Chapter-27-Labor-and-Delivery-

Chapter 27: Labor and Delivery

Objectives

  • Discuss cultural beliefs affecting care of women in labor.

  • Compare advantages and disadvantages of childbearing settings: hospitals, freestanding birth centers, and home.

  • Describe four components of the birth process known as the “four Ps”: Powers, Passage, Passenger, Psyche.

  • Explain the interrelation of the four Ps in the birth process.

  • Clarify common nursing responsibilities during labor and delivery.

  • Detail the care of newborns immediately after birth.

Labor and Delivery

Alternative Labor and Delivery Sites

  • Plan for Delivery: Established during pregnancy.

  • Traditional Hospital Settings:

    • Sterile environment.

    • Limited visitors and designated recovery areas.

  • Birthing Centers:

    • Within hospitals, designed to be more homelike.

    • Open and welcoming staff interactions with family.

  • Home Births:

    • Requires agreement from healthcare provider.

    • Suitable only for uncomplicated deliveries.

Normal Labor

Overview

  • Typically, the fetus matures and labor begins at a precise time.

  • Continuous research to understand the precise onset of labor.

Theories of Labor Onset

  • Mechanical Theory:

    • Involves uterine stretching leading to contractions.

  • Hormonal Theory:

    • Influences from oxytocin, withdrawal of progesterone, stimulation of estrogen, and fetal cortisol.

Signs of Impending Labor

  • Lightening:

    • Decreased abdominal distention as the fetal head descends into the pelvic inlet.

  • Fluid Outflow:

    • May signify loss of amniotic fluid; use Nitrazine paper to test.

  • Bloody Show:

    • Increase in vaginal discharge with blood-tinged mucus due to the mucous plug's release.

  • Braxton Hicks Contractions:

    • Irregular tightening of the uterus, varying in intensity; does not cause cervical dilation.

  • True Labor:

    • Regular contractions leading to cervical dilation and effacement.

Differences Between True and False Labor

True Labor

False Labor

Regular pattern

Irregular pattern

Stronger with walking

Stops with relaxation

Cervical dilation occurs

No change in dilation

The Process of Labor and Delivery

Four Components of Labor

  • Passageway: Pelvis and soft tissue.

  • Passengers: Fetus and placenta.

  • Powers: Uterine contractions.

  • Position of Mother: Various positions like squatting, side-lying.

  • Psyche: Psychological response to labor.

Passageway

  • Pelvis Structure:

    • Superior pelvis offers support; divided by the linea terminalis.

    • True pelvis shape and size crucial for delivery.

    • Types of Pelvis:

      • Gynecoid: Most common; round.

      • Android: Heart-shaped; often requires C-section.

      • Anthropoid: Oval; may allow vaginal birth with forceps.

      • Platypelloid: Flat; less common.

Passengers: Fetus

  • Fetal Skull: Large, bones not fused for molding through the birth canal.

  • Fetal Attitude: Ideal is flexion (fetal position).

  • Fetal Lie: Longitudinal (parallel) vs. transverse (perpendicular) to mother’s axis.

  • Fetal Presentation: Cephalic, breech, or shoulder; head is the preferred.

Mechanisms of Labor

  • Engagement: Fetal head settles at pelvic inlet.

  • Descent & Flexion: Fetal head descends while flexing.

  • Internal Rotation, Extension, External Rotation, Expulsion: Sequence leading to delivery.

Stages of Labor

1st Stage: Dilation

  • Phases:

    • Latent (0-3 cm): Early contractions; pain relatively controlled.

    • Active (4-7 cm): Stronger contractions.

    • Transition (8-10 cm): Increased urge to push and may cause emotional distress.

2nd Stage: Delivery

  • From 10 cm dilation to birth.

  • Urge to push with perineal burning sensation.

  • Crowning occurs when the widest part of the head is visible.

3rd Stage: Delivery of the Placenta

  • Occurs within 30 minutes post-birth; involves mild contractions.

4th Stage: Stabilization

  • Initial assessment of the mother; vital signs monitored closely.

Nursing Responsibilities

Nursing Care Before Birth

  • Monitor fetus and laboring woman.

  • Provide support to cope with labor.

Nursing Responsibilities During Birth

  • Prepare instruments and infant equipment.

  • Assist with perineal scrubs and medication administration.

  • Perform infant assessments and ensure effective parent-infant bonding.

Immediate Postpartum Period

  • Monitor for hemorrhage and assess pain.

  • Observe bladder function and recovery from anesthesia.

Monitoring Fetal Status

  • Fetal Heart Rate (FHR): Normal range 110-160 bpm. Change in rate needs immediate reporting.

  • Monitoring Techniques: Intermittent auscultation or continuous electronic monitoring.

Nursing Assessment and Interventions

  • Values and beliefs of the laboring woman should be respected and integrated into the care plan.

  • Addressing cultural practices, especially for non-English-speaking women, is critical.

Psychosocial Assessment

  • Coping with Labor: Emotional support and encouragement from staff or designated persons can significantly aid procedures.

  • Doulas: Presence can lead to decreased pain perception and enhanced coping.

Pain Management in Labor

  • Pharmacological options include IV narcotics, epidurals, and local infiltration for pain management.

  • Non-pharmacological methods include position changes, hydrotherapy, breathing techniques, and relaxation techniques.

Conclusion

  • Understanding the various components, responsibilities, and processes of labor and delivery is crucial for effective nursing care to ensure the well-being of both the mother and newborn.