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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-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 Chapter 12 The Process of Labor and Birth Edited by Catherine Marin, MSN/Ed(c), WHCNP, RN
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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 Process— Critical Factors Powers (physiologic forces) Passageway (maternal pelvis) Passenger (fetus and placenta) Passageway + passenger relationship Psychosocial influences
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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 Powers Uterine contractions—primary force Maternal pushing efforts—secondary force Characteristics of uterine contractions Increment Acme Decrement
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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 Assessment of Uterine Contractions Characteristics Frequency Duration Intensity Palpation Electronic fetal monitoring
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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 Electronic Fetal Monitoring External monitor—tocodynamometer Noninvasive Internal monitor—internal pressure catheter Invasive
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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 IMPORTANT TERMS Effacement: shortening and thinning of cervix Expressed as a percentage (0% to 100%) Dilation: opening and enlargement of cervix Expressed in centimeters (1 to 10 cm)
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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 Powers Maternal Pushing Efforts “Bearing down” sensation Urge to push No urge to push
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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 Passageway Maternal Pelvis and Soft Tissues Four classic types Gynecoid—normal female Android—heart shaped, male Anthropoid—apelike Platypelloid—flat oval
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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 Passenger Fetus and fetal membranes Molding of head Fetal lie Longitudinal Transverse Oblique
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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 Passenger (cont.) Fetal attitude—flexion Fetal presentation Cephalic Vertex Military Brow Face
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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 Advantages of Cephalic Presentations Head usually largest part of infant Molding Optimal shape—smooth and round
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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 Breech Presentations Buttocks enter maternal pelvis first Frank: legs extended toward shoulders Complete: legs flexed Footling: one or both feet present first into maternal pelvis (SACRUM is landmark)
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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 Disadvantages of Breech Presentation Risk of cord prolapse Presenting part less effective in cervical dilation Risk of cord compression Risk of prolonged labor
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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 Shoulder Presentation Occurs when fetus in transverse lie Cannot be delivered vaginally unless rotation occurs
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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 Passageway + Passenger Relationship Engagement Station Ischial spines—0 station Above ischial spines—(–) minus station Below ischial spines—(+) plus station +4 cm means that...
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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 Position Vertex—occiput (O) Face—chin (M = mentum) Breech—sacrum (S) Shoulder—acromion process (A) Four quadrants of maternal pelvis
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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 Landmarks Abbreviations are used First and last letter—maternal pelvis Middle letter—fetus presenting part Examples ROA (right occiput anterior) ROP LSP
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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 Psychosocial Influences Other critical factors Readiness, educational preparedness, etc. Cultural views of childbirth Role transition facilitated by positive childbirth experience Negative experience interferes with bonding and maternal role attainment
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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 Signs and Symptoms of Impending Labor
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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 Lightening May cause Leg cramps Increased pelvic pressure Increased urinary frequency Increased venous stasis Increased vaginal secretions
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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 Signs and Symptoms Braxton Hicks contractions Cervical changes-true labor Bloody show Rupture of membranes Energy spurt Weight loss, GI disturbances
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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 True and False Labor TRUE labor Leads to dilation and effacement of cervix Regular contractions Contractions increase in duration, frequency, and intensity
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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 True and False Labor FALSE labor No cervical changes Contractions Felt in abdominal region Do not increase in intensity Often stop with activity
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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 Childbirth Settings and Labor Support
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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 Admission Procedures Establish positive relationship Collect admission data Initial admission assessments Focused Psychosocial assessment Cultural assessment Laboratory tests
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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 FIRST STAGE OF LABOR Stage of dilation Three phases Latent phase—0 to 3 cm Active phase—4 to 7 cm Transition—8 to 10 cm Friedman curve
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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 Nursing Care Ongoing assessment Facilitate a positive birth experience Manage discomfort Advocate for patient’s needs Provide anticipatory guidance
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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 Support Presence Promote comfort Environment Personal hygiene Elimination Supportive relaxation techniques
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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 Fetal Assessment Position Fetal heart sounds Baseline FHR Presence of Variability Accelerations Decelerations
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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 Interpretation of FHR Tracings Consider contraction frequency and intensity, stage of labor, and earlier FHR pattern Reassuring Non-reassuring
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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 Nursing Care FHR decelerations Early: no action Variable and late Lateral position changes Oxygen per face mask Palpation for hyperstimulation Discontinue oxytocin Increase IVF rate
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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 Second Stage of Labor Full dilation through birth of infant Urge to push Promote effective pushing Closed-glottis Open-glottis Position of comfort
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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 Preparation for Birth Bulging of the perineum and rectum Flattening and thinning of the perineum Increased bloody show Labia begin to separate
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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 Imminent Birth Crowning Burning sensation Intense pressure in rectum Episiotomy Midline Mediolateral
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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 Cardinal Movements of Birth Descent Flexion Internal rotation Extension
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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 Cardinal Movements (cont.) Restitution External rotation Expulsion
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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 Umbilical Cord Clamping Controversy regarding when, how Nurse—inspect cut cord for presence of two arteries and one vein Collect cord blood sample for laboratory analysis
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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 Nursing Diagnoses for Intrapartal Patient Pain Knowledge deficit Anxiety Fatigue Risk for infection Impaired fetal gas exchange
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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 Third and Fourth Stages of Labor Immediate care of the newborn Delivery of the placenta Monitoring and assisting mother with physiological adjustments following birth Facilitating maternal-infant attachment
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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 Third Stage Birth of baby to complete delivery of placenta Smaller, spherical uterus Elevation of uterus in abdomen Lengthening and protrusion of cord Gush of blood from vagina
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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 Separation and Expulsion of the Placenta
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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 Nursing Care—Third Stage Observe for signs that placenta has separated Oxytocic medications to control blood loss Examine cotyledons Offer emotional support Foster infant attachment
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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 Immediate Care of Newborn Airway Warmth Appraisal—Apgar score Identification of newborn
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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 Fourth Stage Delivery of placenta through 1 to 2 hours after birth Monitor position and firmness of uterus “Boggy,” soft uterus Report immediately Initiate fundal massage
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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 FOURTH STAGE Assess lochia Vital signs and urine output Shivering—offer blankets Promote comfort Facilitate attachment and breastfeeding
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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 Fourth Stage—Risk Signs Hypotension Tachycardia Excessive bleeding Noncontracting uterus
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