MATERNAL & CHILD: THE WOMAN DURING CHILDBIRTH (PART 2)

When to seek medical attention:

Contractions following the 5-1-1 rule

Contractions following the 4-1-1 rule

Rupture of membranes

Decreased fetal movement

Vaginal bleeding

Severe headache

Contractions coming every 5 minutes, lasting for 1 minute each, for at least 1 hour (for first-time mothers).

Contractions following the 5-1-1 rule

Contractions every 4 minutes, lasting 1 minute each, for 1 hour (for women who have given birth before).

Contractions following the 4-1-1 rule

Seek medical attention immediately, regardless of whether contractions have begun.

Rupture of membranes

If the baby's movements noticeably decrease or stop.

Decreased fetal movement

Bright red bleeding (more than spotting) requires immediate medical attention.

Vaginal bleeding

- visual changes, or significant swelling

- indicate preeclampsia, a serious pregnancy complication.

Severe headache

"Coping with early labor at home"

If you're experiencing early labor signs but don't need to go to the hospital yet, these coping strategies may help:

Rest and relaxation: Alternate between resting and light activity.

Hydration and nutrition: Drink water and eat light, easily digestible foods.

Comfort measures: Try warm showers, massage, or position changes.

Distraction: Watch a movie, listen to music, or engage in a calming activity.

Breathing techniques: Practice the breathing methods learned in prenatal classes.

"Preparing for hospital admission"

When true labor is confirmed, preparing for hospital admission involves:

Hospital bag: Ensure it contains essential items for mother and baby.

Documentation: including ID, insurance information, and birth plan.

Communication: Inform healthcare providers, family members, and support persons.

Transportation: Arrange safe transportation to the hospital.

Three Stages of Labor:

First Stage of Labor: The Longest Journey

Second Stage of Labor: The Birth of the Baby

Third Stage of Labor: Delivery of the Placenta

- begins with the onset of regular uterine contractions and ends when the cervix is fully dilated to 10 centimeters.

- divided into three phases: latent, active, and transition.

First Stage of Labor: The Longest Journey

- The gradual beginning

- is characterized by mild to moderate contractions that gradually increase in frequency, duration, and intensity.

Cervical changes: The cervix effaces (thins) and begins to dilate, typically progressing to about _________.

Duration: This phase is usually the longest

(primiparas) - _____________ for first-time mothers

(multiparas). - _____________ for those who have given birth before

Contractions: Typically occur every ___________, and are mild to moderate in intensity.

- Latent phase

- 3-4 centimeters

- 6-12 hours

- shorter

5-20 minutes, last 30-45 seconds

Monitoring vital signs, timing contractions, checking for membrane rupture, and assessing fetal heart rate.

Assessment

Providing information about what to expect, encouraging mobility, and teaching breathing techniques.

Support

Suggesting position changes, warm showers, back massages, and adequate hydration.

Comfort measures

- The intensification

- As labor progresses to the active phase, contractions become more frequent, stronger, and longer:

Cervical changes: Dilation progresses from __________

Duration: Typically lasts _________ for primiparas and may be shorter for multiparas.

Contractions: Occur every ______________, and are moderate to strong in intensity.

Active phase

- 4 to 7 centimeters.

- 3-5 hours

- 2-3 minutes, last about 45-60 seconds

More frequent assessments of maternal vital signs, contraction patterns, cervical dilation, and fetal heart rate monitoring.

Regular monitoring

- offering pharmacological pain relief options if desired (epidural, opioids), and helping with positioning.

Pain management

Ensuring adequate fluid intake and providing ice chips or clear fluids as per hospital policy.

Hydration and nutrition

- The most challenging yet shortest phase

- marks the end of the first stage of labor and is often the most challenging for the mother:

Cervical changes: Dilation progresses from ____________ (full dilation).

Duration: Typically lasts __________

Contractions: Occur every ______________, and are very intense.

- Transition phase

- 8 to 10 centimeters

- 30 minutes to 2 hours

- 1.5-2 minutes, last 60-90 seconds

Nursing interventions during transition are critical:

Intense support: Providing constant reassurance and encouragement, maintaining a calm environment, and offering one-to-one care.

Helping with focus: Guiding breathing techniques to help the mother resist premature pushing.

Position changes: Assisting with positions that maximize comfort and promote descent of the fetus.

Preparation: Getting ready for the second stage by preparing delivery equipment and notifying the healthcare team.

Nursing Management During the First Stage of Labor:

Initial Assessment and Monitoring - The initial examination includes:

History taking: Reviewing the antenatal record, birth plan, and obstetric history including gravida, para status, previous labor experiences, and any complications.

Vital signs: Monitoring maternal temperature, pulse, respiration, and blood pressure.

Abdominal examination: Assessing fundal height, fetal position, presentation, and engagement using Leopold's maneuvers.

Vaginal examination: Evaluating cervical dilation, effacement, fetal station, membrane status, and pelvic adequacy.

Maternal vital signs:

_____________ - during the latent phase

_____________ - during the active phase.

- 30-60 minutes

- 15-30 minutes

Monitoring frequency, duration, and intensity.

Uterine contractions

Fetal heart rate (FHR): Assessing FHR every

__________ - during the latent phase

__________ - during the active phase, using "intermittent auscultation"

- 30 minutes

- 15 minutes

Cervical progress: Performing vaginal examinations approximately every ______ during the latent phase

every ______ during the active phase

- 4 hours

- 2 hours

Pain Management Strategies:

Non-pharmacological methods

- Non-pharmacological pain relief methods can be particularly effective during the early stages of labor and may reduce the need for medication:

Non-pharmacological methods

Teaching slow, rhythmic breathing during contractions to promote relaxation and oxygenation.

Breathing techniques

Encouraging upright positions, walking, sitting on a birthing ball, or hands-and-knees positions to utilize gravity and optimize fetal descent.

Position changes

Facilitating shower or warm bath immersion, which can provide significant pain relief through relaxation of tense muscles.

Hydrotherapy

Applying pressure to the lower back during contractions, particularly effective for relieving back labor.

Massage and counter-pressure

Using warm compresses on the lower abdomen/back or cool cloths on the forehead/neck.

Heat and cold therapy

Applying low-voltage electrical impulses through electrodes placed on the skin to block pain signals.

Transcutaneous Electrical Nerve Stimulation (TENS)

- When non-pharmacological methods are insufficient, several medication options are available:

Pharmacological interventions

Administering opioids like pethidine or tramadol to reduce pain perception, while monitoring for side effects like respiratory depression and nausea.

Systemic analgesics

Offering inhaled gas (Entonox) for self-administration during contractions, providing short-term relief.

Nitrous oxide

Facilitating epidural or combined spinal-epidural analgesia in collaboration with the anesthesia team

Regional analgesia

- begins when the cervix is fully dilated (10 centimeters) and ends with the birth of the baby.

- active maternal pushing and the descent of the baby through the birth canal

Second Stage of Labor: The Birth of the Baby

Characteristics of the second stage:

Duration:

_________ for primiparas

_________ for multiparas.

Contractions: Continue to occur every _________ but may temporarily decrease in frequency after full dilation.

Physical signs: Increased rectal pressure, ______________, bulging of the perineum, and visible fetal head during contractions.

- 30 minutes to 2 hours

- short as a few minutes

- 2-3 minutes

- strong urge to push

The second stage involves several important physiological processes:

Descent

Rotation

Extension

External rotation

Expulsion

The baby moves down through the pelvis.

Descent

The baby's head rotates to navigate the pelvic curve (internal rotation).

Rotation

The baby's head extends as it passes under the pubic symphysis.

Extension

After the head emerges, it rotates to align with the shoulders.

External rotation

Complete delivery of the baby's body.

Expulsion

- Regular monitoring of blood pressure, pulse, temperature, and respiratory rate helps detect early signs of complications.

- Blood pressure should be checked every 30 minutes

Maternal vital signs

- Intermittent or continuous fetal monitoring is critical during the second stage to detect any signs of fetal distress.

- The normal fetal heart rate ranges from _____________.

- Fetal heart rate monitoring

- 110-160 beats per minute

- Assessing the frequency, duration, and intensity of contractions helps determine the progress of labor.

- During the second stage, contractions typically occur every __________, last about ___________

- Contraction pattern

- 2-3 minutes

- 60-90 seconds

coaching the mother through effective pushing.

Guiding effective pushing techniques

Proper breathing can enhance pushing effectiveness while preventing maternal exhaustion

Breathing techniques

Preparing for delivery:

- Ensuring a sterile environment

- Equipment preparation

- after the birth of the baby and ends with the delivery of the placenta.

- Although this is the shortest stage, it carries significant risks, particularly postpartum hemorrhage.

Third Stage of Labor: Delivery of the Placenta

Characteristics of the third stage

Duration: Usually lasts _________

Signs of placental separation:

- 5-30 minutes.

- A small gush of blood

- Lengthening of the umbilical cord

- Change in uterine shape from discoid to globular

- Rising of the uterus in the abdomen

Placental delivery mechanisms:

- Schultz mechanism

- Duncan mechanism

The fetal surface delivers first, appearing shiny and bluish

Schultz mechanism

The maternal surface delivers first, appearing rough and red

Duncan mechanism

There are two main approaches to managing the third stage:

Active management

Includes prophylactic administration of uterotonic drugs (oxytocin), controlled cord traction, and uterine massage after placental delivery to reduce the risk of postpartum hemorrhage.

Active management

- Allows the placenta to deliver naturally without the use of uterotonic drugs or cord traction.

- This approach is less commonly used in hospital settings due to higher risk of hemorrhage.

Physiological (expectant) management

Nursing interventions during the third stage

- Careful nursing care during this stage is crucial to prevent complications:

Administering medications

Monitoring bleeding

Assisting with placental delivery

Placental examination

Uterine massage

Monitoring vital signs

Facilitating bonding

Giving uterotonic drugs as prescribed (typically oxytocin) to help the uterus contract and minimize bleeding.

Administering medications

Carefully observing for excessive bleeding, which could indicate postpartum hemorrhage.

Monitoring bleeding

Supporting the healthcare provider during controlled cord traction and placental delivery.

Assisting with placental delivery

Assisting with the examination of the placenta for completeness to ensure no fragments remain in the uterus.

Placental examination

Performing fundal massage to promote uterine contractility after placental delivery.

Uterine massage

Checking maternal vital signs frequently to detect early signs of complications.

Monitoring vital signs

Continuing to support mother-baby bonding and initial breastfeeding, which helps stimulate uterine contractions naturally.

Facilitating bonding

- when the baby's head becomes visible at the vaginal opening and stays visible with each contraction,

- indicating the baby is about to be born

CROWNING

- Your baby's scalp will appear

- A powerful pushing urge

- Instructions to slow down or pant

- The whole head appears

- Provider removes any blockages

- The body emerges

CROWNING