1st stage of labor

Admission care

-Signs of advanced labor: visualize perineum, sterile vag exam (if safe), contact provider -Signs of painless bleeding: do not do a vaginal exam, contact provider, abd ultrasound

1st stage assessments

-VS every 4 hr to 30 mins -Temp every 4 hours (ROM or over 99.6 every 1) -assess FHR every 30 mins if low risk and every 15 mins if high risk -limit vaginal exams -void every 1-2 hours PRN

Physical Assessment

-VS, weight -lungs, fundus, edema, hydration, perineum,membranes -fetal movement, FHT, presentation, position, descent -UC: dilation, effacement

Cultural Preferences

-birth position -garments -temp of fluids -privacy -gender of providers -support people in labor/birth room -labor preferences -when to breastfeed

1) Passageway

-bony pelvis (gynecoid is ideal or anthropoid) -ability for cervix to dilate and efface -ability of vaginal canal and introitus to distend

Active phase (3-6 hr)

-cervix dilate 4-7cm -moderate to strong intensity -client ask more questions, dependent, increased pain, inward focus -rapid UCs every 3-5 mins lasting 40-70 secs, palpated every 15-30 mins

Transition Phase (20-40 mins)

-cervix dilate 8-10cm -strong intensity -vague communication, severe pain, loss of control, irritable -UCs every 2-3 mins lasting 45-90 secs, palpate every 15 mins -assess vitals and FHR every 15-30 mins

Contractions

-frequency: beginning of one to beginning of next -duration: beginning to end of one contraction -intensity: baseline to peak (acme is peak) -resting tone: baseline

3. Powers (true contractions)

-involuntary contractions where upper uterus thickens and exerts downward pressure to push fetus towards cervix -aids in: effacement: thinning of cervix (0-100%) dilation: widening of cervix opening (1-10cm) -ferguson reflex: urge to push: +2 station

Signs of preceding labor

-lightening: fetus settles into pelvic inlet (engagement) making breathing easier -weight loss -surge of energy -more urinary frequency -cervical ripening: softening -blood show: ping tinged from expulsion of mucous plug -ROM: immediate birth

2) Passenger

-size of fetal head -presentation (part entering pelvis inlet) -lie: relation of fetal spine to maternal spine -attitude -position

Deviations from normal (notify provider)

1) painless vaginal bleeding: do not perform vag exam! assess FHR 2) meconium stained fluid: maintain on bed rest on left side, evaluate prolapse and presentation, FHR 3) absence fetal movement: remain truthful and with couple, emergency csection 4)Prolapsed cord: give oxygen, knee to chest, relieve pressure on cord, FHR monitor, emergency csection

Passenger: Fetal Position

1. is fetal spine facing R or L side of maternal spine 2. what is the presenting part? -O (head), M (chin), S (breech) 3. Is the landmark facing front (A), back (P), or side (T) of the pelvis LOA/ROA ideal/common

7/100/0

Cervical dilation (cm)/effacement/station

4th stage of labor

Placental delivery--> maternal stabilization (PP) 2 hours after birth of placenta

Effacement/Station

Thinning of the cervix (0-100%)/ where is the presenting part -0 is thick and 100 is paper thin ready for birth -vaginal exam to determine but contraindication for placenta previa

True labor (cervical changes)

UC at regular intervals increasing in frequency/duration/intensity, happens at top of uterus, back pain radiates to abdomen, intensity increases with ambulation

Contraction intensity

at peak there is no blood flow into uterus -want to see acceleration or steadiness!! -decelerations are BAD!

1st stage of labor

begin of regular uterine contractions until the full cervical effacement/dilation (10cm)

3rd stage of labor

birth of the fetus to expulsion of the placenta

Physiologic labor

causes are unclear, progesterone relaxes smooth muscles and estrogen stimulates uterine contractions connective tissues loosen to permit opening of cervix

Latent Phase (6-8 hours)

cervix dilate 0-3 cm. -happy, alert,talkative -mild, moderate intensity -UC every 5-30 mins lasting 30-45 seconds

2nd Stage of labor

cervix fully dilated (10 cm) / onset of pushing ---> birth of fetus

5. Psychological response

important for client to write birthing plan to give to providers during 2-3rd trimester -sociocultural beliefs -emotional status -support from other -previous childbirth experiences

Passenger: Engagement

largest diameter of presenting part reaches or passes thru pelvic inlet and is at the level of ischial spines

Vertex presentation

most common type fetal head is flexed to chest and the smallest part of fetal head (Cephalic/Occiput) presents to maternal pelvis

4. Position of Mother

moving alot in latent phase, comfort when squatting or leaning forward, do not position on back to prevent hypotension

Breech presentation

not as common but fetal butt or feet are the presenting part -increased risk for prolapsed cord leading to risk of hypoxia

Passenger: Station

refers to relationship of the presenting part to the imaginary drawn line b/w ischial spines of maternal pelvis 0 station: presenting part is at spine (negative it is further up in canal)