Module 7 Labor Mwpo1

Southern Luzon State University
College of Allied Medicine
MW CO1
Module 7- Labor and Delivery
Course Description
The course deals with the concepts of normal pregnancy, labor and
delivery, puerperium and the care of the newborn, introduction of
concepts related to family planning and responsible parenthood. It
includes intravenous insertion vaginal examination and and suturing.
Class schedule: 3 Units, (3 hours week/ lecture)

Monday 6:00pm- 7:00pm/ Tuesday 8:00am- 9:00am
Dear students
This module is dedicated to the students of Southern Luzon
State University at College of Allied Medicine in support to distant
learning during this time of pandemic, we hope that the students who
read this module will prepare you to shape your future in the care of
Southern Luzon State Normal Obstetrics and to apply an immediate care to Newborn client.
University
Brgy Kulapi, Lucban
Quezon
cbaslan@slsu.edu.ph
[Your Phone]
(https://classroom.googl
e.com/cMjYooTgooTAwO
Dz)
MW C01 Normal OB and Immediate Newborn Care|Prepare by: Rodela Cristina l. Baslan RN RM MAN
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OVERVIEW
This module is a continues process of care by the midwives asking the obstetric history of the pregnant women and
the fetus development during first, second, and third trimester of pregnancy. Labor and delivery are the most exciting
learning experience by the student midwife but this requires skills, knowledge, and attitude. The student will be going
to learn on how to differentiate the true and false labor, able to observe the signs of the 4 stages of labor. This time
the student midwife has a great task to care for a woman who will going to give birth. Health teaching to the family is
also requires to promote a good patient midwife relationship.
LEARNING OBJECTIVES
At The end of the subject the student will be able to:

Describe common theories explaining the onset of labor and the role of passenger, passage,
powers and psyche in labor
Describe the woman’s physiologic and psychological responses to labor
Describe fetal responses to labor
Explain how each component of the birth process affects the course of labor and birth and the
interrelation of these components
Relate the mechanisms of labor to the process of vaginal birth
This topic provides basic information about normal labor and delivery. If you need information on
pregnancy, other types of childbirth, or the first 6 weeks after childbirth (postpartum)
Describe the woman’s physiologic and psychological responses to labor
Explain premonitory signs of labor
Differentiate true and false labor
Describe the ongoing assessment of maternal progress during the first, second, third and fourth
stages of labor
Describe the roles and responsibilities of midwives during labor and delivery
Explain the importance of family support in fostering maternal confidence and facilitating the
progress of labor and birth.
DISCUSSION
Labor" and "delivery" describe the process of childbirth. The series of physiologic and mechanical processes
by which all the product of conception is expelled from the birth canal.
Theories:
Causes of Uterine Stretch Theory: as uterus gets stretched, the contractibility of muscle increases.
Progesterone Deprivation Theory during pregnancy
there is a balance between the effect of estrogen and relaxing effect of progesterone on uterus.
a decrease in amount of the hormone progesterone therefore results in uterine contraction.
Oxytocin Theory
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stimulate uterine contraction

secreted by posterior lobe of pituitary gland
causes milk ejection from lactating mother breast
Prostaglandin Theory
originating fatty acid classified as hormones
stimulate uterine contraction
relative progesterone deprivation estrogen predominance set off production of cortical steroids which act as
lipid precursor to release Arachidonic Acid
Theory of Aging Placenta
decrease nutrients and blood supply in aging placenta causes uterine contraction
Premonitory signs of Labor
descent of presenting part into the true pelvis or sinking of the uterus in the pelvis.
settling of fetal head in the pelvic brim
Effects of Lightening
relief dyspnea and abdominal tightness
increase frequency of micturition/ voiding
shooting pain down the left-pressure on sciatic nerve
increase pedal edema and leg varicosities
Time of Lightening
Primigravida ➢10-14 days or about 2 weeks prior to onset of labor
Multigravida ➢a day or two before labor onset
Increase level of Activity
due to increase epinephrine release initiated by a decrease in progesterone produced by placenta.
Increase Braxton Hicks Contraction, 3-4weeks before labor painless, irregular and intermittent
uterine contraction
Relieved by walking and enema
Ripening of the Cervix
seen only on pelvic exam
cervix becomes even softer, described as “butter soft”
Rupture of BOW
maybe seen as sudden gush or scanty slow slipping of amniotic fluids
clear, colorless and contain white speeks of vernix caseosa
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Things to Consider in Rupture
True labor False labor

Contraction
Contraction
Occur at regular interval
Occur at irregular interval
PAIN
Pain
Start at the back and sweep around the
abdomen Interval Occur at irregular interval
Lumbosacral pain
Intensified by walking and enema
SHOW Present and increasing SHOW Absent/none
CERVIX CERVIX
Close, uneffaced Close, uneffaced
BOW
uterine contraction/ labor will occur within24 hours
integrity of uterus has been destroyed
umbilical cord compression may occur esp. if fetus is in breech position
If labor does not occur within the next 24 hours, IV drip of oxytocin is to be administered
Show
pinkish vaginal discharge, blood tinged mucus discharge from the cervix shortly before or during labor.
STAGES OF LABOR
1- FIRST STAGE – stage of cervical dilation and effacement
stage of cervical dilation and effacement
It starts with the first uterine contraction and ends with fully dilated cervix (10 cm dilatation)
Three Phases:
1. Latent – longest phase; most comfortable
1. cervix; 0-3 cm dilatation; complete effacement
2. contractions; mild, lasting for about 30-45 seconds with frequency of 5-8 minutes or over 10 minutes
mother; talkative, alert, excited, less anxious
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2. Active – cervix; 4-7 contractions; moderate, lasting for 45-60 seconds with 3 to 5 minutes frequency
mother; less talkative, more anxious, skin warm and flushed, may HYPERVENTILATE
Sign of hyperventilation: pallor, dizziness, lightens, tingling sensation in fingertips and lips
Management: allow mother to breathe into a paper bag or capped hands best stage for analgesia
3. Transition – most difficult phase for the mother cervix; 9-10 cm contractions: strong, lasting for 60-
90 seconds of 2-3 minutes frequency mother: increased perspiration, irritability, anxiety, with nausea
and vomiting, trembling legs, white ring around the mouth increased show; may have amnesia in
between contractions; out of control; in panic.
The woman in the transition may have the desire to push during contractions. But pushing should not be
done, when the cervix is not yet fully dilated to prevent caput succedaneum
II. SECOND STAGE – DELIVERY STAGE
A. It starts with full cervical dilatation and ends with the delivery or expulsion of the baby.
B. Contractions are strong: duration: 60-90 seconds; frequency: 2-3 minutes
C. Mother – with eagerness, and excitement
- perineum bulges; with spontaneous pushing during contractions; with increased bloody show.
- bags of water ruptures most commonly in early second stage
- crowning is the hallmark of the second stage of labor.
To effect gradual extension of the fetal head, RITGEN’S maneuver should be applied with the mother
PANTING AND NOT PUSHING during crowning.
D. Essential care in the second stage of labor
1. Coach mother on proper pushing/bearing down during contraction.
2. Monitor: contractions, maternal, BP, FHT
3. Provide psychological support; inform mother of progress
4. Transfer to the delivery room
a. Primigravida – when cervix is fully dilated with bulging of the perineum
b. Multigravida – when cervix is 8-9 cm dilated
c. Lithotomy – pads stirrups; equal height of legs, simultaneous placing of legs on stirrups
* alternate position – Fowler’s, side lying, squatting
d. Perineal prep front to back motion
5. Practice strict asepsis to prevent sepsis
6. With head extension
a. clear mouth and nose of secretions using bath syringe; wipe face
b. feel nape for cord coil
7. With expulsion
a. delay clamping of the cord until cord pulsation disappear to transfuse placental blood
to the baby. About 50 – 100 ml of blood is transfused to the infant if cord clamping is
delayed and his volume is enough to prevent anemia in infancy.
b. hold infant with back slightly bent and with the head in a dependent position for drainage
c. dry and warm infant falls; putting her on NPO can prevent vomiting and aspiration
of gastric contents.
The woman’s blood pressure should be monitored as these analgesic and anesthetic drugs are likely to
cause hypotension that can cause fetal bradycardia or fetal distress.
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MECHANISMS OF LABOR
I. The mechanisms of labor are called the CARDINAL MOVEMENTS of labor
II. The mechanisms of labor occur DEPENDENTLY on each other. The first
four mechanisms
(engagement, descent, flexion, and internal rotation) are necessarily in
such order. In some cases, flexion may be present before descent.
(E D F I E R E).
III. The 7 mechanisms of labor are:
A. ENGAGEMENT – the mechanism by which the greatest diameter of the fetal head (the BIPARIETAL
DIAMETER) passes through the pelvic inlet. The biparietal of the fetal head measures 9.5 cm and can be
revealed by ULTRASONOGRAPHY.
B. DESCENT – refers to the progress of presenting part through the pelvis.

Descent is the FIRST REQUISITE for the birth of the baby. It may occur earlier in a
NULLIPAROUS woman, descent usually begins with engagement.
FORCES TO DESCENT amniotic fluid pressure direct fundal pressure upon the breech
abdominal muscle contraction fetal body extension and straightening
* Crowning – encirclement of the largest diameter of the fetal head by vulvar ring
C. FLEXION – occurs when descending head meets resistance from the cervix, pelvic wall or floor. In
flexion, the chin is brought in contact with the chest.
* In flexion, the smallest anteroposterior diameter of the fetal head, the SUBOCCIPITOBREGMATIC
DIAMETER, (9.5 cm) presents.
D. INTERNAL ROTATION – turning of the head so that the occiput moves anteriorly toward the
symphysis pubis.
* Internal rotation allows long axis of fetal head o change from transverse diameter to an
anteroposterior diameter.
E. EXTENSION – delivery of the head in vertex presentation; emergence of the occiput under the symphysis
pubis, or head leaves the outlet.
In extension, the occiput is out first, then the face and finally the chin.
The duration of extension is controlled by the doctor;
1. Breaking of the bags of water; if it has not broken (to prevent aspiration of amniotic fluid)
2. Episiotomy to prevent tearing of the perineum, to shorten the second stage of labor and to
minimize/prevent trauma to the fetal head.
There should be GRADUAL extension of the fetal head. To accomplish this, the woman should not
push in crowning. She should pant, instead of effect gradual extension.
RITGEN’S MANEUVER/MODIFIED RITGEN’S MANEUVER – allows to control of the delivery of the

head. It allows GRADUAL EXTENSION of the fetal head.
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In RITGEN’S MANEUVER with a towel draped one gloved hand to protect it from the anus, exerts a
forward pressure on the chin of the fetus through the perineum, while the other hand
exerts pressure superiorly against the occiput.
As soon as the head extends, quickly wipe the face, mouth and nape of the baby to prevent
aspiration of amniotic fluid.
After clearing the nasopharynx, should feel the nape for any cord coil. If present and if loose enough,
the cord should be drawn down between the fingers and slipped over the infant’s head.
But if this action is impossible for the cord is too tight around the neck, it should double
– clamped, then cut between two clamps, followed by the delivery of the infant.
F. RESTITUTION – when the head rotates briefly to the position that it occupied when it was
engaged in the inlet. This restitution is followed by completion of external rotation
to the transverse position which corresponds to the rotation of the fetal body.
Restitution is EXTERNAL ROTATION. External rotation, is brought anteriorly behind
the symphysis and the other, posteriorly. The anterior shoulder is delivered first.
G. EXPULSION – final birth of the infant. Gentle but firm pressure downward pressure traction of the
head is done to deliver the anterior shoulder, -then the head is gently raised to
deliver the posterior shoulder. The entire body later follows without difficulty.
DURATION OF LABOR The duration of first labor is 12-14 hours, while that of the multigravida is 6-8 hours.
A danger signs of dystocia is when labor extends beyond 18 hours in primigravida and when it extends
beyond 14 hours in multigravida.
DYSTOCIA – prolonged difficult labor of 24 hours or more duration.
PRECIPITATE LABOR – short labor lasting for 2 hours or less; an emergency birth.
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III. THIRD STAGE: PLACENTAL STAGE

1. The stage of placental separation and delivery start with the delivery of the baby and ends with the
expulsion of the placenta.
2. Sign of Placenta Separation
a. CALKIN’S SIGN – uterus changes in shape and consistency becomes globular and firm:
FIRST SIGN
b. Uterus becomes mobile and it rises up in the uterus.
* Immediately after placental detachment, the fundus is midway between the symphysis pubis and
umbilicus; then rises to the level of umbilicus, midline and firm.
* If uterus is not in the midline, a full bladder likely is pushing it to the side. Assess for a full bladder and
stimulate voiding once identified.
c. Sudden gush of blood
d. Slight lengthening of the cord
3. Types of Placental Delivery/Presentation
a. SCHULTZ MECHANISM
More common; present in 80% of cases Shiny, clean side first delivered; bluish
Inverted umbrella in shape. Types where separation starts at the center, then to the sides
Less external bleeding because blood is usually concealed behind the placenta
b. DUNCAN’S MECHANISM Less common, present in 20% of cases Rough, “dirty”, reddish
Reddish maternal side out first Umbrella in shape More external bleeding so it appears “bloody”
In reality, the amount of blood loss in delivery whether the placenta is delivered by Schultz or
Duncan’s mechanism is 300 ml, with 500 ml as the upper limit. Bleeding exceeding 500 ml means
hemorrhage.
4. Brandt – Andrew Technique

- This is a technique of placental delivery where we wind the cord around the clamp until
placenta is borne. The placenta is then held and rotated gradually to ensures that no membranes
are retained.
5. Essential care in the Third Stage of Labor
A. Do not hurry the expulsion of the placenta by forcefully pulling out the cord or doing vigorous
fundal push as this cause uterine inversion. Just watch for the signs of placenta separation.
B. Tract the cord slowly, winding it around the clamp until placenta spontaneously comes out;
rotating it slowly so that no membranes are left inside the uterus, a method called Brandt –
Andrew maneuver. Note the time of placental delivery; should be delivered within 20 minutes
after delivery of the baby. Otherwise, refer immediately to the doctor.
C. Inspect for completeness or cotyledons; any placental fragment retained can lead to severe
bleeding and possible death.
D. Palpate the uterus to determine degree of contraction. If relaxed, boggy or non-contracted, first
nursing action is to massage gently and properly. An ice cap over the abdomen will also help the
contract the uterus since cold causes vasoconstriction
E. Inject oxytocins (Merthergin = 0.2 mg/ml or Syntocinon = 10 U/ml) IM to maintain uterine
contractions, thus prevent hemorrhage. Note: oxytocin is not given before placental delivery
because placental entrapment can occur.
F. Inspect the perineum for lacerations. Anytime the uterus is firm following placental delivery, yet
bright red vaginal bleeding is gusting forth from vaginal opening signifies lacerations.
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Categories of lacerations (tend to health ore slowly because of ragged edges)

First Degree – involves the vaginal mucous membranes and skin
Second Degree – involves not only the vaginal mucous membranes and the skin, but also the muscles.
Third Degree – involves not only the vaginal mucous membranes, the skin, the muscles and the
external sphincter of rectum, but also the mucous membrane of the rectum.
Assist the doctor doing episiorrhaphy (repair of episiotomy or lacerations). In vaginal episiorrhaphy, packing
is done to maintain pressure on the suture line, thus prevent further bleeding. Note: vaginal packs have to
be removed after 24-28 hours.
G. Make mother comfortable by perineal care and applying clean sanitary napkin snugly to prevent its
moving forward from the anus to the vagina. Soiled napkins should be removed from front to back.
H. Position the newly-delivered mother flat on bed without pillows to prevent dizziness due to decrease in
intra-abdominal pressure.
I. The newly-delivered mother suddenly complains of chills due to the rapid decrease of pressure, fatigue or
cold temperature in the delivery room. Management: Provide additional blankets
J. May give initial nourishment, e.g. milk, tea or coffee
K. Allow patient to sleep in order to regain lost energy
IV. FOURTH STAGE OF LABOR: RECOVERY STAGE
1.This is the period from the delivery of the baby to the first hour. This is considered the most DANGEROUS
for the mother as she can have hemorrhage from uterine atony.
2.Essential Care
a. Monitor vital signs every 15 minutes until stable
b. Palpate fundus every 15 minutes; check fundal height and position in relation to the umbilicus;
check consistency (firm or soft)
1. If relaxed, massage until firm, DO NOT COVER MASSAGE as this can tire the uterine muscles causing
relaxation.
2. If displaced to the side, the first action of the midwife is to feel the lower abdomen for a distended
bladder. If the bladder is full, stimulate the mother to void. It should be remembered that a full
bladder can cause the uterus to be relaxed.
3. Make sure the bladder is empty before fundic height determination. Ask the mother to void. An empty
bladder ensures ACCURATE RESULT.
c. Assess lochia
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d. Check for bladder distention. Determine mother’s first voiding.

e. Check the perineum: note general appearance, redness, swelling, bruising, vaginal bleeding
COUNT vaginal pads, Lochia is excessive if it can saturate a vaginal pad in 15 minutes.
Ice bag to perineum immediately after delivery can reduce edema and swelling.
f. Promote comfort; keep warm (chills-common); give partial bath; pericare; charge wet linens
g. Promote foods and fluids as tolerated
h. Promote BONDING. Early feeding can contract the uterus and promote bonding. Breastfeeding after
normal vaginal birth can be after 30 minutes.
PUERPERIUM
1. DEFINITIONS
A. Puerperium/Postpartum – refers to the six weeks period after delivery of the baby during
which reproductive organs undergo involution.
B. Involution – the return of the reproductive organs to their pre-pregnant state.
2 major changes:
1. Regressive – nerves backward into earlier state
2. Progressive – building new tissues
II. PRINCIPLES OF POSTPARTUM CARE

A. Promote healing and return to normal (involution) of different parts of the body.
1.Vascular changes
a. The 30%-50% increase in total cardiac volume during pregnancy will be re-absorbed into
the general circulation within 5-10 minutes after placental delivery. Implication: The first
5-10 minutes after placental delivery is crucial to gravida cardiac because the weak
heart may not be able to handle such workload.
b. White Blood Cell count (WBC) increases to 20,000-30,000/mm3. implication: The WBC count,
therefore, cannot be used as an indicator of postpartum infection.
c. There is extensive activation of the clotting factors, which encourages thrombo embolization.
This is the reason why:
Ambulation is done early after 4-8 hours in normal vaginal delivery. When ambulating the patient for the
first time, the nurse should hold onto the patient’s arm.
Exercises are recommended:
1. Legal and abdominal breathing on postpartum day 1 (PPD1).
2. Chin-to-chest-on second day to tighten and firm up abdominal muscles.
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3. Knee-to-abdomen when perineum has healed, to strengthen abdominal and gluteal muscles.
Massage is contraindicated.
d. All blood values are back to prenatal levels the third or fourth week postpartum.
2. Genital changes
a. Uterine involution is assessed by measuring the funds by fingerbreadths. On PPD 1-fundus
one fingerbreadths below the umbilicus on PPD 2 fingerbreadths below and so forth until on the
10th PPD, it can no longer be palpated, because it is already behind the symphysis pub
Involuted uterus – a big uterus and vaginal bleeding with clots. Since blood clots are good
media for bacteria, it is therefore a sign of puerperal sepsis.
b. To encourage return of the uterus to its usual anteflexed position, prone and knee-chest
positions should be advised.
c. After pains / after birth pains-strong uterine contractions felt more particularly by multis those
who delivered large babies or twins and those who breastfed.
Management:
* NEVER apply hot on abdomen
* Give analgesics, as ordered
* Explain that it is normal and rarely lasts for more than 3 days
d. Lochia – uterine discharge consisting of blood, decidua, WBC, mucus and some bacteria.
Pattern:
* Rubra – first 3 days postpartum; red and moderate in amount.
* Serosa – next 4-9 days; pink or brownish and decreased in amount.
* Alba – from 10th day up to 3-6 weeks colorless and minimal in amount.
Characteristics:
* pattern should not reverse
* it should approximate menstrual flow (it increases with activity and decreases with
breastfeeding)
* it should not have offensive odor. It has the same fleshy odor of menstrual blood.
Otherwise, it means either poor hygiene or infection.
* it should not contain large dots
* it should never be absent, regardless or method of delivery. Lochia has the same pattern and
amount, whether CS or normal vaginal delivery.
e. Pain in perineal region may be relieved by:
Sim’s position – minimizes strain on the suture line.
Perineal heat lamp or warm Seitz bath twice a day vasodilation increases blood supply and,
therefore, promotes healing.
Application of topical analgesics or administration of mild oral analgesics, as ordered.
3.
Urinary changes
a. There is a marked diuresis within 12 hours postpartum to eliminate excess tissue fluid
accumulation during pregnancy.
b. Some newly-delivered mothers may complain of frequent urination in small amounts;
explain that it is due to urinary retention with overflow. others, on the other hand, may
have difficulty voiding because of decreased abdominal pressure or trauma to the
trigone of the bladder. (is a smooth triangular region of the internal urinary bladder
formed by the two ureteric orifices and the internal urethral orifice).
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Voiding may be initiated by pouring warm and cold water over the vulva, encouraging the patient to go
to the comfort room and let her listen to the sound of running water. If these measures
fail, catheterization, done gently and aseptically, is the last resort on doctor’s order. (if
there is resistance to the catheter when it reaches the internal sphincter as patient to
breathe through the mouth while rotating the catheter before mobbing it inward again)
4. Gastrointestinal changes – delayed bowel evacuation postnatally be due to:
Decreased muscle tone
Lack of food + enema during labor
Dehydration
Fear of pain from perineal tenderness due to episiotomy lacerations or hemorrhoids.
5. Vital sign
a. Temperature may increase because of the dehydrating effects of labor.
Implication: any increase in body temperature during the first 24 hours
postpartum is not necessarily a sign of postpartum infraction.
b. Bradycardia (heart rate 50-70/minute is common for 6-8 days postpartum
c. There is no change in respiratory rate & BP
6. Weight
- there is an immediate weight loss of 10-12 lbs. representing the weights of the fetus, placenta,
amniotic fluid and blood. Further weight loss will occur during the next days due to diaphoresis. 5
lbs. loss in the second week.
7. Psychological phases
a.Taking a phase – first 1-2 days postpartum when mother is passive and relies on the others to
care for her and her newborn. She keeps on verbalizing her feelings regarding the recent
delivery for her to be able to integrate the experience into herself.
b. Taking hold phase – begins (and overwhelming feelings of sadness that cannot be accounted
for) may be observed. Could be due to hormonal changes, fatigue or feelings of inadequacy
in taking care of a new baby.
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Management: Explain that it is normal and that crying is therapeutic, in fact.

B. Prevent Postpartum Complication
1.Hemorrhage – blood loss of more than 500cc. (Normal blood loss during labor and delivery is 250-
350cc); cause of maternal mortality associated with childbearing.
a. Classification
1. Early Postpartum hemorrhage – if during the first 24 hours postpartum.
A. Uterine Atony – most frequent cause
1. Predisposing factors:
a. Overdistension of the uterus-e.g multiple pregnancy, multiparity, excessively large baby,
polyhydramnious
b. Caesarean Section
c. Placental accidents
d. Prolonged and difficult labor
2. Management:
a. Massage first action
b. Ice compress
c. Oxytocin administration
d. Emptying the bladder
e. Bimanual compression to explore retained placental fragments
f. Hysterectomy-last resort
B. Lacerations
C. Hypo fibriginemia- a clotting defect
II. Late postpartum hemorrhage
A. Retained placental figure
management: dilatation and curettage (D&C)
B. Hematoma – due to injury to blood vessels during delivery
1. Incidence: Commonly seen in precipitate delivery and those with perineal varicosities.
2. Treatment:
1. Ice compress during the first 24 hours
2. Oral analgesics as ordered
3. Site is incised and bleeding vessel is legated
2. Infection
a. Sources:
Endegenous (primary) sources – bacteria in the normal flora become virulent when tissues are
traumatized and general resistance is lowered.
Exogenous sources – pathogen induced from external sources. Organism most frequently
responsible for postpartum infections:
Anaerobic streptococci
Common exogenous sources:
Hospital personnel –most common excessive obstetric manipulations
Breaks in aseptic techniques – faulty hand washing, utensil, equipment and supplies
Coitus in late pregnancy
Premature rupture of the membranes
b. General symptoms: malaise, anorexia, fever, chills and headache
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c. General Management: complete bed rest (CBR), proper nutrition, increased fluid intake,
analgesics, antipyretics and antibiotics as ordered.
d. Types of infection:
Infection of the perineum
Specific symptoms
pain, heat and feeling of pressure in the perineum inflammation of suture line, with 1 or 2
stitches sloughed off with or without elevated temperature
Specific Management:
* Doctors remove sutures to drain area and restore.
* Hot sitz bath or warm compress
Endometriosis – inflammation/infraction of the lining of the uterus
Specific symptoms: abdominal tenderness, uterus not contracted and painful to touch
dark brown, foul smelling lochia
*Oxytocin
*Fowler’s position to drain out lochia and prevent pooling of infected discharge.
Thrombophlebitis – infection of the lining of the blood vessel with formation of clots; usually an extension
of endometriosis.
* Pain, stiffness and redness in the affected part of the leg
* Leg begins to swell below the lesion because venous circulation has been blocked
* Skin is stretched to a point of shiny whiteness, called milk leg- phlegmasia dolens . (Phlegmasia
cerulea dolens is an uncommon, severe form of deep venous thrombosis - blood
clots in the vein). It most often occurs in the upper leg.
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Positive Homan’s sign – pain in the leg when the foot is dorsiflexed.
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** Bed rest with affected leg elevated
** Analgesic, but NEVER Aspirin because it causes bleeding and thus can dislodge the clot and cause
pulmonary embolism.
Side Effects: hematuria, and increasd lucjia
* Monitor prothrombin time
* Always have Protamine Sulfateor Vitamin K at bedside to counteract toxicity.
C. Establish successful lactation
Physiology of breast milk production
DECREASED ESTROGEN AND PROGESTERONE LEVELS

After placental delivery --→ stimulates anterior pituitary gland to produce prolactin → acts
on acinar cells to produce foremilk → stored in collecting tubules.
WHEN INFANT SUCKS → posterior pituitary gland is stimulated to produce oxytocin → causes
contraction of smooth muscles of collecting tubules → milk ejected forward → LET DOWN or MILK
EJECTION REFLEX mindmilk → is produced.
Implications of physiology of breast milk production:
Regardless of the mother’s physical condition, method of delivery or breast size, milk will
be produced.
Lactation does not occur during pregnancy because estrogen and progesterone are present and,
therefore, inhibit production of prolactin.
Lactation – suppressing agents are to be given immediately after placental delivery to be effective.
Oral contraceptives are contraindicated in lactating mothers because they decrease milk supply.
After pains are felt more of breastfeeding women because of oxytocin production; they
also have lochia and experience more rapid uterine involution.
In emergency delivery when the uterus would not contract, put the infant to the breast.
During initial contact in emergency, determine whether the woman in labor is a primi or a multi,
the EDC and also assess the stage of labor. And if no sterile equipment is available to cut the cord,
wrap the baby and the placenta together, never cut the cord unless sterile equipments are
available.
3. Health Teachings
a. Hygiene Wash breast daily at bath or shower time. Soap and alcohol should not be used
as they tend to dry and crack the nipple sand to sore nipples. Wash hands before and after
every feeding, insert clean OS squares in the brassiere to absorb moisture when there is
considerable breast discharge.
b. Method – as suggested by the La Leche League
Side – lying position with a pillow under the mother’s head while holding the bulk of breast
tissues away from the infant nose
Stimulate the baby to open his mouth to grasp the nipple by means of the rooting reflex
Infant should grasp not only the nipple but also the areola for effective sucking motion.
Effectiveness is ensured when:
*- The baby’s mouth parts “hike well up” into the areola
*- The mother felt after pains as the body sucks
*- The other nipple flows with milk, to:
To prevent nipples from becoming sore and cracked, infant should be introduced to the breast
gradually. The baby should be fed for only 5 minutes at each breast by 1 minute per day until the
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infant is nursing for 10 minutes at each breastfeeding, making a total feeding time of 20 minutes per
feeding. For continuous milk production, at each feeding, the infant should be placed first on the
breast she fed last in the previous feeding. This ensures that each breast will be completely emptied
at every other feeding. If breasts are completely emptied, they completely refill again; if only half
emptied, will half-refill and after a time, will become insufficient.
To break away from the closed suction at the breast after feeding insert a clean finger in the corner
of the infant’s mouth to release the suction, then pull the chin down. This also helps prevent sore
nipples.
Feed as often as the baby is hungry, especially during the first few days, because he is receiving
colostrum, which is not very filling; however, it contains the only group of substances that can never
be replicated by any artificial formula, the gamma globulin.
Advise the mother to learn how to relax because tension prevents good-let-down.
c. Associated Problems
Engorgement – feelings or tension in the breasts during the third postpartum day, sometimes accompanied
by an increase in temperature (milk fever). The breasts become full, feel tense and hot with
throbbing pain. It lasts for about 24 hours and is due to increase lymphatic and venous
circulation.
Management:
Advise use of firm fitting brassiere for good support. It will not only decrease the
discomfort from breast engorgement but also prevents contamination of the nipples and
areola.Cold compress is applied if mother does not intend to breastfeed; warm compress
is applied if she is desirous to breastfeed.
Breast pump is not used nor do breasts manage done if and mother is not going to breastfeed, since either
will only stimulate milk production. When doing breast manage, put thumbs on the areola
margin, push inward and backward toward the chest wall until secretions flow.
Sore nipples – are not contraindications to breastfeeding
Management:
Expose nipples to air by leaving the bra unsnapped for 10-15 minutes after feeding.
When normal air dying is not effective, exposure to a 20-watt bulb placed 12-18 inches
away. Do not use plastic liners that are found in some nursing bras because they prevent
air from circulating around the breasts. Use nipple shield
Mastitis – inflammation of the breasts
Symptoms:
Localized pain, swelling and redness in breast tissues
Lumps in the breast
Milk become scanty
Management:
Antibiotics, as ordered
Ice compress
Proper breast support
Discontinue breastfeeding in affected area
d. Nutrition – lactating mother should take 3000 calories daily and should have larger amounts of proteins
(96 gms/day) calcium, iron, Vitamin A, B and C. Non-breastfeeding women can have the
same caloric requirements as in pregnancy.
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SY 2020-2021
e. Contraindications:
Drugs – oral contraceptives, atropine, antigoagulants, antimetabolites, cathartics,
tetracyclines. Insulin (diabetes, therefore is not contraindicated), epinephrine, most
antibiotics, antidiarrheas or antihistamines are generally not contaminated.
Certain disease conditions, specifically tuberculosis because of the close contact between
mother and baby during feeding. No TB germs are ever transmitted through breast milk.
f. Motivate use of family method

Birth spacing and postpartum family planning
Family planning is about deciding how many children you choose to have and when you want to have
them (timing of pregnancies and birth spacing). The recommended interval before
attempting the next pregnancy is at least 24 months in order to reduce risks to the mother
and infant. A woman can become pregnant within several weeks after birth if she has
sexual relations and if she is not breastfeeding exclusively. It is important that as a health
worker you discuss the importance of family planning and birth spacing, and help couples
in choosing the contraceptive method that is right for them.
Method
LAM- (breastfeeding) start immediately after childbirth; can use if exclusively breastfeeding day and night
for up to 6 months or until periods return n/a . effective with correct use, few side effects.
IUD - insert within 2 days of childbirth, or from 4 weeks after childbirth. insert within 2 days of childbirth,
or from 4 weeks after childbirth effective, long term method but may have side-effects.
Female sterilization - perform within 7 days, or from 6 weeks after childbirth. effective, permanent method,
fewer side-effects.
Combined pill - (estrogen & progestogen) From 6 months after childbirth From 3 weeks after childbirth
effective with careful use, may have side-effects.
Monthly injection - (combined) From 6 months after childbirth From 3 weeks after childbirth. Very
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SY 2020-2021
Mini-pill - (progestogen only) from 6 weeks after childbirth from immediately after childbirth. effective
with careful use, may have side-effects.
DMPA and NET-EN- (3 or 2 month injection) from 6 weeks after childbirth from immediately after childbirth
Implants from 6 weeks after childbirth from immediately after childbirth effective, long term
method but may have side-effects
Condoms From immediately after childbirth from immediately after childbirth Effective with careful
use
Diaphragm From 6 to 12 weeks after childbirth (depending on when the uterus and cervix return to
normal) from 6 to 12 weeks after childbirth (depending on when the uterus and cervix
return to normal) effective with careful use.
Fertility awareness- based methods when periods return to normal, When periods return to normal
effective with careful use
ACTIVITY
1. Explain the postpartum immediate care (BUBBLEHEB) give the Midwifery interventions
2. Enumerate 7 mechanism of labor- give midwifery management.
References:
References: Ladewig P. et al (2014) Contemporary Maternal-Newborn Nursing, 8th Edition
Mckinney E. et al. (2013) Maternal-Child Nursing, 4rth Edition, Elsevier Inc.
Murray, Sharon Smith and McKinley Emily Slone, Foundations of Maternal-Newborn and Women’ s
Health Nursing
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SY 2020-2021
Images and pictures adopted to pinterest
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SY 2020-2021

Module 7 Labor Mwpo1

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Module 7 Labor Mwpo1

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Southern Luzon State University

College of Allied Medicine

Module 7- Labor and Delivery

Class schedule: 3 Units, (3 hours week/ lecture)

At The end of the subject the student will be able to:

stimulate uterine contraction

Things to Consider in Rupture

True labor False labor

B. DESCENT – refers to the progress of presenting part through the pelvis.

RITGEN’S MANEUVER/MODIFIED RITGEN’S MANEUVER – allows to control of the delivery of the

III. THIRD STAGE: PLACENTAL STAGE

4. Brandt – Andrew Technique

Categories of lacerations (tend to health ore slowly because of ragged edges)

IV. FOURTH STAGE OF LABOR: RECOVERY STAGE

d. Check for bladder distention. Determine mother’s first voiding.

II. PRINCIPLES OF POSTPARTUM CARE

Management: Explain that it is normal and that crying is therapeutic, in fact.

DECREASED ESTROGEN AND PROGESTERONE LEVELS

f. Motivate use of family method

2. Enumerate 7 mechanism of labor- give midwifery management.

Mckinney E. et al. (2013) Maternal-Child Nursing, 4rth Edition, Elsevier Inc.

Images and pictures adopted to pinterest

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