LABOR & DELIVERY

DEFINITION OF TERMS
LABOR

- is the process of moving the fetus, placenta and membranes out of the uterus and through the birth canal. Synonymous with childbirth and parturition. – is the actual birth of

Delivery

baby

TRUE LABOR CONTRACTION Regular increasing frequency, duration & intensity Shortening of interval DISCOMFORT

FALSE LABOR Irregular No change in frequency, duration & intensity

Radiates from back around the Pain at abdomen abdomen REST /ACTIVITY Contraction does not decrease with rest or activity/ walking CERVIX Progressive effacement and dilatation of cervix Cervical changes does not occur yet Contraction may lessen with activity or rest

Escent of fetus into pelvic inlet Lightening pening cervical OS Dilatation oftening of the cervix
ontraction of uterus that are progressive & regular

upture of BOW
ffacement – progressive thinning & shortening of cervix

pprehension Ucus plug expulsion – bloody

A. First Stage
Stage of dilatation - Begins with true labor pain and ends with complete dilatation of the cervix
-

PHASES

DILITATION

DURATION/ INTERVAL

INTENSITY

LATENT

0-3 CM

10-30 sec, 5-30 mins.

Mild to moderate

ACTIVE

4-7 CM

30-40 sec. 3-5 mins

Moderate to strong

TRANSITION

8-10 CM

45-90 sec. 2-3 min

Strong

Duration – from the beginning of one contraction to the end of same contraction (A-B) Interval – from the end of one contraction to the beginning of the next contraction (B-C) Frequency – from the beginning of contraction to the beginning of next contraction (A-C)

Nursing Care
A.

Hospital admission – provides privacy and reassurance from the very start. Personal data – name, age, address, civil status Obstetrical data – determine EDC, obstetrical score, amount & character of SHOW, whether BOW have ruptured or not

2. General physical examination, internal exam and leopold’s are done to determine: EFFACEMENT AND DILATATION
STATION PRESENTATION PRESENTING POSITION

PART

3. Monitoring and evaluating
Uterine

contraction Blood Pressure Fetal Heart Rate

4. Emotional Support is provided 5. Health teachings

B. Second Stage
Stage

of Expulsion Begin with complete dilatation of the cervix and ends delivery of baby Contractions change from the characteristic crescendodecrescendo pattern to overwhelming uncontrollable urge to push or bear down with each contraction as if to move her bowels

Woman

perspire and the blood vessels in her neck may become distended Crowning takes place The need to push become intense and the woman cannot stop herself

6 Cardinal Movements of the Mechanism of labor ED FIRE ERE Engagement – presenting fetal
part at station or below
Descent

– downward movement of the biparietal diameter of the fetal head to within the pelvic inlet
◦ full descent occurs and the fetal head extrudes beyond the dilated cervix and touches the posterior vaginal floor

Flexion

– the head bends forward onto the chest, making the smallest anteroposterior diameter Rotation – the occiput rotates until it is superior, or just below the symphysis pubis, bringing the head into the best relationship to the outlet of the pelvis

Internal

Extension

– as the occiput is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head, the face and chin are born. External Rotation – almost immediately after the head of the infant is born, the head rotates (from the anteroposterior position it assumed to enter the outlet)

Expulsion

– the rest of the baby is born easily and smoothly because of its smaller part size. The end of the pelvic division of labor.

Nursing Care:
Put

both legs at the same time when positioning to the lithotomy position mother to push as fetal head crowns. If hyperventilation occurs, let patient breathe into a brown paper or a cupped hand.

Instruct

C. Stage 3   Placental Stage – begins from the
delivery of the baby up to the delivery of the placenta 2 Phases: a. Placental Separation Signs:
◦ Lengthening of the cord ◦ Sudden gush of blood ◦ Change of shape of the uterus

Types of Placental Presentation
Schultze’s – appearing shiny and glittering from the fetal membranes

Duncan – it looks raw, dirty, meaty, red and irregular(maternal surface)

b. Placental Expulsion - Brandt Andrew’s Maneuver – tract the cord slowly, winding it around the clamp until placenta spontaneously comes out rotating it slowly so that no membranes are left

Nursing Care:
Don’t

hurry the expulsion of the placenta, just watch for the signs of placental separation Take note of the time of placental delivery Inspect for the completeness of the placenta Palpate the uterus to determine degree of contraction. If relaxed, massage gently and apply ice cap Inspect for lacerations

Stage 4

(Puerperium Stage) – first 4 hours after delivery of placenta   Degrees of Perineal Lacerations: 1. First Degree – skin and superficial to muscle 2. Second Degree – muscles of the perineum 3. Third Degree – continues to anal sphincter

Episiotomy

– incision made to the perineum to enlarge the vaginal opening for easy delivery

Types: a. Midline/Median b. Mediolateral c. Lateral

Advantages: 1. Enlarging of the vaginal opening 2. Shortening of the second stage of labor 3. Minimizing the stretching of the perineal muscle 4. Preventing perineal tearing

POST PARTUM ASSESSMENT