1. Normal Labor and Delivery
Nursing Care

2. Signs and Symptoms of the Stage 1 -- Latent Phase
Contraction: dilate 0-3 cm.
Mild
Duration – seconds
Frequency – 5-20 minutes
Scant pinkish discharge, bloody show
Mother’s response
Surge of energy and excited
Talkative, outgoing
Anxiety low
**Best time to do teaching!

3. Nursing Care Stage 1 – Latent Phase
Welcome to the Hospital
Assess goals for this labor
Assess Psychological response
Orient to common procedures
Vital signs and FHT’s
Enema IV
NPO
Assessment of Labor Progress – dilation, effacement, station, lie, etc.

4. Stage 1 – Active Phase Signs and Symptoms
Contractions – dilate 4-7 cm.
Moderate
Duration – seconds
Frequency – 2-5 minutes
Mother’s Response
More serious
Determined, Dependent
Restless
Focuses on self

5. Stage 1 – Active Phase Nursing Care
Anticipate Needs:
Sponge face with cool cloth
Keep bed clean and dry- change chux
Provide with mouth care – lip balm to lips
Assess voiding
Non-Pharmacological Measures
Modified breathing
Effleurage
Music
Analgesia and Anesthesia

6. Stage 1 – Transition Phase Signs and Symptoms
Contractions cm
Strong
Irregular with multiple peaks
Duration – seconds
Frequency – 2 minutes
Mother’s response
Withdrawn, drowsy,
Nausea, trembling of legs
Irritable, aggressive
Urge to push

7. Stage 1- Transition Nursing Care
Provide support- may need to breathe with the patient – get in her face
Back rub
Assist with pant-blow breathing
Watch for hypervention – have breathe in mask and slow down the breathing
Do NOT allow to push by having patient blow-blow-blow with urge.
Do not be offended by irritability

8. Stage Two of Labor Signs and Symptoms:
Sudden Appearance of sweat on upper lip
An episode of vomiting
Increase in bloody show
Shaking of extremities
Increased restlessness
Pressure on rectum; involuntary bearing down
Bulging of perineum

9. Stage 2 Nursing Care The key to care during this stage
is to teach QUALITY PUSHING !
Keep perineum clean and dry
Provide quiet environment
Support with positive feedback
Repeat doctors instructions
Allow to hold the baby , Congratulate!!

10. Stage 2 – Mechanisms of Labor
1. Engagement and Descent
2. Flexion
3. Internal Rotation
4. Extension
5. External Rotation
6. Expulsion

11. Stage 3 of Labor Signs and Symptoms of Placental Separation:
1. A globular rise in the abdomen
the placenta changes from a discoid to a globular shape
2. Sudden gush of blood
3.Lengthening of the cord

12. Stage 3 – Nursing Care Congratulate on delivery of baby
Coach in relaxation for delivery of the placenta
Initiate contact with the infant
May allow to breast feed if desires

13. Test Yourself!
The cardinal movement that facilitates the emergence of the fetal head ____________.
A. Flexion
B. Extention
C. External rotation
Cardinal movement that allows the smallest diameter of the head to pass through the pelvis is__________________.
B. Internal rotation
C. Extension
Cardinal movement that occurs as the fetal shoulders engage and descend through the pelvis is termed ______.
A. Internal rotation
B. External rotation

14. The End
RETURN

15. Causes of Pain in Labor Stage One Stretching of the cervix
during dilation & effacement
Stage One
Uterine Anoxia
Stretching of the
uterine ligaments

16. 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
Traction on and stretching of
the perineum

17. Factors affecting Mothers Response to Pain in Labor
Knowledge and confidence gained through childbirth classes
Cultural influences on expression of pain
Maternal fatigue and anxiety
Previous experiences with pain

18. Methods of Pain Relief Nonpharmacologic Childbirth methods Effleurage
Breathing Techniques
Relaxation Techniques
Touch
Focusing attention on one object
Effleurage

19. Non-Pharmacological Sensory Stimulation
Listening to music; subdued lighting
Imagery
Applying heat and cold
Massage (lower back); Counterpressure
TENS
Position Changes

20. Pain Relief in Labor Pharmacologic Methods Analgesia Barbiturates
Demerol
Stadol
Barbiturates
Seconal; Nembutal
Tranquilizers
Vistaril

21. Anesthesia Regional Local General Paracervical Epidural; Caudal Spinal
Pudendal
Local
General
Used mainly in cesarean deliveries

22. True or False ?
The anesthesia used for both labor and delivery is an epidural
A. True
B. False
The anesthesia used for delivery and an episiotomy is paracervical.

23. True or False ?
The nurse would be careful to keep the patient flat following delivery with a pudendal block
A. True
B. False
The initial side effect of an epidural anesthesia is fetal bradycardia

24. The End
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