CA Psychological changes - Anemia

Bonding

is a CONTINUATION of the relationship that began during pregnancy — it can be influenced by family history, role models, support system, culture, and birth experience.

Attachment

is the strong affection that develops between the infant and another person (usually the primary caregiver).

Taking-in Phase

woman is passive letting other people do things and make decisions for her .

Taking-in Phase

this dependence is probably due to physical discomfort and exhaustion from the labor process.

Taking-in Phase

The woman may want to talk about her labor.

1. Taking-In

2. Taking-Hold

3. Letting-Go

RUBIN’S PUERPERIUM PHASES

Taking-hold Phase

2-4 days after delivery

Taking-in Phase

1-2 days after delivery

Taking-hold Phase

the phase where the woman begins to initiate action herself.

Taking-hold Phase

Shows a great interest on caring for the baby.

Taking-hold Phase

The woman may still feel insecure about her abilities in caring for the child.

Taking-hold Phase

The woman may still feel insecure about her abilities in caring for the child.

Taking-hold Phase

This is the time the nurse should provide relevant instructions and adequate praise for the things she does well to help increase her confidence

Letting go Phase

Occurs after new mother returns home

Letting go Phase

The woman finally defines her role.

Letting go Phase

She gave up fantasized image of her child for the real one.

6–10 days

● Bradycardia is normal/expected during the first _____ postpartum (physiologic response to decreased cardiac workload).

1st hr - Monitor vital signs every 15 minutes.

2nd hr - Monitor vital signs every 30 minutes.

Next 2 hrs - Monitor every 1 hour, or until stable.

VS Monitoring Frequency Post-Birth

power

the ability of the uterine muscle to contract.

contraction

cause the cervix to stretch open (dilate/efface) and allow the baby to enter the birth canal.

● Amniotic membranes may rupture.

● Braxton–Hicks contractions (irregular, practice contractions).

● Burst of energy / increase in activity level ("nesting instinct").

● Backache.

● Cervical changes (softening/ripening).

● Lightening (fetal descent into the pelvis).

● Urinary frequency.

● Weight loss (slight, due to fluid/electrolyte shifts).

Preliminary Signs of Labor

FALSE Labor

No effect, or decreases contractions

Not present

Irregular; decrease in frequency & intensity; longer intervals

No change

Lower abdomen and groin

Decreases or stops contractions

TRUE Labor

Increases contractions

Present

Progressive frequency & intensity; shorter intervals

Progressive thinning (effacement) and opening (dilation)

Lumbosacral (back) area

Does NOT stop contractions

No effect, or decreases contractions

Activity (Walking) in False Labor

Not present

Bloody show in False Labor

Irregular; decrease in frequency & intensity; longer intervals

Contractions in False Labor

Lower abdomen and groin

Discomfort in False Labor

Decreases or stops contractions

Sedation in FALSE Labor

Does NOT stop contractions

Sedation in TRUE Labor

Lumbosacral (back) area

Discomfort in TRUE Labor

Progressive thinning (effacement) and opening (dilation)

Cervix in TRUE Labor

Progressive frequency & intensity; shorter intervals

Contractions in TRUE Labor

Present

Bloody show in TRUE Labor

Increases contractions

Activity (Walking) in TRUE Labor

Stage 1 — Cervical Stage

longest stage and begins with the onset of regular contractions (true labor pain) and ends when the cervix is fully dilated to 10 centimeters

• early/latent

• active

• transition

Stage 1 (Cervical Stage) is further divided into three phases:

Latent Phase

This phase is characterized by mild, irregular contractions that may be spaced 10 to 20 minutes apart and last for about 30 to 45 seconds.

Latent Phase

The cervix begins to thin out and dilate, to about 3 to 4 cm.

Latent Phase

This phase can last for several hours or even days, and the contractions may become more frequent and intense over time.

Active Phase

contractions become stronger, more regular, and closer together, typically occurring every 3 to 5 minutes and lasting for about 45 to 60 seconds.

Active Phase

The cervix continues to dilate rapidly, reaching 7 to 8 cm.

Active Phase

The mother may experience increased discomfort.

Transition Phase

This is the final and most intense phase of the first stage of labor, during which the cervix dilates from 8 to 10 cm.

Transition Phase

Contractions become very strong, lasting for up to 90 seconds and occurring every 2 to 3 minutes.

Stage 2 — Fetal / Pushing Stage

Begins when cervix is fully dilated (10 cm); ends with the BIRTH of the baby.

Stage 2 — Fetal / Pushing Stage

last anywhere from a few minutes to a few hours, and it is marked by strong contractions and the active pushing of the baby through the birth canal

Stage 2 — Fetal / Pushing Stage

the mother will be coached to push during contractions, bearing down as if having a bowel movement, while holding her breath.

Modified Ritgen's Maneuver

Used during Stage 2 to control extension of the fetal head and PREVENT/REDUCE perineal lacerations, especially anal sphincter tears.

Modified Ritgen’s maneuver

By applying gentle, controlled pressure and guiding the fetal head, the maneuver helps the head pass through the perineum with its smallest diameter, protecting the maternal tissues.

First degree tear

- Injury to skin and subcutaneous tissue of perineum and vaginal epithelium

Second degree tear

Injury extends into the fascia and perineal muscles

Third degree tear

Injury extends through the fascia and perineal muscles, and involves some or all of the fibers of the anal sphincter muscles

Fourth degree tear

- Injury to the perineum involves both the internal and external anal sphincters, and the anal mucosa

3a

<50% of external anal sphincter (EAS) thickness torn

3b

>50% of EAS thickness torn

3c

Both EAS and internal anal sphincter (IAS) torn

Fourth-degree

Injury to perineum involving anal sphincter complex (EAS & IAS) AND anorectal mucosa

Episiotomy

a surgical incision in the perineum to enlarge the vaginal introitus at delivery.

Episiotomy

was introduced to prevent severe, spontaneous perineal lacerations and to shorten the second stage of labor, thereby reducing potential harm to the mother and baby.

routine episiotomy

is NOT beneficial and may be harmful — increased risk of perineal pain, dyspareunia, and anal sphincter dysfunction

Median (midline) episiotomy

• The incision starts at the posterior fourchette and runs along the midline through the central tendon of the perineal body.

Median (midline) episiotomy

The incision originates within 3 mm of the midline and is angled between 0 degrees and 25 degrees.

Median (midline) episiotomy

The incision extends to about half the length of the perineum.

Modified-median episiotomy

A variation of the median episiotomy

Modified-median episiotomy

Two transverse incisions are added bilaterally, just above the anal sphincter, extending the median incision.

Modified-Median Episiotomy

The transverse cuts are perpendicular to the midline, with a total length of 2 to 5 cm.

Modified-median episiotomy

This approach aims to increase the vaginal outlet diameter by about 83% compared to a standard median episiotomy.

Mediolateral episiotomy

The incision begins at the midline of the posterior fourchette but is directed laterally and downward at a minimum angle of 60 degrees.

Mediolateral episiotomy

This method is designed to avoid the anal sphincter and is typically directed toward the ischial tuberosity.

Mediolateral episiotomy

• more common in Europe and usually results in a 45-degree angle postdelivery.

J-shaped episiotomy

begin with a midline incision and curve laterally to avoid the anus.

J-shaped episiotomy

The initial incision is made along the midline, up to 2 to 5 cm from the anus.

J-shaped episiotomy

The cut is then curved towards the ischial tuberosity to divert the incision away from the anal sphincter.

Lateral episiotomy

This type begins further from the midline (>10 mm from the posterior fourchette) and is directed laterally.

Lateral episiotomy

The cut is angled towards the ischial tuberosity, avoiding the midline and sphincter.

Radical lateral (Schuchardt incision)

A deep and fully extended incision into one vaginal sulcus, curving downward and laterally around the rectum

Radical lateral (Schuchardt incision)

Often used in gynecologic procedures, eg, radical vaginal hysterectomy or trachelectomy, but may occasionally be used for complicated deliveries.

Radical lateral (Schuchardt incision)

The incision originates >10 mm from the midline and extends laterally around the rectum.

Anterior episiotomy (deinfibulation)

performed during delivery in women who have undergone infibulation (ie, genital mutilation).

Anterior episiotomy (deinfibulation)

The fused labia minora are incised along the midline until the external urethral meatus is reached

Anterior episiotomy (deinfibulation)

Care is taken not to cut the clitoris or surrounding tissue. The incision runs in the midline, directed towards the pubis.

Stage 3 — Placental Stage

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

• Calkin's sign

• Sudden gush of blood from the vagina.

• Lengthening of the umbilical cord protruding from the vagina.

Signs of Placental Separation:

Calkin's sign

change of uterine shape from discoid to ovoid, indicating separation from the uterine wall.

Stage 4 — Recovery Stage

Begins immediately after delivery of the placenta and lasts about 1 to 4 hours. Priority: hemorrhage prevention and maternal stabilization.

● Schultze

● Duncan

Types of Placental Delivery

Schultze

expulsion of the placenta with the FETAL surface (shiny surface) foremost.

Duncan

passage of the placenta from the uterus with the ROUGH (maternal) side foremost.

Crede’s maneuver (Fundal pressure)

involves placing one hand on the top of the uterus (uterine fundus) and squeezing it between the thumb and other fingers to help placental separation and delivery.

Brandt-Andrew's Maneuver (Controlled Cord Traction)

— gentle traction on the umbilical cord while maintaining counter-pressure upward with a hand on the lower abdomen. Controlled cord traction should ONLY be performed AFTER signs of placental separation appear.

dehydration, renal impairment, malnutrition, electrolyte imbalance.

● Complications of excessive vomiting: dehydration

Hyperemesis Gravidarum

●       Extreme morning sickness causing long-lasting, intense nausea, vomiting, and weight loss.

●       Exact cause unknown; many believe it is caused by a rapid rise in hCG hormone levels.

●       Symptoms may be severe enough to interrupt daily activities.

4th–6th

Hyperemesis Gravidarum develops between the ___ week of pregnancy and may last beyond week 20.

cerclage

The treatment for an incompetent or weakened cervix is a procedure is called a

14-16

The treatment for an incompetent or weakened cervix is a procedure is called a cerclage and is usually performed between week ____ of pregnancy.

36–38

●       Cerclage sutures are removed between weeks ____ to prevent complications when labor begins.

Incompetent Cervix

●       Characterized by PAINLESS dilation of the cervical os WITHOUT uterine contractions.

Premature Rupture of Membranes (PROM)

A pregnancy complication in which the amniotic membrane ruptures BEFORE week 37 of pregnancy.

37

Premature Rupture of Membranes (PROM)

● A pregnancy complication in which the amniotic membrane ruptures BEFORE week __ of pregnancy.

Cord Compression / Cord Prolapse

the cord slips out ahead of the presenting part and becomes compressed between the fetal presenting part and the maternal pelvis.