Maternal Newborn Pt 2 (pt 1)

Stages of Labor and Delivery

There are four stages of labor and delivery:

  • First Stage (Labor):

    • Defined by muscle contractions that dilate and efface the cervix.
    • Focuses on the uterus, not the baby.
    • Involves three phases:
      • Latent: Cervix dilates from 0 to 4 cm.
        • Contractions occur every 5 to 30 minutes.
        • Contractions last 15 to 30 seconds.
        • Contraction intensity is mild.
      • Active: Cervix dilates from 5 to 7 cm.
        • Contractions occur every 3 to 5 minutes.
        • Contractions last 30 to 60 seconds.
        • Contraction intensity is moderate.
      • Transition: Cervix dilates from 8 to 10 cm.
        • Contractions occur every 2 to 3 minutes.
        • Contractions last 60 to 90 seconds.
        • Contraction intensity is strong.
          Phases of Labor Mnemonic: LAT (Latent, Active, Transition)

  • Second Stage:

    • Delivery of the baby (pushing stage).

  • Third Stage:

    • Delivery of the placenta.

  • Fourth Stage:

    • The first two hours after the delivery of the placenta.

Labor (First Stage) Details

  • Cervical Dilation, Contraction Frequency, Duration, and Strength by Phase:

    • Latent:
      • Dilation: 0-4 cm
      • Frequency: Every 5-30 minutes
      • Duration: 15-30 seconds
      • Intensity: Mild
    • Active:
      • Dilation: 5-7 cm
      • Frequency: Every 3-5 minutes
      • Duration: 30-60 seconds
      • Intensity: Moderate
    • Transition:
      • Dilation: 8-10 cm
      • Frequency: Every 2-3 minutes
      • Duration: 60-90 seconds
      • Intensity: Strong
    • Three-Column Sequential Table:
      • Memorize the Active phase as the middle ground.
      • Less intense than Active = Latent.
      • More intense than Active = Transition.

  • Contraction Limits:

    • Contractions should not be closer than 2 minutes apart.
    • Contractions should not last longer than 90 seconds.
    • Exceeding these limits indicates a high-priority situation.

Timing Contractions

  • Frequency:

    • Time from the beginning of one contraction to the beginning of the next (e.g., point A to point C).

  • Duration:

    • Time from the beginning to the end of one contraction (e.g., point A to point B).

  • Intensity (Strength):

    • Subjective: Mild, moderate, or severe.
    • Palpate with one hand over the fundus using fingertips.

Complications of Labor and Delivery

  • Prolapsed Cord:

    • The cord comes down before the baby, risking compression and fetal death.
    • Intervention: Push, then position.
      • Push the baby's head up off the cord (gloved hand).
      • Position the mother in knee-chest position or Trendelenburg.
      • Call the healthcare provider immediately (likely C-section).

  • Other Complications:

    • LION: Left side, IV increase, Oxygen, Notify.
      • Left side: Improves placental perfusion.
      • IV increase: Dilutes hormones that drive contractions.
      • Oxygen: Improves oxygenation for mother and baby.
      • Notify healthcare provider.
      • Assume standing orders for LION.

  • Pitocin:

    • If Pitocin is running when a complication occurs, stop it first before implementing push position or LION.

Pain Management

  • Systemic Pain Medications:

    • Do not administer systemic pain medication if the baby is likely to be born when the medicine is peaking because it can cause respiratory depression in the baby.

  • Epidurals:

    • Epidurals are not systemic and can be administered throughout labor.

Fetal Heart Tracing Patterns

  • Seven Patterns:

    • Low fetal heart rate
    • High fetal heart rate
    • Low baseline variability
    • High baseline variability
    • Late decelerations
    • Early decelerations
    • Variable decelerations

  • Low Fetal Heart Rate:

    • Under 110 bpm
    • Bad; apply LION.

  • High Fetal Heart Rate:

    • Fetal heart rate acceleration.
    • Okay; document.

  • Low Baseline Variability:

    • Minimal variation in the tracing.
    • Bad; apply LION.

  • High Baseline Variability:

    • Significant fluctuations in fetal heart rate.
    • Good; document.

  • Late Decelerations:

    • Heart rate slows down near the end of contraction.
    • Bad; apply LION.

  • Early Decelerations:

    • Heart rate slows down at the beginning of contraction.
    • Okay; document.

  • Variable Decelerations:

    • Heart rate slows down with no pattern.
    • Very bad; indicates prolapsed cord; push, then position.

  • Memorization Tips:

    • Variable = Very Bad (Prolapse; Push, then Position)
    • If it starts with L, it's bad and needs LION.
    • If it's not variable and doesn't start with L, it's okay; just document.