Labor and Delivery Summary

Overview of Labor Physiology

  • Physiology of Labor: Sign of Labor

    • Key indicators: bloody show, burst of energy, contractions, spontaneous rupture of membranes

    • True labor defined by cervical changes and contractions

Cervical Changes

  • Effacement and Dilation

    • Effacement: cervix thinning measured in percent (100% is fully effaced)

    • Dilation: opening of cervix from 0 cm to 10 cm

    • Fetal station measured relative to ischial spines (0 = level, + for below, - for above)

Fetal Position and Station

  • Cephalic Position

    • Best presentation is cephalic (vertex head down) for faster delivery

    • Monitor fetal position and attitude (flexed limbs ideal)

Labor Progression Monitoring

  • Contractions Assessment

    • Monitor: frequency (beginning to beginning), duration (start to end), intensity (strength at peak)

    • Desired contractions: 60 seconds duration, 2-3 minutes apart

Maternal Position and Psych

  • Impact of Maternal Position

    • Moving during labor can progress labor, even with epidurals

  • Psychological Factors

    • Mental preparation can lower anxiety affecting labor progression

Pain Management

  • Pain in Labor

    • Labor is natural but painful; each woman's perception varies

    • Pain management can include medications (IV pain meds, epidurals) with risks after 6 cm dilation

Stages of Labor

  • First Stage: Regular contractions to full dilation (10 cm); longest for first-time mothers

    • Early Phase: Up to 6 cm dilation

    • Active Phase: Increased focus on contractions

  • Second Stage: Pushing phase until baby is born

  • Third Stage: Delivery of placenta (5-15 mins)

Immediate Postpartum Care

  • Recovery

    • Assess uterine firmness and bleeding; monitor signs of infection

    • Encourage bonding and education on postpartum changes

  • Lochia Assessment

    • Lochia rubra (bright red), then serosa (pink/brown), then alba (white) progress

Complications and Emergencies

  • Umbilical Cord Prolapse: Emergency; causes fetal distress, requires immediate action

  • Shoulder Dystocia: Obstetric emergency requiring maneuvers (McRoberts, suprapubic pressure)

  • Uterine Rupture: Signs include sudden abdominal pain, cessation of fetal heart tones

Preterm Labor

  • Defined by contractions and cervical change before 37 weeks; management focuses on delaying delivery to allow fetal lung development

Techniques for Inducing Labor

  • Chemical and Mechanical Induction: Using prostaglandins or foley balloons to soften the cervix and induce contractions

Summary of Nursing Care

  • Ongoing education, monitoring vital signs, lochia changes, and uterine tone

  • Non-stress tests for ongoing fetal monitoring and care, especially if induction occurs

Emotional Care Post Loss

  • Provide support during perinatal loss, facilitate bonding with the infant, and prepare for the emotional response involved with loss.