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PLACENTAL STAGE
is the period from birth of the baby through delivery of the placenta
Lengthening of the umbilical cord Sudden gush of vaginal blood Change in shape of the uterus (globular) Firm contraction of the uterus Appearance of the placenta at vaginal opening
PLACENTAL EXPULSION
After separation, placenta is delivered either by: -the natural bearing down effort of the mother or -gentle pressure on the contracted uterine fundus by the physician or nurse-midwife (Credes maneuver)
MECHANISM
SCHULTZE
DUNCAN
INFORMATION TO RECORD
a. Time the placenta is delivered. b. How delivered (spontaneously or manually removed by the physician). c. Type, amount, time and route of administration of oxytocin. Oxytocin is never administered prior to delivery of the placenta because the strong uterine contractions could harm the fetus. d. If the placenta is delivered complete and intact or in fragments.
Pharmacology
OXYTOCIN (PITOCIN)
ACTION It stimulates the uterus to contract to control postpartum hemorrhage -10-40 units to 1L intravenous solution Hypertension Monitor blood pressure
DOSAGE
-slightly increase during the first 24 hours because of dehydration during the labor
Pulse
-usually slightly slower than normal during the
postpartal period
Respiratory Rate
- maybe fairly rapid immediately after birth
Blood Pressure
- decrease in BP can indicate bleeding -Elevation above 140 mmHg systolic may indicate the development of postpartal PIH -Oxytocics may increase BP
5. Provide warmth
-offer a clean gown or warmed blanket
delivery of the head. Suction secretions from mouth and nose. -Compress bulb syringe before inserting -Suction mouth first, then, the nose -Insert bulb syringe in one side of the mouth
Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions
Trendelenburg position head lower than the body Side lying position If trendelenburg position is contraindicated,place infant in side lying position to to permit drainage of mucus from the mouth.
Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until they are about 3 weeks old.
2.WARM
-rub dry -Take auxillary temperature at the end of the first hour of life then every 4 hours for the 1st 24 hours of life -If rectal the purpose is to detect bowel imperporate anus
Do not slap the buttocks rather rub the soles of the feet. Stimulate to cry after secretions are removed. The normal infant cry is loud and husky.
High, pitched cry indicates hypoglycemia, increased intracranial pressure. Weak cry prematurity Hoarse cry laryngeal stridor
5.EYE CARE
Crede Treatment- Gonorrheal conjunction prophylaxis
Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.
7. Initial Feeding
-may breastfeed immediately after birth
(Breastfeeding and Rooming in Act of 1992 RA 7600 Also promotes breastfeeding and requires immediate rooming in of the newborn)
8.BATHING
Complete bath within an hour after birth to remove vernix caseosa
(current practice in some settings delays bathing after an hour and vernix caseosa is spread throughout the newborns body for temperature maintenance)
Mild soap Proceed from the cleanest to the dirtiest area of the body
9.IDENTIFICATION
Foot stamping Nametag
APGAR SCORING
The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborns adjustment to extrauterine life.
APGAR SCORING
Score: 7 10 Good adjustment, vigorous 4-6Moderately depressed infant, needs airway clearance 0-3Severely depressed infant, in need of resuscitation.
The cells and antibodies in breast milk protect babies from illness.
Breast milk is easier to digest Breast milk is easier to digest than formula. The proteins in formula are made from cows milk and it takes time for babies stomachs to adjust to digesting them. Breastfeeding provides maternal bonding
It can help them feel more secure, warm, and comforted
Breastfeeding is economical
Formula and feeding supplies can cost well