Care of the Family in Childbirth Linda L. Franco RN MSN NE-BC Green = need to know Blue = History Red = Important to know

Reasons to come to the Hospital Rupture of membranes Regular, frequent uterine contractions Primigravida – 5 minutes apart for 1 hour Multigravidas – 6-8 minutes apart for 1 hour Any vaginal bleeding Decreased fetal movement

Admission Initial encounter sets tone Explanation of procedures and policies Intrapartal Assessment – vaginal exam, FHR, uterine contractions Urine - protein (1+ or more sign of preeclampsia), glucose Lab – H&H (she has enough blood cells to carry the oxygen), Blood type & crossmatch, platelets ID bands Notify physician

First Stage of Labor First Stage – From the beginning of labor to the full opening of the cervix to about 4 inches or 10 centimeters. Initial (Latent) Phase – Contractions become progressively stronger. Discomfort is minimal. Cervix thins and opens to about 4 cm. May last an average of 12 hours in first pregnancy and 5 hours in subsequent pregnancies. Active Phase – Cervix opens from 4 cm to 10 cm. The presenting part of the baby begins to descend into the woman’s pelvis. The woman begins to feel the urge to push. This phase lasts about 3 hrs in 1st pregnancy and 2 hrs in subsequent pregnancies.

Nursing Care – First Stage Integration of Family Expectations Safety of mom & baby Specific expectations – birth plan Nursing support Emotional support Comfort measures Information and advice Advocacy Support of partner Cultural Beliefs Modesty Pain expression Specific Beliefs

Assessments of First Stage Latent VS, Temp Temp q4 hours unless ROM FHR, fetal activity Assess Uterine contraction NPO – ice chips Active VS q 1 hour, Pain control Bladder status FHR ROM and increased bloody show, prolapse of cord FHR monitoring Every 30 mins for low risk women and every 15 mins for high risk Transition Changes in Mood (mom’s) Assistance with breathing - monitor for hyperventilation

Promotion of Comfort: First stage Identify goals General comfort measures Anxiety Client teaching Supportive Relaxation techniques Breathing techniques

Second Stage of Labor From complete opening of the cervix to delivery of the baby. This stage averages about 45 to 60 minutes in the first pregnancy and 15 to 30 minutes in subsequent pregnancies

Nursing Care – Second Stage Provision of care Complete Dilatation More frequent VS Assist with positioning, breathing, & pushing Promotion of Comfort Rest between UC’s (uterine contractions) Assisting during birth Room prepared Birthing positions Cleansing the Perineum

Third Stage of Labor From delivery of the baby to delivery of the placenta. This stage usually lasts only a few minutes but may last up to 30 minutes

Apgar Scoring

Nursing Care – Third Stage Initial Care of the Newborn Placed on mother’s abdomen or under radiant warmer Apgar Done at 1 min and 5 mins Assess Umbilical cord for 3 vessels Number of vessels is recorded on the chart. Clamp on baby’s cord before they cut it, removed about 24 hours after birth when the cord has started to dry up Cord blood banking Some people save it for blood collection Physical assessment Newborn ID Mom and dad both get id bands along with baby. Typically come in sets of 4, one on wrist and ankle of baby, one on mom and one on dad. They can’t pick up baby without these Try not to use oxygen on these guys if we don’t need to, does effect their eyes (esp if it’s long term), and deep suctioning can hurt them

Birth of Placenta Uterus rises up in abdomen Umbilical cord lengthens Trickle of blood Uterus shape changes from a disk to a globe Sometime pitocin (sp?) is given to clamp down on the uterine muscles and help deliver the placenta

Nursing Care – Fourth Stage Placenta – inspect for missing pieces Episiotomy repair Uterus midline and firm Cleanse perineum with warm H2O and place ice to perineum Monitor maternal VS Warm blankets Mom’s may be shaking, hormone and blood flow changes Enhancing attachment

Nurse Attended Birth – Preciptious Birth Remain with patient Amniotic sac intact – must rupture Apply gentle pressure to head to prevent tears to perineum Check for nuchal cord after head delivered Fishhook your fingers and pull the cord over the head and away from around the neck of the baby Suction mouth & nose Gentle traction on anterior shoulder then upward pressure on the posterior shoulder Hold securely and place on mother’s abdomen Clamp cord and cut Watch for signs of placenta delivering Precipitous birth occurs when labor and delivery occurs in 3 hours or less…