1. CHAPTER 14 Caring for the Woman Experiencing Complications During Labor and Birth

2. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Dystocia  Long, difficult, or abnormal labor  May arise from  Powers  Passenger  Passageway

3. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Dysfunctional Labor Pattern: Hypertonic  Strong, painful, ineffective contractions  Contributing factor—maternal anxiety  Occiput-posterior malposition of fetus  Management  Rest, hydration, sedation  Facilitate rotation of the fetal head

4. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Dysfunctional Labor Pattern: Hypotonic  Contractions decrease in frequency and intensity  Maternal and fetal factors that produce excessive uterine stretching  Management  Walking, position changes  Augmentation of labor

5. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Precipitate Labor and Birth  Rapid intense contractions  Nursing considerations  Careful examination for dilation and effacement  Reassure woman and support person  Breathing to avoid pushing and prevent tearing  Careful examination of maternal soft tissue and placenta

6. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Pelvic Structure Alterations  Pelvic dystocia  Soft tissue dystocia  Trial of labor  To assess safety of vaginal birth

7. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Obstetric Interventions—Amnioinfusion  Risks: infection, overdistention of uterus, increased uterine tone  Nursing  Careful monitoring of infusion, intensity and frequency of contractions, and maternal vital signs  Educate  Pharmacological induction of labor  Nonpharmacological stimulants of labor

8. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Obstetric Interventions—Amniotomy  Artificial rupture of membranes  Augment or induce labor  Nursing  Careful monitoring of vital signs, cervical effacement/dilation, station, FHR, contractions  Document regarding amniotic fluid

9. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Induction of Labor  Indications for induction  Bishop score  Cervical ripening agents  Mechanical methods  Oxytocin  Augmentation of labor

10. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Induction—Nursing Considerations  Informed consent  Careful monitoring of labor  Discuss pain relief measures  Position changes  Keep patient and support person informed of progress

11. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Instrumentation Assistance of Birth  Forceps  Vacuum extraction

12. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal Complications—Hypertensive Disorders  Preeclampsia-eclampsia, HELLP syndrome  Nursing  Careful assessments  Monitor lab values  Administer platelets as appropriate  Ongoing education

13. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal Complications—Diabetes  Fetal lung maturity  Intrapartum management—maternal hydration and blood glucose levels  Labor: normal progression of labor  Upright or side-lying position  Encourage breastfeeding

14. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Preterm Labor and Birth  Careful maternal monitoring  FHR monitoring ***  Identify and report symptoms suggestive of fetal hypoxia  Assess psychological status

15. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Labor and Birth Complications—Fetal  Fetal malpresentation  Version: external or internal  Shoulder dystocia  Cephalopelvic disproportion  Multiple gestation  Non-reassuring FHR patterns

16. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Amniotic Fluid Complications  Oligohydramnios  Hydramnios  Meconium  Nuchal cord

17. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Complications—Placental Problems  Placenta previa  Placental abruption  Disseminated intravascular coagulation

18. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Other Complications  Uterine rupture  Obstetric emergency  Uterine inversion  Umbilical cord prolapse

19. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Variations—Umbilical Cord and Placenta  Velamentous cord insertion  Fetal vessels separate at distal end and insert into placenta away from the margin  Vasa previa  Fetal vessels cover cervical os

20. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Placental Variations  Circumvallate placenta  Succenturiate placenta  Battledore placenta  Placenta accreta  Placenta increta  Placenta percreta

21. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Amniotic Fluid Embolism  Rapidly deteriorating maternal condition  Acute dyspnea, severe hypotension  Rapid delivery after stabilizing mother  Ethical conflict  Save mother versus fetus

22. Collaboration in Perinatal Emergencies

23. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Perinatal Fetal Loss  Nursing considerations  What to say  What not to say

24. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cesarean Birth  Indications  Health of mother or fetus is jeopardized  Ethical considerations  Surgical procedures  Surgical and postoperative care  Vaginal birth after cesarean

25. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Postterm/Prolonged Pregnancy  Postterm—extends beyond 42 weeks  Risk for fetal/neonatal problems  Increased maternal risk  Management—labor induction  Nursing implications  HomeWork:

26. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Home work # 2  Describe labor pain relief options, rationale for use, and contraindications for each.  -Epidural & Spinal  -General  -Local  -IV Medication Describe the medication, it’s indication, and contraindications:  -Cervidil  -Pitocin  -Methergine  -Hemabate  -Duramorph