Week 10: Labor and Delivery Methods

Preterm Labor

Uterine contractions and cervical changes between 20 weeks and 36 weeks + 6 days gestation.

• Moderately Preterm: 32-34 weeks.

• Late Preterm/”Early Bird”: 34-36 weeks.

Complications of Preterm Labor

Include asthma risk, cardiac issues, neurological risk (cerebral palsy), gastrointestinal problems, and sepsis.

COAT Assessment for Water Breakage

Color (clear; brown/green indicates meconium/aspiration risk)

Odor (clean; odorous indicates infection)

Amount (about 1 liter)

Time (delivery within 24 hours to prevent infection).

Symptoms of Concern of COAT Assessment

Change in vaginal discharge, pelvic/abdominal pressure, low-back pain, mild cramping, gush/trickle of water, or more than 4 contractions in 1 hour.

Risk Factors for Preterm Labor

Infections (UTI, HIV, active HSV, chorioamnionitis), previous preterm births, multifetal pregnancies, substance use, history of abuse, lack of prenatal care, uterine abnormalities, and low pre-pregnancy weight.

Nifedipine- Meds for PTL

Calcium channel blocker; suppresses contractions.

Caution: Do not administer with magnesium sulfate or beta-adrenergic agonists.

Magnewsium Sulfate- Meds for PTL

Tocolytic; depresses the CNS and relaxes smooth muscle. It can also be used for preclampsia. 

Antidote is 10% Calcium Gluconate.

Terbutaline- Meds for PTL

Beta-adrenergic agonist; relaxes smooth muscle. Turbulence delays the arrival time

Dosage: 0.25 SQ.

Monitor cardiac output.

Indomethacin- Meds for PTL

NSAID; blocks prostaglandin production, effective under 32 weeks, enhances fetal-lung maturity.

Betamethasone- Meds for PTL

Glucocorticoid; IM in two injections (24 hours apart) to enhance fetal lung maturity.

Intrapartum Nursing Care

Focuses on the fetus, birthing parent, and family unit.

Characterists of Labor Pain

Purposeful, Anticipated, Intermittent, and Normal (PAIN)

Stages of Pain:

• Early labor stage pain can vary in intensity and location.

  • Radiating from the back to the hips.

• The delivery stage involves somatic and visceral pain.

  • Releases endorphin when experiencing pain.

Fear-Tension-Pain Cycle

Fear leads to tension (jaw, pelvic floor, legs), amplifying pain and hindering labor progress due to reduced oxygen to the uterus.

• Comforting environments and support aid in labor delivery, increasing oxytocin levels, which help with uterine contractions and promote a more effective birthing process.

Gate Control Theory of Pain

Other sensations can block pain signals (e.g., warm compressions, massage).

• Warm compressions, rice sock, or cold wash clothes on pressure points.

Passageway- 5 P’s of Labor

The pelvis (birth canal).

Negative movement implies descent, positive movement signifies exiting (e.g., +4 hit the floor).

Gynecoid pelvis is ideal/perfect for delivery. 

• Arrest of labor/sephlow pelvis disproportion may result in the mom needing a C-section due to the inability to deliver it through the canal.

Passenger- 5 P’s of Labor

The fetus. Includes:

• Presentation (part entering pelvic inlet first)

• Fetal lie (orientation to maternal spine)

• Breech/transverse (often require C-section)

• Vertex (head down, ideal; complete flexion is optimal: chin to chest).

• Occipital posterior causes back pain; position changes help (during contractions, encourage leaning against a wall or partner. During delivery, suggest using a birth ball or positioning on all fours)

Powers- 5 P’s of Labor

Uterine contractions, measured by effacement (cervical thinning, 0% to 100%) and dilation (cervical opening, 0 to 10 cm).

Position- 5 P’s of Labor

Maternal positioning to aid fetal descent (e.g., hands and knees for back pain relief and movement).

Contraindicated with an epidural.

Psyche- 5 P’s of Labor

Psychological readiness, influenced by stress and support (e.g., water immersion, doulas).

• Water immersion: Provides buoyancy and can ease labor discomfort, promoting relaxation and a sense of privacy.

• Doula: A trained professional who provides continuous physical, emotional, and informational support to the mother before, during, and shortly after childbirth, helping to enhance the birth experience.

Seven Cardinal Movements of Labor

• Engagement: Fetal head passes through the pelvic inlet.

• Descent: Fetus moving down within the pelvis.

• Flexion: Chin to chest to allow easier passage through the pelvis.

• Internal Rotation: The presenting part rotates to align with the maternal pelvis (done to move against mom’s back). 

• Extension: The fetal head emerges from the vagina.

• External Rotation: The fetal head rotates to align with the shoulders after delivery (when the head reaches the perineum). 

• Expulsion: Delivery of the rest of the body post-head delivery (shoulder slips under the pelvic bone). 

These adapt the fetus to the pelvis for delivery.

Characteristics of Uterine Contractions

Increment, Peak (Acme), Intensity, Duration, Decrement, Interval, Frequency.

Stage One of Labor

Cervical thinning and dilation

• Latent: 0−6 cm, 30−45 sec contractions, 5−30 min apart

• Active: 6−8 cm, 45−60 sec contractions, 3−5 min apart

• Transition: 8−10 cm, 60−90 sec contractions, 3−5 min apart).

Stage Two of Labor

Pushing and birth.

Stage Three of Labor

Placenta delivery.

Stage Four of Labor

Recovery and breastfeeding.

Fetal Monitoring

External (assess fetal heart rate/contractions).

• Goal: To ensure that both the mother and baby remain stable throughout labor and to identify any potential complications early on.

Internal (more accurate for high-risk, requires at least 2 cm dilation and ruptured membranes).

• It’s attached to the baby's scalp and indicated for high-risk pregnancies where closer monitoring is necessary to ensure the safety of both mother and child.

Latent (Early) Labor

• Lasts up to 12 hours with contractions 30-60 seconds apart. Begins effacement and dilation. Expected signs include mucous discharge and potential water break.

  • Dilation: 0-6 cm.

  • Tips: Stay at home, rest, take a short walk, or do light activities.

    • Contractions: 30-45 seconds each, 5-30 minutes apart.

Active Labor

• Lasts about 6 hours; contractions become stronger and more frequent. Dilation progresses up to 8 cm.

  • Dilation: 6-8 cm.

  • Tips: Actively try getting to the hospital, use different positions, breathing exercises, and relaxation techniques.

  • Contractions: 45-60 seconds each, 3-5 minutes apart.

Transition Stage

• Lasts a few minutes to hours, the most intense phase, contractions are very strong. Dilation reaches 10 cm.

  • Dilation: 8-10 cm.

  • Tips: May feel nauseous or shaky, support people needed to provide focus.

  • Contractions: 60-90 seconds each, 3-5 minutes apart.

Non-Pharmacological Pain Management During Labor

Sensory stimulation, cutaneous strategies, labor support, hydrotherapy (showering), ambulation, focused breathing, and effleurage (circular massage for the abdomen). 

Pharamacological Pain Management During Labor

• Sedatives: For early labor (ex, barbiturates).

• Opioids: IV or IM (ex, fentanyl).

• Regional Anesthesia (Epidural)

• General Anesthesia

Regional Anesthia (Epidural)

Requires informed consent, monitor for maternal hypotension (biggest concern), other side effects include headache, N/V, itching, and high block.

Assess fetal heart rate and empty bladder prior.

General Anesthesia

Reserved for emergencies due to neonatal respiratory depression risk; involves antacids and rapid delivery.