Labour and birth

natrual labour

- good cases

- potential for complications

C section

- higher risk

- infections, pain, bleeding

spontaneous vaginal birth

- delivery without interventions

- least risk for mother and baby

vaginal delivery with interventions

- includes medical aids or procedures

Supportive continuous care

- encourage participation in care

- build good connection and trust with birthing person

- physical pressence helps reduce need for interventions (e.g. reduce pain)

family centered care in labour

- having chosen support can reduce medication needs, enhances baby care and overwall experinece

- enhances family satisfaction, and positive attitudes towards pregnancy

mother + baby friendly birthing

- allow brithing person to eat, drink, and change poistions freely

- maintain confidentiality allow birthing

- premote skin to skin contact, breast feedings, mother + newborn care

- educations, evidence based interventions

- respect culture, choice of support

midwives

- attendants trained to help women give birth

- callaborate with nurses

- care for low risk, helathy pregancies

- pressence at natural briths

midwives role

5'p of labour and brith

factors that influence birth

1. passenger - baby factors (e.g. fetal position, skull size)

2. passageway - mother factors (e.g vaginal canal, cervix, pelvic floor)

3. powers - contractions: involuntary and voluntary pushing during delivery

4. position - different birthing positions possible

5. psychological response - response to pregnancy; influences (e.g. history, beliefs, attitude, support)

factors affecting labour and birth

- complications / personal health issues

- healthcare factors

- fear or anxiety about pregnancy and birth

pre-labour

- lightening and engagement

- increased discomfrot in lower back, pelvis and hips

- braxton hicks contractions

- nesting (surge in energy due hormones)

- flu-like symtoms

- increased vaginal discharge (blood show)

braxton hicks contractions

- false labour

- irregular, in the low back and upper abdomen, tightening

- Stop with position changes

cervix - prelabour

- firm, positioned posteriorly

- no change in effacement or dilation

contractions - labour

- regular, with waves of intensity

- becomes more intense during movement, felt in the lower back and the lower abdomen,

- Descent of fetus into birthing conal, cervical changes in effacement and dilation

cervix - labour

- soft, moves anterioly

- changes in effacement and dilation

pre-labour support

- educaiton on braxton hicks contraction, bloody show

- support and comfort measures; build trust

- create birth plan (optional)

- monitor for complications (fetal heart rate, fetal movement, bleeding (small ammounts is normal)

latent - first stage of labour

- Early irregular mild contractions (transition to labour contractions), the fetus begins to descend further from birth canal to cervix

- cervix 0-3 cm dilated

- hands-off approach

active - first stage of labour

- regular contractions, more intense contractions, rapid dilation (after 4cm dilation, ~ 0.5cm/hr)

- hands-on approach

first stage of labour

- period from the first regular uterine contraction until the cervix is fully dilated

- longest stage

second stage of labour

- from complete dilation, effacement of the cervix until the birth of the baby -

passive - no active pushing, fetus deceneds naturally by involuntary contractions -

active - fergusons reflex, more frequent and intense contractions, guided by urge, pushing at same time of contraction (open glottis, closed glottis)

thrid stage of labour

- delivery of the fetus until delivery of the placenta - usually 15 min, folowing release of oxytocin that contracts uterus - inspect and repair perineum if necessary

forth stage of labour

- first 2 hours after delivery of placental until considered stable - may include tremors or shaking

- frequent assement of bleeding and vitals needed, risk for postpartum hemorrhage - proper contraction of the uterus

prenantal assement

Determine stage of labour

- review EDB, GTPAL, blood type, GBS status

- past helath history, allergies, vital signs, medication

- fetal health surviellence

- uterine activity

- amnitoric fluid status, vaginal discharge

- lab wrok

- vaginal examination

- pain / coping

fetal health surveilance

- frequency depends on risk factors, stage of labour

- fetal well being indicates when decompensation (r/t perfusion) may be occuring

- involves intermittent ausculation, electronic fetal monitoring

- uterine activity

- montioring for contractions, to determine stage of labour

- frequency (10 minute periods)

- intensity (mild, moderate, strong - patient descrption)

- duration (usually 45-60 seconds)

- resting tone (relaxed uterus between contractions - needed for perfusion to fetus, decent of fetus - should be at least 30 seconds)

vaginal examination

- preformed by trained HCP, sterile gloves with lubricant

- positioned supine, feet together, knees apart

- measures effacement, dilation, position of cervix, station, fetal presentation and engagement

effacement

- thickness of cervix

- measured in % (1 - 100 % effaced)

intermiten ausculation

- component of fetal health surveillance, Listening to the fetal heart rate (FHR) at regular intervals using a Doppler, instead of continuous electronic fetal monitoring

--> recomended for low risk pregnacies (instead of EFM), better experince - decrease need for interventions + C-section

- Leopold's maneuver to determine fetal position before auscultation

Leopold's maneuvers

Palpation technique to assess fetal position.

doppler ausculation

- ultrasound deivce to measure fetal heart rate

- assess if fetus is tolerating labour, before, during and after contractions

electronic fetal monitoring

- continous mointoring of fetal heart rate in relation to contractions

- recomended with high risk pregancies / complications

steps of intermittent aucultation

1. leopolds maneuver to determine fetal position

2. ausculate with doppler for one minute

3. assess between contractions

3. document fetal heart rate

note: frequency depnds on stage of labour

primary powers

- part of uterine assement

- involuntary uterine contraction that initiate dilation, effacement of cervix and begin labour process

compoenets of vaginal examination

dilation: 0-10 cm depending on stage of labour

Effacement: firm to soft, cervix thins

position of cervix - posterior to anterior

station - fetal descent (0, -2, +3); presenting fetal part in relation to birthing person ichial tuberosity

fetal presentation - part of fetus that enters the pelvis first (usually cephalic, maybe breech - butt)

engagement - fetal presenting part is engaged in pelvis (pre-labour), no longer ballotable

station 0

presenting part at level of the ichial spine

station -2

presenting part 2 cm above the ischial spine

station +3

presenting part 2cm below ischial spine

amnitoic fluid status

- rupture spontenously or artifically

- can occur with or without contraciton; contractions often befcome more intense following ROM - assess FHR follwing ROM

- nitrazine or ferning test

nitrazine test

- this is a test of vaginal secretions if the client is uncertain whether the membranes have ruptured. Color will indicate whether amniotic fluid is present. Yellow = urine. Blue = Amniotic fluid.

ferning test

- Swab vaginal area, rub on slide, under microscope it should look like a fern; positive indicates ROM

pharmalcological interventiosn for comfort?

- acetaminophen

- narcotics

- nitrous oxide

- epidural

second stage of labour passive

- period between full dilation adn pushing contractions

- alow for fetal decend naturally, allowing for less active phase

- position changes for diconfort - listent ot body, use graivty

second stage of labour active

- strong urge to push/bear down with contraction (rerguson reflex)

- contraction are more intense

- push when they feel the urge; not directed

- open glottis / closed glottis pusshing

open glottis pushing

method of breathing during bearing down efforts characterized by a strong expiratory grunt or groan

closed glottis pushing

term for method of pushing where woman holds breath and pushes at the count of 3 (provider directed)

- decreased placenta persion increased risk of fetal hypoxia, increased risk for pelvic floor damage

nursing management for second stage of labour

- confirm dilation, effacement, electronic fetal monitoring

- maintian privacy, vaginal show (visuallize perineum)

- support

birthing position

- less pain, fatigue, truama, inteventions, fetal distress

delivery

- head --> shoulders --> body extremities

- HCP support the delivery of fetus, once head is delivered, feel for nuchal cord (? umbilical cord around the neck)

perioneal streching

- burning sensation, streching of perineum as head is being delivered

nurses role in delivery

- encouragement

- explain what is happening

- premote comfort

(not in RN scope to deliver babies unless emergency - midwife ...)

cardinal movemnet of fetus

engagement and decent --> flexion: fetus brings chin to chest --> internal roation: head rotates to move throught pelvis --> head extends with delivery --> external roation (return to normal position) --> restitution - fetus roates to deliver anteior should and then roates to deliver posterior sholder --> expulsion: after shoulders are dillivered

skin to skin contact

-newborn placed on bare chest dried and covered with blanket

- remian skin to skin fro least 1 hour - perfect time to begin breatfeeding

umbilical cutteign

- delayed clamping and cutting of the umbilical cord for 1-3 minutes increase placenta transfuciotn of blood to fetus

APGAR score

- rapid assement of newborn's transition

- each category is rated at 1, 5, and 10 minutes after delivery

- categories scored between 0-2

thirs stages of labour

- time from delivery of fetus to delivery of placenta

- usally around 15 min

- release of oxytocin required: skin to skin contact, breastfeeding, nipple stimulation, oxytocin injection

- may have cramping prior to delivery of placenta

after stage 3

- HCP inspect and repair perineum if necessary

fourth stage of labour

- from delivery of placenta to 2 hours postpartum

- may have intense tremors

- frequent assement - monitor vital signs, bleeding, uterine contraction, and overall well-being of mother and baby.

safety postpoartum

- premote bonding and breastfeeding

- assist with first time ambulating