on the bony and soft
tissues of the pelvis.
5. Extension.   This is the mechanism by which the head normally negotiates the pelvic curve.
6. External Rotation (Restitution).  This is the spontaneous realignment of the head with the shoulders.
7. Expulsion.  This is anterior and then posterior shoulders, followed by trunk and lower extremities in rapid
succession.
STAGES OF LABOR AND DELIVERY

1. First Stage (Dilatation Stage)

▪ From the onset of true labor to complete effacement and dilation of the cervix.
A. Latent Phase
✔ Mild, short contractions, cervix dilated 0 to 3 cm
✔ Mother excited and happy that labor has started some apprehension; follows directions readily.

B. Active Phase
✔ Moderate to strong contractions 5 minutes apart, cervix dilates from 4 to 7 cm, bloody show,
membranes may rupture, breathing techniques help in relaxing.
✔ Medications may be necessary for discomfort, supportive measures (e.g., encouragement, praise,
reassurance, keeping the mother informed of progress, providing rest between contractions,
presence of a supporting person) by the husband or nurse help; has difficulty in following
directions.

C. Transition Phase
✔ Strong contractions 1 to 2 minutes apart (lasting 45 to 60 seconds or more with little rest in
between).
✔ Cervix dilates from 7 to 10 cm with a bloody show.
✔ Mother becomes irritable, restless, agitated, highly emotional, belches, has leg tremors, perspires,
pale white ring around mouth (circumoral pallor), flushed face, sudden, nausea, and vomiting
✔ Mother feels need to have a bowel movement because of pressure on anus; unable to
communicate or follow directions.
2. Second Stage (Expulsive Stage)
▪ Beginning with full dilation of the cervix and ending with birth of the infant.
▪ Perineum bulges, pushing with contractions, grunting sounds, behavior changes from great irritability to great
involvement and work, sleep and relaxation occur between contractions, leg cramps are common.

3. Third Stage (Placental Stage)

▪ Following birth of the infant through expulsion of the placenta.
▪ Placental separation (5 to 30 minutes) after delivery heralded by globular formation of uterus, lengthening of
umbilical cord, and gush of blood.
▪ May have alteration in perineal structure either from episiotomy (prophylactic incision into perineum to allow
for delivery of head) or laceration (may be 1, 2, 3, or 4 degrees) from rapid expulsion of presenting part.

4. Fourth Stage (Recovery and Bonding)

▪ Following expulsion of placenta to 3 to 4 hours after delivery
▪ Fundus firm in the midline and at or slightly above the umbilicus
▪ Scant, bloody vaginal discharge (lochia rubra)
▪ Fatigue, thirst, chills, nausea; excitement and intermittent dozing.

DANGER SIGNS DURING LABOR AND DELIVERY

There is a wide variation in the pattern of labor contractions and maternal response to labor and delivery.
Certain signals alert you that the course of event is deviating too far from normal.
FETAL DANGER SIGNALS PROBABLE CAUSE
▪ Decreasing fetal heart rate (below 100
beats/ minute). ⮚ Hypoxia is developing.

▪ Increasing fetal heart rate (above 160 beats/

minute). ⮚ Hypoxia is developing.

▪ Abnormal fetal monitoring patterns ⮚ Hypoxia from cord compression or

placental insufficiency
▪ Meconium staining.
⮚ Anoxia with vagal stimulation.
▪ Hyperactivity.
⮚ Hypoxia
▪ Fetal acidosis (fetal blood pH below 7.2)
⮚ Hypoxia
MATERNAL DANGER SIGNALS PROBABLE CAUSE
▪ Decreasing blood pressure. ⮚ Hemorrhage
▪ Increasing blood pressure. ⮚ Hypertension of pregnancy
▪ Increasing pulse rate (over 100 beats/
⮚ Hemorrhage
minute)
▪ Contractions longer than 70 seconds
⮚ Uterine tetany (fetal hypoxia will result
duration.
⮚ Cephalopelvic disproportion (uterine
▪ Pathologic retraction ring
rupture is imminent)
▪ Abnormal lower abdomen contour ⮚ A full bladder is in danger of rupture.
▪ Increasing apprehension ⮚ Psychological trauma or oxygen want.
POSSIBLE NURSING DIAGNOSIS

Mother
▪ Fear related to lack of knowledge and unfamiliarity with labor process
▪ Ineffective individual coping related to exhaustion
▪ Self-esteem disturbance related to inability to live up to behavioral expectations.
▪ Pain related to labor process and episiotomy.
▪ Impaired gas exchange related to hyperventilation.
▪ Impaired physical mobility related to need for fetal monitoring, bed rest, or positioning.
▪ Altered patterns of urinary elimination related to pressure of enlarged uterus, analgesia or anesthesia, and
trauma of labor and delivery.
▪ High risk for injury related to lack of control, especially during transition phase, position during delivery,
and administration of anesthesia.
▪ Altered cardiopulmonary tissue perfusion associated with hypovolemia related to uterine relaxation
following birth and/ or cervical lacerations.

Infant
▪ Decreased cardiac output related to prolonged contractions, short umbilical cord, head compression,
pressure on umbilical cord, or uteroplacental insufficiency.
▪ Ineffective airway clearance related to excessive mucus, aspiration of meconium, or inability to clear
airway.
▪ High risk for injury related to trauma of birth or maternal infection.
▪ Ineffective thermoregulation related to immature heat regulation, inability to shiver, and lack of brown fat.

NURSING CARE DURING INTRAPARTUM

FIRST STAGE

1. Admit mother and labor coach

a. Orient to unit
b. Obtain history
c. Obtain vital signs
d. Perform Leopold’s maneuvers
e. Time and assess contractions
f. Assist with vaginal examination
g. Do perineal prep and give enema if ordered
h. Test urine for protein and glucose
i. Collect blood for complete blood count (CBC) and cross-match
j. Give emotional support to mother and labor coach

2. Maintain asepsis; use universal precaution

3. Monitor frequency, duration, and strength of contraction

a. Palpate fundus
b. Interpret data on maternal uterine monitor
c. Prolonged contractions of 90 seconds or more may occur with administration of Oxytocin; discontinue
drug
4. Monitor Fetal Heart Rate (FHR)
a. Fetoscope
b. Internal or external fetal monitor

5. Interpret data of fetal monitoring

a. Baseline FHR: normal heart rate between uterine contractions is 120 to 160 beats per minute.

b. Tachycardia: heart rate above 160 beats per minute lasting over 10 minutes.

1) Transient tachycardia may occur with fetal activity; may be due to maternal fever, dehydration and
ingestion of drugs like atropine or ritodrine.
2) Nursing intervention includes reducing maternal fever, increasing fluids, and monitoring amnionitis.

c. Bradycardia: heart rate below 120 beats per minute lasting longer than 10 minutes.
1) May be due to fetal hypoxia; anesthetics used; maternal hypotension; prolonged umbilical cord
compression.
2) Nursing intervention includes repositioning mother on side assessing for prolapsed cord,
positioning to relieve pressure on cord, elevating lower extremities.

d. Variability: normal irregularity of cardiac rhythm; manifested by cyclic fluctuations and beat-to-beat
changes of heart rate; usually transient; often occurs with fetal tachycardia.

1) Absence of these fluctuations is indicative of fetal central nervous system (CNS) depression
2) Associated with drugs such as narcotics and barbiturates, fetal hypoxia, acidosis, and immaturity of
fetus.
3) Nursing intervention includes administration of oxygen, repositioning of mother on left side.

e. Decelerations: periodic decrease in FHR

1) Early decelerations
a) FHR decreases but not below 100 beats per minute
b) Occur early in contraction phase, before peak
c) Indicate head compression
d) No nursing intervention needed

2) Late decelerations
a) FHR rarely decreases below 100 beats per minute but, if severe, may decrease to 60 beats per
minute
b) Begin as contraction peaks with lowest rate after peak of contraction
c) Long recovery time; FHR may not return to normal until well after contraction ends.
d) Often associated with loss of variability; may be accompanied by Bradycardia or tachycardia.
e) Indicative of uteroplacental insufficiency caused by uterine tetany from Oxytocin
administration; maternal supine hypotension; regional anesthesia; hypertensive disorders;
diabetes mellitus; and other chronic disorders.
f) Ominous if persistent or associated with decreased variability
g) Nursing intervention includes discontinuing Oxytocin if being administered, positioning mother
on left side, administering oxygen by mask at 8 to 10 L/minute, increasing rate of intravenous
fluids, assisting with fetal blood sampling; preparing for delivery if there is no improvement.
6. Prevent supine hypotension by positioning the mother on the left side to keep the gravid uterus from
compressing vena cava.

7. Assist the mother with breathing techniques throughout labor by teaching and encouraging appropriate
breathing patterns in varying phases of labor and rebreathing techniques to correct and prevent
hyperventilation.

8. Use measures to promote comfort and rest by providing warmth, administering analgesics and
tranquilizers as ordered, except in the late phase of labor (less than 2 hours before birth) to prevent fetal
depression; encourage use of relaxation techniques and positions learned in childbirth classes; support and
encourage mother and coach.

9. Provide physical, emotional, and pharmacologic support as needed.

a. Provide pleasant, comfortable surroundings
b. Provide pharmacologic support as prescribed.
c. Provide support during contractions by coaching breathing, giving back rubs, and offering cool cloths.

10. Observe perineum for bloody show and appearance of amniotic fluid (indicates ruptured membranes);
note:
a. Amount
b. Color; if greenish, check for breech position and obtain fetal heart
c. Odor; if foul may indicate amnionitis
d. FHR following amniotomy to artificially rupture membranes (AROM)

11. Assess body fluids, bladder, and bowel function; offer the mother an opportunity to void every 1 to 2
hours to prevent trauma to the bladder during pushing and birth of the newborn.

12. Monitor for:

a. Prolonged strong contractions; may indicate tetanic uterus
b. Taut boardlike abdomen; may indicate abruption placenta
c. Increase in pulse and temperature; may indicate infection
d. Hypertension; may indicate preeclampsia
e. Hypotension; may occur following epidural or spinal anesthesia; turn client on side
f. Vaginal bleeding; may indicate placenta previa
g. Meconium-stained amniotic fluid; may indicate breech position or fetal distress
h. Abnormal variations in FHR patterns; may indicate fetal distress

SECOND STAGE (see also Essential Intrapartum and Newborn Care Management below)
1. Assist mother with pushing
2. Prepare for delivery when the perineal area is bulging in a primipara and when the cervix is dilated 7 to 8
cm in a multipara.
3. Prepare the delivery area with equipment and supplies.
4. Place the mother in the birthing position.
5. Assist the attending physician or nurse-midwife with the birth; help the support person to be supportive,
and check all vital signs and FHR.

THIRD STAGE
1. Implement immediate newborn care.
a. Establish and maintain a patent airway; and place the newborn on his side.
b. Compensate for poor newborn thermoregulation.
▪ Dry the newborn immediately with a warm blanket
▪ Wrap the newborn in a warmed, dry blanket or place the newborn on the mother’s skin.
c. Determine the Apgar score at 1 to 5 minutes after delivery.
d. Inspect the umbilical cord for two arteries and one vein.
e. Weigh and measure the newborn as his condition stabilizes.
f. Record the newborn’s first voiding and stool passage.
g. Assess the newborn’s gestational age.
h. Administer prophylactic eye medication to protect the conjunctiva from infection.
i. Administer vitamin K if prescribed.
2. Encourage initial parent-newborn bonding by placing the newborn in the mother’s arms with skin to skin
contact.
3. Record delivery and accompanying events

FOURTH STAGE
1. Palpate the fundus frequently for firmness and height in relation to umbilicus; if relaxed and dextroverted,
check for bladder fullness
2. Check for bladder distention; determine voiding pattern.
3. Check the perineum for vaginal and suture line bleeding; count vaginal pads; assess for concurrent uterine
relaxation; massage uterus.
4. Monitor temperature, blood pressure, and pulse; report fluctuations
5. Administer oxytocic medication as ordered; after delivery an oxytocic may be administered rapidly to
enhance uterine contractions
6. Check episiotomy or laceration site for hematoma, bleeding, or edema; apply icebag to perineum
immediately after delivery to reduce edema.
7. Keep warm; chills are common after delivery
8. Provide fluid and food as tolerated.
9. Document Intrapartum care:
a. Time and delivery of newborn and placenta
b. 1 and 5 minute Apgar score
c. Any immediate neonatal care provided
d. Extent and repair of perineal lacerations or episiotomy
e. Estimated maternal blood loss
f. Medications administered before, during, and after delivery
g. Placement of identification bands, foot printing, and fingerprinting
h. Maternal and newborn vital signs
i. Neonatal care given
j. Maternal or newborn voiding or bowel elimination
k. Maternal and newborn breastfeeding attempts and responses
l. Newborn’s condition when transferred to the nursery
m. Maternal condition when transferred to the postpartum unit.