1. Alicia A. Stone PhD, RN, FNP Molloy College
Labor and Delivery
Alicia A. Stone PhD, RN, FNP Molloy College
2/8/2018

2. “Pa….I think it’s time to go!”
2/8/2018

3. What is Labor?
Demonstrating progressive cervical changes, in the presence of regular, frequent, painful uterine contractions
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5. Phases of Labor During First Stage
Latency (0 to 3 cm)
Prodromal, early, preliminary
4- 24 hours
Active (4 to 7 cm)
3 to 5 hours
Transition (8 to 10 cm)
½ to 2 hours
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6. Physiologic Forces of Labor
Frequency of contractions
Effectiveness of pushing
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8. Uterine Contractions Palpation Timing Frequency Duration strength
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9. Birth Passage Size of maternal pelvis Type of maternal pelvis
Ability of cervix to dilate
Ability of vaginal canal to distend
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11. Dilation and Effacement
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12. Fetal Head
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13. Fetal attitude
Fetal lie
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17. Passage
Engagement
Station
Fetal position
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19. Psychosocial considerations
Mental and physical preparation for childbirth
Sociocultural values
Previous experience
Support
Emotional status
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20. Admission to Labor Suite
History
Contractions
When they last ate
Vital signs
Ultrasound
Examination
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21. Membranes Rupture 600 to 800 cc Color Odor Consistency Nitrazine Paper
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22. Leopold’s Maneuvers
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23. External fetal monitoring
Two belts
Uterine contractions
Fetal heart monitoring
benefits
negatives
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24. Internal fetal monitoring
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25. Fetal heart variability
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26. Early decelerations
Head compressions
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27. Late decelerations
Uteroplacental insufficiency
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28. Variable decelerations
Cord Compression
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29. Maternal Responses to labor
Cardio, B/P
Respiratory
Renal, GI
Immune/blood
Pain
causes
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30. Cardinal movements Descent Flexion Internal rotation Extension
Restitution
External rotation
Expulsion
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31. Fetus moving through the Pelvis

32. Placental delivery Contraction Globular uterus Cord lengthens
Rush of vaginal blood
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33. Causes of Pain in Labor Stage One Stretching of the cervix
during dilation & effacement
Stage One
What are the causes of pain during the first stage of labor?
Uterine Anoxia
Stretching of the
uterine ligaments

34. Causes of Pain in Labor Stage Two Distention of the vagina and
Perineum
Compression of the nerve
ganglia in cervix & lower uterus
Stage
Two
Pressure on urethra, bladder,
rectum during fetal descent
What are the causes of pain during the second stage of labor?
Traction on and stretching of
the perineum

35. Factors affecting Mothers Response to Pain in Labor
Preparation - Knowledge and confidence gained through childbirth classes
Cultural influences on expression of pain
Maternal fatigue, anxiety, sleep deprivation
Previous experiences with pain
Support
What are factors that may influence a woman's response to pain?

36. Methods of Pain Relief Childbirth methods Nonpharmacological
Breathing Techniques
Relaxation Techniques
Touch
Focusing attention on one object
Effleurage
What are methods of non-pharmacologic pain relief in providing general comfort?

37. Breathing Methods Basic principles Rhythmic chest Shallow chest
Comfortable position
Chest breathing
Focal point
Verbal and non-verbal cues
Cleansing breath
Rhythmic chest
Shallow chest
Pant-blow
Exhalation pushing
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38. Non-Pharmacological Listening to music; subdued lighting
Sensory Stimulation
Listening to music; subdued lighting
Imagery
Applying heat and cold
Massage (lower back); Counterpressure
TENS
Position Changes

39. Pain Management Narcotic Analgesics Timing Effect on labor
Common meds used
Stadol
Nubain
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40. Pain Relief in Labor Criteria for administering an analgesic:
Needs to be in active phase of labor
If give in latent phase – it may slow labor
If give in transition phase – can lead to neonatal respiratory depression

41. Regional Anesthesia Epidural Spinal Pudendal Side effects Hypotension
Bladder distention
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42. Nursing Care related to an epidural
Preparation
Assess platelet count – must be normal
Empty bladder
Assess vital signs for baseline
IV fluids
Following
Assess V/S – especially the B/P because the main side effect is hypotension
Rotate position between right and left side-lying
Assess bladder and catheterize as needed
Assess for other side effects and intervene