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)
