INTRAPARTUM: Labor and Birth Maternal-Newborn and Child Nursing London, Ladewig, Ball, & Bindler Prepared by Mary Ann Gagen, Professor of Nursing

“Pa…I think it’s time to go!”

Process and Stages of Labor and Birth: Chapter 15 Critical Factors in Labor The birth passage The fetus The relationship between the passage and the fetus Primary forces of labor Psychosocial considerations Table 15-1: p 310

The Birth Passage Implications of Pelvic types for Labor and Delivery Table 15-2, p 310

The Fetus Head

The Fetus Attitude Lie Presentation Top: Fetal Attitude flexion, fetal lie longitudinal Bottom: Fetal Attitude flexion, fetal lie transverse

Relationship between the passage and the fetus Engagement Station Fetal position

The Forces of Labor Primary Secondary Phases of Contractions Increment Acme Decrement Characteristics of contractions Frequency Duration Intensity

Psychosocial Considerations Motivation for pregnancy Support Preparation Trust in staff Maintaining control Cultural influences Table 15-3

Physiology of Labor Premonitory signs of labor Lightening or quickening Braxton Hicks Contractions Cervical changes Bloody show Rupture of membranes Sudden burst of energy Other: diarrhea, nausea, etc True vs False Labor Table 15-4: p 321

Stages of Labor and Birth First stage Latent Active Transition Second stage Crowning Positional changes of the fetus Table 15-5: Characteristics of Labor, p 323

Stages: cont’d Third stage Placental separation Placental delivery Fourth stage 1-4 hours

Stages: cont’d Maternal responses to labor Cardio, B/P Respiratory Renal, GI Immune/blood Pain Causes Fetal responses

Intrapartal Nursing Assessment Chapter 16 Admission assessment Data Collection Assessments Assessment Guide, pp

Intrapartal Nursing Assessment, cont’d Evaluating labor progress Leopold’s Maneuvers FHR and Pattern Accelerations Decelerations Early Late Variable

Evaluations of FHR Tracings

Intrapartal Nursing Assessment cont’d Contractions Frequency Intensity Duration Vaginal exam

The Family in Childbirth: Needs and Care, Chapter 17 Nursing management The admission process The first stage of labor Family expectations Cultural beliefs Pain, modesty Promotion of comfort Clinical Pathways pp

The Family in Childbirth: Needs and Care, cont’d Nursing management Second stage comfort Third stage Initial care of newborn Apgar Umbilical cord Warmth Newborn identification

The Family in Childbirth: Needs and Care, cont’d Nursing management Fourth stage Delivery of placenta Enhancing attachment