Ch 16 - Pregnancy, Labour & Delivery

how does pregnancy begin?

when an egg (ovum) is fertilized by a sperm forming an embyro

what is the embryo surrounded by once its planted in the uterus

amniotic sac

after 8 weeks the embryo is now called a

fetus

how does the fetus received nutrients

a placenta forms and is connected through the umbilical cord

how long does the fetus develop until birth

40 weeks

birth process (3)

• begins w rhythmic contractions of uterus, dilation of cervix

• cervix serves as a birth canal passageway

• once baby passes through it is a neonate for first 28 days

assessing labour questions to ask (7)

• first pregnancy?

• are they in a physicians care for high risk factors?

• has the amniotic sac ruptured?

• how far apart are the contractions?

• is there bloody discharge? 

• do they have an urge to push?

• is the baby crowning?

4 stages of labour

1) preparation

2) delivery of baby

3) delivery of placenta

4) stabilization

stage 1 - preparation (3)

• body prepares for delivery

• duration: 1st contraction until cervix fully dilated (10cm)

• when contractions are <3 min apart - delivery is near 

stage 2 - delivery of baby (2)

• duration: full dilation until crowning occurs

• delivery of baby within minutes

stage 3 - delivery of placenta (3)

• normally within 20 min after birth

• placenta separates from uterine wall and exits

• RTD?

stage 4 - stabilization (3)

• inital recovery & stabilization of mother

• duration ~ 1h

• uterus contracts to control bleeding 

preparing for delivery - yourself (4)

• feelings of excitement and fear

• try not to be alarmed by loss of blood

• only bleeding that cannot be controlled after the neonate is born is an issue

• deep breath, try and relax

labour pains: factors that inc pain and discomfort (4)

• irreg breathing

• tensing up because of fear

• not knowing what to expect

• feelings of loneliness and lack of support

preparing for delivery - mother (6)

• reassure that u are here to help

• explain what to expect in the labour process

• suggest reg breath

• ask her to focus on one object in the room

• remain calm

• ask her to use slow, deep breath which will ensure adeq O2 to mother and baby

delivery is near if contractions are

less than 3 mins apart

assisting w delivery

• establish a clean environment using clean sheets blankets and towels

  • under buttock

  • drape over legs

  • keep a clean, warm towel for neonate

other items to help assist w delivery (4)

• bulb syringe to suction secretions from baby’s mouth/nose

• gauze to absorb secretions and vaginal bleeding

• large plastic bag/towel for placenta

• supp O2

assisting w delivery steps (8)

• place mother in pos of comfort

• as crowning occurs place hand on top of baby apply gentle light counterpressure

• mother should stop pushing

• head emerges → baby turn to 1 side which will enable shoulders to pass

• support baby’s head make sure umbilical cord is not looped around head

• guide shoulders DO NOT PULL

• place neonate on its side b/w u and mother

• clamp or tie the cord @ 2 locations (4 and 6” away from neonate)

caring for neonate (5)

• 2 patients now!

• priorities= baby’s airway and body temp

• no spontaneous cries? flick the soles of the feet or dry vig for 30 sec

• if baby does not breath on own begin A/R

• wrap baby up

APGAR score acronym 

appearance (skin colour)

pulse

grimace (irritability)

activity (ms tone)

respiration 

caring for neonate - APGAR score

• take at minute 1 & 5

• score b/w 7-10 is normal

• 4-6 is low

• 0-3 is critically lower

• a score of 10 is fairly uncommon

postpartum bleeding

bleeding after birth

postpartum bleeding (4)

>500 mL of blood loss (approx 2 cups)

• freq occurs within 1st few hours after delivery but can delay up to 24h

• RTD

• do not attempt vaginal packing to control bleeding

• care for ext bleeding from tears and open wounds 

stillbirth

birth of an infant after 20 weeks of pregnancy that died at some point during pregnancy or labour

stillbirth imp fact

if baby dies during delivery it is NOT considered stillborn and resuscitation may be effective

multiple births

do not pose a danger

u just have to do everything more than once

complications during childbirth (4)

• prolapsed cord

• breech birth (delivered feet/buttock first)

• limb presentation

• multiple births 

spontaneous abortion aka

miscarriage 

miscarriage

spontaneous termination of pregnancy from any cause before 20 weeks of gestation