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Reproduction Intrapartal Care non voice over (1) (2)

Module 33: Reproduction

Intrapartum Care

  • Focuses on care during labor and delivery.

Birth

Factors Important to Labor and Birth

  • Five Key Factors:

    • Passage Way (birth canal)

    • Passenger (fetus & placenta)

    • Position (relation between passage and fetus)

    • Power (physiological forces of labor)

    • Psychological & Psychosocial considerations

The Birth Passage

  • True Bony Pelvis: Forms the bony canal for birth.

  • Three sections:

    • Inlet

    • Pelvic cavity

    • Outlet

Passenger

Key Aspects of the Fetus

  • Fetal Skull: Largest and least compressible part.

  • Fetal Attitude: Refers to the relationship of fetal parts to one another.

  • Fetal Lie: Orientation of the fetus in relation to the mother.

  • Fetal Presentation: Part of the fetus that presents at the cervix (e.g., cephalic, breech).

  • Fetal Position: Relationship of the fetus to the maternal pelvis.

  • Fetal Station: Degree of descent of the presenting part.

  • Fetal Engagement: When the presenting part reaches or passes through the pelvic inlet.

The Fetus Overview

  • Fetal head: Molds during birth due to sutures and fontanelles that allow flexibility.

  • Fetal Attitude: Position of fetal parts relative to one another.

  • Fetal Lie: Longitudinal (vertical) or transverse (horizontal).

Fetal Presentation Types

  • Cephalic (vertex): Normal presentation of the head.

  • Breech:

    • Frank: buttocks presenting.

    • Full/complete: feet or legs presentation.

    • Footling: feet presenting.

  • Shoulder Presentation: Less common.

Labor Process

Relationship Between the Passage and the Fetus

  • Engagement: Largest diameter of presenting part at pelvic inlet.

  • Station: Position relative to ischial spines of maternal pelvis.

  • Fetal position: Relation of fetal part landmarks to maternal pelvis.

Cardinal Movements of Labor

  • These refer to the movements of the baby as it progresses through the birth canal:

    • Engagement

    • Descent

    • Flexion

    • Internal Rotation

    • Extension (restitution)

    • External Rotation (shoulder rotation)

    • Expulsion

Physiological Forces of Labor

  • Primary Forces: Uterine contractions.

  • Secondary Forces: Maternal pushing.

  • Contraction Phases: Frequency, duration, intensity.

  • Bearing Down: Can lead to cervical edema if not fully dilated.

Psychosocial Considerations

  • Parents' Readiness: Critical for smooth labor.

  • Expectant women prepare mentally, may fear pain.

  • Empowering the mother by giving control is important.

  • Support systems greatly influence the birth experience.

Physiology of Labor

  • Onset of Labor: Occurs typically between 38-42 weeks gestation.

  • Causes are not fully understood; linked with hormonal changes and physical readiness.

Musculature Changes in Pelvic Floor

  • Levator ani muscle and fascia: Supports the bladder and uterus; thins as fetal head descends.

Premonitory Signs of Labor

  • Signs include:

    • Lightening

    • Braxton Hicks contractions

    • Cervical changes

    • Bloody show

    • Rupture of membranes (ROM)

    • Sudden burst of energy prior to labor.

Differences Between True and False Labor

  • True Labor: Regular contractions, progressive dilation, and effacement.

  • False Labor: Irregular contractions, no cervical change, discomfort mainly in abdomen.

Nursing Process

Maternal Data Collection

  • History and Risk Factors: Screening for intrapartum factors, review prenatal records, build trust with maternal patients.

Intrapartum High-Risk Screening

  • Assess physical and psychosocial history; monitor vital signs and contractions continuously.

Planning by Nursing Staff

  • Develop a personalized care plan for laboring women.

Stages of Labor and Birth

  1. First Stage: Onset of labor to full dilation (10 cm).

    • Latent phase: Early part.

    • Active phase: More intense.

    • Transition phase: End with increased anxiety and pressure.

  2. Second Stage: Complete dilation to birth of the newborn.

  3. Third Stage: Birth to delivery of placenta.

  4. Fourth Stage: 1-4 hours post-delivery.

Signs of Placental Separation and Nursing Care in Third & Fourth Stage

  • Monitor mother and newborn; promote maternal recovery and bladder emptying.

  • Ensure breastfeeding and bonding post-delivery.

Intrapartum Risk Factors

  • Precipitous Birth: Labor < 4 hours, require assistance.

  • Preterm Labor: Regular contractions between 20 and 36 weeks; major risk factors include low socioeconomic status and previous preterm labor.

Labor Induction and Cervical Ripening

  • Cervical Ripening: Use of medications like misoprostol and prostaglandins.

  • Indications: Medical necessity (e.g., diabetes, PROM).

Cesarean Birth

  • Various indications including fetal distress or abnormal positions; higher risks compared to vaginal births.

Vaginal Birth After Cesarean (VBAC)

  • Criteria for candidates to safely attempt a vaginal delivery after cesarean.

Maternal and Fetal Response to Labor

  • Monitoring systems in place to assess maternal and fetal health during labor.

Implementation Strategies for Nursing Care

  • Address comfort needs, support decision-making in birth choices, monitor for complications, etc.

Conclusion

  • Holistic care approaches that include physiological, psychological, and social factors are crucial for both maternal and fetal well-being during labor and delivery.