Intrapartum Care

Lecture 8

Maternal and child Nursing NUR 362

Intrapartum care
Intrapartum period extends from the beginning of contractions that cause cervical dilatation to the first 1 to 4 hours after delivery of the newborn and placenta.

Factors affecting the intrapartum experience

Experience Culture Prepregnant health & biophysical preparedness for childbearing Motivation for childbearing Socioeconomic readiness Age of mother

Phenomena and process of labor and delivery

Onset of labor labor is the process by which the fetus and products of conception are expelled as the result of regular ,progressive frequent and strong uterine contractions.

Theoretically ,labor is thought to result from: a- progesterone depriviation. b- oxytocin stimulation. c- fetal endocrine control. d- Uterine decidua activation

Factors affecting labor

1-passageway: The adequacy of the pelvis and birth canal allowing fetal descent 2-passenger: refer to the fetus Size of fetal head. Fetal presentation. Fetal position. Fetal attitude-the relationship of fetal parts to one another

Fetal presentation-the part of the fetus that enters .the maternal pelvis first

Fetal position

Factors affecting labor

3- power: Frequency, duration and strength of the uterine contractions to cause complete cervical effacement and dilatation.

4-placental factors.-site of placenta.

5-Psyche: clients psychological state

Signs and symptoms of impeding labor

1-lightening: The descent of the fetus and uterus into the pelvis cavity 2 to 3 weeks before the onset of labor.

Signs and symptoms of impeding labor

2-Braxton Hicks contractions: Irregular ,intermittent contractions that have occurred throughout the pregnancy ,become uncomfortable and produce a drawing pain in the abdomen.

Signs and symptoms of impeding labor

3-Cervical changes: include softening 4-Rupture of the amniotic membrane 5-Burst of energy or increased tension and fatigue. 6- weight loss: about 1 to 3 pounds may occurs 2 to 3 days before the onset of labor.

True and false labor

False labor

True labor

-contractions may be irregular. -decrease in frequency and intensity. -longer interval between contractions. -activity has no effect or decrease contractions

-regular contractions -progressive frequency and intensity. -shorter interval between contractions. -activity increase contractions.

False Contractions

True contractions

-disappear while sleeping. -sedation decrease or stop contractions. -bloody show usually not present. -no appreciable changes in the cervix.

-continue while sleeping. -sedation does not stop contractions. -bloody show usually present. -progressive thinning and opening of the cervix.

Stages of labor

1-First stage. begins with the onset of regular contractions. Latent phase: dilation of cervix to3 to 4 cm. contraction become increasing Active phase: dilation continues from 3 to 4 cm to 7 cm. Contraction become stronger and painful Transition phase: cervix dilates from 8 to 10 cm

Stages of labor

2- Second stage. (expulsive stage)-begins with complete dilatation of the cervix and ends with delivery of the newborn. -it should be complete within one hour after complete dilatation.

Cont, second stage

-movements.. 1. descent. 2. flexion. 3. internal rotation. 4. extension. 5. external rotation. 6. expulsion.

Cont, second stage -crowning occurs when the newborns head or presenting part appears at the vaginal opening. -Episiotomy surgical incision in the perineummay be done to facilitate delivery and avoid laceration of the perineum.

3-Third stage (placental stage)

-This stage begins with delivery of the newborn and ends with delivery of placenta. -It occurs in two phases placental separation and placental expulsion.

4-Fourth stage

-It lasts from 1 to 4 hours after birth. -the mother and the newborn recover from physical process of labor. -systems readjustment. Newborn body systems begins to adjust to extrauterine life.

-Intrapartum pain experience.

-overview of pain. -factors affecting perception of intrapartum pain. -physiologic causes of intrapartum pain. -uterine anoxia. -compression of the nerve ganglia in the cervix. -stretching of the cervix. -traction on, stretching of the perineum. -pressure on the urethra, bladder and rectum during fetal descent. - distension of the lower uterine segment.

- Intrauterine pain management

-overview of goals. -none pharmacologic pain management. -pharmacological pain management. -narcotic analgesics. -barbiturates. -tranquilizers. -regional anesthesia. - general anesthesia.

Nursing process overview for labor.

1-Maternal assessment. -complete health history. -screening for risk factors. -physical assessment. -psychological assessment -labor progress assessment. 2-Fetal assessment -position. Possible size -monitor fetal status-FHR

Nursing diagnosis.

-Health-seeking behaviors. -Anxiety. -Ineffective individual coping. -Pain. -Risk for injury. -Risk for ineffective airway clearance. (newborn). -Risk for hypoxia. (newborn).

-Planning
-

The women will experience maximum safety The women will be prepared for the birth of her child The newborn will receive essential immediate care The newborn and parents will experience early contact

Implementation
-Perform admission procedures. -Provide client and family teaching throughout the first and second stages. -Reinforce coaching, breathing and other relaxation measures. -Provide physical, emotional and pharmacologic support as needed.

Implementation
-Promote safety during the first and second stage. -prevent cord prolapse. -asses hydration -offer the client opportunity to void.

Implementation

-prepare for the birth of the newborn. -Implement immediate newborn care. 1 -airway maintaining.

2-compensate for poor newborn thermoregulation. -dry the newborn immediately with warm blanket. -place the newborn under a radiant warmer. -wrap the newborn in a warmed dry blanket or place the newborn on the mother skin.

Implementation
3-Determine the Apgar score at 1 and 5 minutes after delivery. 4-Inspect the umbilical cord for two arteries and one vein. 5-Weigh and measure the newborn. 6-Footprint the newborn. and fingerprint the mother. 7-record the newborn first voiding and stool passage.

Implementation
8-Assess the newborns gestational age. 9-Administer prophylactic eye medication to protect conjunctivae from infection. 10-Administer Vit. K if prescribed.

-Encourage initial parental-newborn bonding. -Outcome evaluation.