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

2. 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

3. 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

4. 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.

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. Apgar Scoring

12. 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

13. 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

14. 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

15. 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…