1. Nursing Care of Mother and Infant During Labor and Birth
Chapter 6
Nursing Care of Mother and Infant During Labor and Birth 1

2. Cultural Influences on Birth Practices
Role of woman in labor and delivery
Cultural preferences require flexibility
Role of father/partner in labor and delivery
May be driven by cultural practices
Look at Table 6-1 on page
Refer to Table 6-1, pages
Discuss the responsibilities of the nurse when interacting with families of different cultures.
GOAL: The Student will learn to identify and respond appropriately to patients of different cultures. 2 2

3. Uterine Contractions Effect of contractions on the cervix
Efface
Dilate
Phase of contractions
Increment
Peak
Decrement
Frequency
Duration
Intensity
Mild
Moderate
Firm
Maternal pushing
A uterine contraction results from involuntary smooth muscle contractions.
The contractions assist in the effacement (thinning) of the cervix.
During labor, one of the nurse’s roles is to monitor uterine contractions.
Define frequency and duration.
What are the differences among mild, moderate, and firm contractions?
GOAL: The student will learn how to identify contraction effect, phases, frequency, duration and intensity during labor. 3 3

4. Cervical Effacement and Dilation
Cervical effacement and dilation can be likened to sucking on a Lifesaver. As the candy becomes thinner, the center opening becomes wider.
Describe the differences between cervical effacement and dilation for the primigravida and multigravida woman.
GOAL: The student will learn how to identify contraction effect, phases, frequency, duration and intensity during labor. 4 4

5. Contraction Cycle
Nurses must understand the components of the contraction cycle.
Review the increments and peak of the contraction pattern.
GOAL: The student will learn how to identify contraction effect, phases, frequency, duration and intensity during labor. 5 5

6. Nursing Tip
Provide emotional support to the laboring woman so she is less anxious and fearful
Excessive anxiety or fear can cause greater pain, inhibit the progress of labor, and reduce blood flow to the placenta and fetus
What interventions can the nurse implement to reduce anxiety and fear during labor?
GOAL: The student will learn how to identify contraction effect, phases, frequency, duration and intensity during labor. 6 6

7. The Passage Bony pelvis Soft tissues True False
Directly involved in childbirth
Inlet
Midpelvis
Outlet
False
Flares
Upper portion of pelvis
Soft tissues
If previous delivery, will yield more readily to contractions and pushing efforts
May not yield as readily in primiparas or older women
GOAL: The student will learn how to accurately identify the true and false pelvis and their purpose. 7 7

8. The Passenger—Fetal Skull
The bones in the fetal head are separated by connective tissue.
What is the importance of this tissue in relation to the birthing process?
Compare and contrast the fontanels.
GOAL: The student will learn how to identify the anterior and posterior fontanel. The student will learn the importance of fontanel assessments. 8 8

9. The Passenger—Fetal Lie
Fetal lie refers to the position of the fetus in relation to the maternal spine.
Review the various fetal lie positions.
GOAL: The student will learn the importance of identifying the fetal lie and how it pertains to the labor process. 9 9

10. The Passenger—Presentation
GOAL: The student will learn the importance of identifying the fetal lie and how it pertains to the labor process. 10 10

11. Classifications of Fetal Presentations and Positions
Review the terminology used in each of the fetal presentations.
GOAL: The student will learn the importance of identifying the fetal lie and how it pertains to the labor process. 11 11

12. Psyche Mental state can influence the course of labor
The woman’s cultural and individual values influence how she will cope with childbirth
GOAL: The student will learn how the mental state, culture and pain level contribute to the course of labor. 12 12

13. Signs of Impending Labor
Braxton Hicks contractions
Increased vaginal discharge
Bloody show
Rupture of the membranes
Energy spurt
Weight loss
Compare and contrast the clinical manifestations of Braxton Hicks contractions and true labor.
Bloody show is a normal occurrence prior to the onset of labor. Describe the manifestations associated with bloody show.
Rupture of membranes warrants evaluation of the pregnant woman at the health care facility.
GOAL: The student will learn and be able to identify the signs of impending labor. 13 13

14. Mechanisms of Labor Descent Engagement Flexion Internal rotation
Station
Engagement
Flexion
Internal rotation
Extension
External rotation
Expulsion
Mechanisms of labor refer to those physiological changes in positioning which take place during a normal vaginal delivery.
Describe each of these positions. 14 14

15. Birth Station
Station refers to the position of the fetal head relative to the ischial spines. 15 15

16. Mechanisms of Labor Also referred to as “cardinal movements.” 16
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16 16

17. When to Go to the Hospital or Birth Center
Contractions
Ruptured membranes
Bleeding other than bloody show
Decreased fetal movement
Any other concern
What is the timeline for patient education concerning how and when to seek care?
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17 17

18. Admission Data Collection
Three major assessments performed promptly on admission
Fetal condition
Maternal condition
Impending birth
Discuss Skill 6-1, Assisting with an Emergency Birth on page 130.
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18 18

19. Admission Procedures Permits/consents Laboratory tests
Intravenous infusion
Perineal prep
Determining fetal position and presentation
Discuss the actions required for each task listed.
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19 19

20. Comparison of False and True Labor
False labor
Contractions irregular
Walking relieves contractions
Bloody show usually not present
No change in effacement/dilation of cervix
True labor
Contractions gradually develop a regular pattern
Contractions become stronger and more effective with walking
Discomfort in lower back/abdomen
Bloody show often present
Progressive effacement and dilation of cervix
Refer to Table 6-2, page 131.
What is the greatest difference between the types of labor? False labor does not result in cervical changes, while true labor causes changes in cervical dilation and effacement.
At what point during the pregnancy should education be provided regarding false and true labor? Successful education should begin early in the pregnancy. This approach allows time for reinforcement throughout the pregnancy at each visit to the health care provider.
Audience Response Question #1
Which is a characteristic of true labor?
1. Contractions are regular, and the intensity remains the same
2. Contractions are irregular, and the intensity remains the same
3. Contractions are regular and are intensified by walking
4. Contractions are regular and are not intensified by walking 20 20

21. Nursing Care Before Birth
After admission to the labor unit, nursing care consists of
Monitoring the fetus
Monitoring the laboring woman
Helping the woman cope with labor
Fetal monitoring can be intermittent or continuous.
Review factors which can determine the type of monitoring employed. 21 21

22. Monitoring the Fetus Fetal heart rate Intermittent auscultation
Continuous electronic fetal monitoring
Review Skill 6-2 on page 133, Box 6-2 on page 134, and Skill 6-3 on page 135. 22 22

23. Evaluating Fetal Heart Rate Patterns
Accelerations
Early decelerations
Variable decelerations
Late decelerations
Prolonged decelerations
Recurrent decelerations
Intermittent decelerations
Sinusoidal pattern
Baseline FHR
BPM
Fetal bradycardia
<110 BPM
Fetal tachycardia
>160 BPM
Baseline variability
Moderate variability
Marked variability
Absent variability 23

24. Reassuring and Nonreassuring FHR and Uterine Activity Patterns
Reassuring patterns
Stable fetal heart rate (FHR)
Moderate variability
Accelerations
Uterine contraction frequency greater than every 2 minutes; duration less than 90 seconds; relaxation interval of at least 60 seconds
Nonreassuring patterns
Tachycardia
Bradycardia
Decreased or absent variability; little fluctuation in rate
Late decelerations
Variable decelerations
See Box 6-3 on page 137 for more details.
A part of the nursing assessment is the evaluation of fetal heart patterns.
Nonreassuring patterns require reporting to the health care provider.
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24 24

25. Late Decelerations
Review Box 6-3, page 137.
GOAL: The student will learn how to visually identify late decelerations and the what causes them. 25 25

26. Monitoring the Woman Vital signs Contractions Progress of labor
Intake and output
Response to labor
Discuss the frequency of each of the items to be monitored. 26 26

27. Six Lamaze Institute Basic Practices for Maternity Care
Labor should begin on its own
Woman should have freedom of movement
Woman should have a birth support person or doula
No routine interventions should be performed
Woman should be in non-supine positions
Woman should not be separated from infant
GOAL: The student will learn the basic practices of lamaze via lecture and clinical experience. 27

28. Helping the Woman Cope with Labor
Labor support
Teaching
Providing encouragement
Supporting/teaching the partner
Teach how labor pains affect the woman’s behavior/attitude
How to adapt responses to the woman’s behavior
What to expect in his/her own emotional responses
Effects of epidural analgesia
Review the components of labor support with the class.
What are the recommended positions of comfort for the laboring women?
GOAL: The student will learn how to identify the needs of the woman and labor and how to provide appropriate care. 28 28

29. 4 stages of labor power point
Stages and Phases of Labor
First stage—dilation and effacement (can last 4 to 6 hours)
Second stage—expulsion of fetus (30 minutes to 2 hours)
Third stage—expulsion of placenta (5 to 30 minutes)
Fourth stage—recovery
4 stages of labor power point
The labor of the primigravida will last longer than that of a multigravida.
What behaviors are associated with each of the stages of labor?
Audience Response Question #2
During which stage of labor does “crowning” occur?
1. First
2. Second
3. Third
4. Fourth
GOAL: The student will understand and be able to identify the four stages of labor. 29 29

30. Vaginal Birth After Cesarean
Main concern
Uterine scar will rupture
Can disrupt placental blood flow
Lead to hemorrhage
Woman may need more support than other laboring women
Nurse provides empathy and support
Discuss some of the psychological barriers that may arise for a woman with VBAC.
GOAL: The student will understand and be able to identify the four stages of labor. 30

31. Nursing Responsibilities During Birth
Assessing Apgar score
Assessing infant for obvious abnormalities
Examining the placenta
Identifying mother and infant
Promoting parent- infant bonding
Preparing the delivery instruments and infant equipment
Perineal scrub
Administering medications
Providing initial care to the infant
GOAL: The student will understand and be able to identify the four stages of labor. 31 31

32. Immediate Postpartum Period: Third and Fourth Stages of Labor
Third stage—expulsion of placenta
Schulze or Duncan’s
Fourth stage—nursing care includes
Identifying and preventing hemorrhage
Evaluating and intervening for pain
Observing bladder function and urine output
Evaluating recovery from anesthesia
Providing initial care to the newborn infant
Promoting bonding and attachment between the infant and family
After the birth of the baby, the nurse continues to assess the mother.
Review both normal and abnormal findings.
GOAL: The student will understand and be able to identify the four stages of labor. 32 32

33. Nursing Care Immediately After Birth
Care of the mother
Observing for hemorrhage
Vital signs
Skin color
Location and firmness of uterine fundus
Lochia
Pain
Promoting comfort
Keep warm and dry
Ice to perineum to help reduce swelling and bruising
GOAL: The student will learn how and why to assess the mother immediately post delivery. 33 33

34. Nursing Care Immediately After Birth (cont.)
Care of the infant
Phase 1
From birth to 1 hour (usually in delivery room)
Phase 2
From 1 to 3 hours (usually in transition nursery or postpartum unit)
Phase 3
From 2 to 12 hours (usually in postpartum unit if rooming-in with the mother)
If the newborn does not experience any difficulty with adaptation to extrauterine life, the infant will often remain with the mother in the delivery room.
GOAL: The student will learn how and why to care for a newborn immediately post delivery. 34 34

35. Phase 1: Care of the Newborn
Initial care includes
Maintaining thermoregulation
Maintaining cardio-respiratory function
Observing for urination and/or passage of meconium
Identifying the mother, father, and newborn
Performing a brief assessment for major anomalies
Encouraging bonding/breastfeeding
GOAL: The student will learn how and why to care for a newborn immediately post delivery. 35 35

36. Care of the Newborn
GOAL: The student will learn how and why to care for a newborn immediately post delivery. 36 36

37. Apgar Score
GOAL: The student will learn the importance of apgar scoring and how the score is formulated.

38. Administering Medications to the Newborn
Eye care
Vitamin K (AquaMEPHYTON)
Review Skill 6-6 on page 153 and Skill 6-7 on page 154.
Audience Response Question #4
What medication is most often used for neonatal eye care?
1. Silver nitrate 1%
2. Triple dye
3. Silver nitrate 2%
4. Erythromycin ophthalmic ointment
GOAL: The student will learn how and why erythromycin ointment and Vitamin K are administered to the infant, immediately after birth. 38 38

39. Observe for Major Anomalies
Head trauma from delivery
Symmetry and equality of extremities
Are they of equal length?
Do they move with same vigor on both sides?
Assess digits of hands and feet
Any evidence of webbing or abnormal number of digits
What else should be assessed in regard to major anomalies?
Which anomalies require immediate notification to the RN or health care provider?
GOAL: The student will learn how and why to assess for head trauma, extremity symmetry and hand/feet abnormalities. 39

40. Umbilical Cord Blood Banking
This type of blood is capable of regenerating stem cells that are able to replace diseased cells
Informed consent is essential
Collect blood after cord has been clamped
Blood must be transported within 48 hours of collection to blood banking facility
GOAL: The student will understand why and how cord blood is collected and saved per the patient’s request. 40 40