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.