Labor and Delivery
Pain Relief During Labor & Delivery
*Breathing/Relaxation Techniques:* This includes walking, rocking, swaying, changing position, showering, massage, guided breathing, listening to music and looking at imagery, and hot/cold therapy. These techniques are especially useful if you choose to have a non-medicated birth. *Narcotic Medications:* Pain medications are given through an IV and take effect quickly by lessening discomfort and making you drowsy, therefore allowing your body to rest. The medication will last several hours and wear off toward the end. We also administer narcotics by injection into muscle. It's important to note that narcotics travel to the baby through the placenta, so we generally don't give them too close to your delivery time. *Epidural Anesthesia:* This is a type of anesthesia is administered by an injection into your back to numb the lower part of the body. Your anesthesiologist will perform this once you have gone into active labor. Please note that you must be able to sit still for this procedure and it generally takes 15-20 minutes to achieve full effect. You'll remain alert and the relief should last throughout labor. Since the epidural numbs the legs, you won't be able to get out of bed during the procedure and your bladder may need to be emptied by a catheter.
Critical Factors of Labor: Powers
Primary: Uterine contractions -contractions adequate enough to lead to effacement and dilation Effacement: refers to the thinning and the dilation of the cervix Secondary: Positioning of the mother, pushing efforts, gravity, walking, coping mechanisms, breathing techniques, and distractors of the contractions
Possible Causes of Labor Onset: Prostaglandin Theory
Prostaglandin is relased from the cervix and softens the cervix to kickstart labor and dilation Prostaglandin is found naturally in semen
A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at (-1) station. The nurse determines that the fetal presenting part is: A.) 1 cm above the ischial spine B.) 1 fingerbreadth below the symphysis pubis C.) 1 inch below the coccyx D.) 1 inch below the iliac crest
A.) 1 cm above the ischial spine Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, is measured in centimeters, and is noted as a negative number above the line and a positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial spines
When monitoring the fetal heart rate of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as: A.) An acceleration B.) An early elevation C.) A sonographic motion D.) A tachycardic heart rate
A.) An acceleration
A client is admitted to the birthing suite in early active labor. The priority nursing intervention on admission of this client would be: A.) Auscultating the fetal heart B.) Taking an obstetric history C.) Asking the client when she last ate D.) Ascertaining whether the membranes were ruptured
A.) Auscultating the fetal heart Determining the fetal well-being supersedes all other measures. If the FHR is absent or persistently decelerating, immediate intervention is required.
A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate? A.) Document the findings and tell the mother that the monitor indicates fetal well-being B.) Take the mother's vital signs and tell the mother that bed rest is required to conserve oxygen C.) Notify the physician or nurse midwife of the findings D.) Reposition the mother and check the monitor for changes in the fetal tracing
A.) Document the findings and tell the mother that the monitor indicates fetal well-being Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve.
A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the physician? A.) Fetal heart rate of 180 beats per minute B.) White blood cell count of 12,000 C.) Maternal pulse rate of 85 beats per minute D.) Hemoglobin of 11.0 g/dL
A.) Fetal heart rate of 180 beats per minute A normal fetal heart rate is 120-160 beats per minute. A count of 180 beats per minute could indicate fetal distress and would warrant physician notification. By full term, a normal maternal hemoglobin range is 11-13 g/dL as a result of the hemodilution caused by an increase in plasma volume during pregnancy.
Which of the following observations indicates fetal distress? A.) Fetal scalp pH of 7.14 B.) Fetal heart rate of 144 beats/minute C.) Acceleration of fetal heart rate with contractions D.) Presence of long term variability
A.) Fetal scalp pH of 7.14 A fetal scalp pH below 7.25 indicates acidosis and fetal hypoxia.
A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action? A.) Place the client in Trendelenburg's position B.) Call the delivery room to notify the staff that the client will be transported immediately C.) Gently push the cord into the vagina D.) Find the closest telephone and stat page the physician
A.) Place the client in Trendelenburg's position When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The mother should be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the physician and notify the delivery room. No attempt should be made to replace the cord. The examiner, however, may place a gloved hand into the vagina and hold the presenting part off of the umbilical cord. Oxygen at 8 to 10 L/min by face mask is delivered to the mother to increase fetal oxygenation
Critical Factors of Labor: Placenta
Abruption: refers to when the placenta tears away from the uterine wall Previa: refers to the placenta coming down and covering the os Velamentous Cord Insertion: the umbilical cord inserts into the fetal membranes (choriamniotic membranes which forms the placenta in the beginning stages of pregnancy), then travels within the membranes to the placenta (between the amnion and the chorion). This divides some distance from the placenta. The exposed vessels are not protected by Wharton's jelly and hence are vulnerable to rupture. Battledore Cord Insertion: the umbilical cord inserts at or near the placental margin Placenta Accreta: is a serious pregnancy condition that occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall. Part or all of the placenta remains firmly attached to the myometrium resulting in maternal hemorrhage (A medical emergency)
Surgical Interventions: Episiotomies
An incision made in the perineum to enlarge the vaginal opening to facilitate delivery and minimize soft tissue damage First degree: laceration extends through the skin of the perineum and does not involve the muscles Second degree: laceration extends through the skin and muscles into the perineum Third degree: laceration extends through the skin, muscles, perineum, and anal sphincter Fourth degree: laceration extends through the skin, muscles, perineum, anal sphincter, and anterior rectal wall Midline Episotomy: straight down; more comfortable in the healing process; easier to repair; less blood loss Medolateral Episotomy: straight down and a little to the side; blood loss is greater; repair is more difficult; local anesthetic is applied prior
Fetal Monitoring During Labor: Early Decelerations
Appear uniform where they occur; deceleration of FHR before or early into a contraction; mirror the contraction; the drop in FHR is caused by head compression due to the contraction; FHR returns to baseline; reassuring pattern; no treatment needed; THIS IS NORMAL
A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? A.) Three contractions occurring within a 10-minute period B.) A fetal heart rate of 90 beats per minute C.) Adequate resting tone of the uterus palpated between contractions D.) Increased urinary output
B.) A fetal heart rate of 90 beats per minute A normal fetal heart rate is 120-160 BPM. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue to pitocin. The goal of labor augmentation is to achieve three good-quality contractions in a 10-minute period
A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the monitor, the initial nursing assessment is which of the following? A.) Identifying the types of accelerations B.) Assessing the baseline fetal heart rate C.) Determining the frequency of the contractions D.) Determining the intensity of the contractions
B.) Assessing the baseline fetal heart rate Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate will be identified if they occur. Options A and C are important to assess, but not as the first priority
When examining the fetal monitor strip after rupture of the membranes in a laboring client, the nurse notes variable decelerations in the fetal heart rate. The nurse should: A.) Stop the oxytocin infusion B.) Change the client's position C.) Prepare for immediate delivery D.) Take the client's blood pressure
B.) Change the client's position Variable decelerations usually are seen as a result of cord compression; a change of position will relieve pressure on the cord. Less invasive first
A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion of Pitocin. The nurse ensures that which of the following is implemented before initiating the infusion? A.) Placing the client on complete bed rest B.) Continuous electronic fetal monitoring C.) An IV infusion of antibiotics D.) Placing a code cart at the client's bedside
B.) Continuous electronic fetal monitoring
A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes this behavior as: A.) Exhaustion B.) Fear of losing control C.) Involuntary grunting D.) Valsalva's maneuver
B.) Fear of losing control Pains, helplessness, panicking, and fear of losing control are possible behaviors in the 2nd stage of labor.
A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred? A.) Hypotonic contractions B.) Forceps delivery C.) Schultz delivery D.) Weak bearing down efforts
B.) Forceps delivery Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture.
A client arrives at a birthing center in active labor. Her membranes are still intact, and the nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure, she will most likely have: A.) Less pressure on her cervix B.) Increased efficiency of contractions C.) Decreased number of contractions D.) The need for increased maternal blood pressure monitoring
B.) Increased efficiency of contractions Amniotomy can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the process begins to slow. Rupturing of membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions.
A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction? A.) Early decelerations B.) Variable decelerations C.) Late decelerations D.) Short-term variability
B.) Variable decelerations Short-term variability
Premonitory Signs
Braxton Hicks Contractions Lightening Increased Secretions -Bloody Show Nesting Small Weight Loss Rupture of Membranes *These do not all have to happen to go into labor*
A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes. 1. Stop of Pitocin infusion 2. Perform a vaginal examination 3. Reposition the client 4. Check the client's blood pressure and heart rate 5. Administer oxygen by face mask at 8 to 10 L/min A.) 1, 2, 3, 4, 5 B.) 1, 4, 2, 3, 5 C.) 1, 4, 3, 5, 2 D.) 1, 2, 4, 5, 3
C.) 1, 4, 3, 5, 2 Stop the Pitocin infusion, Check the client's blood pressure and heart rate, Repositon the client, Administer oxygen by face mask 8-10 L/min, Perform a vaginal examination
A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The most appropriate nursing action is to: A.) Place the mother in the supine position B.) Document the findings and continue to monitor the fetal patterns C.) Administer oxygen via face mask D.) Increase the rate of pitocin IV infusion
C.) Administer oxygen via face mask Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore oxygen is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned to her LEFT side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous pitocin infusion is discontinued when a late deceleration is noted.
A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is dilated to 3 cm. Her fetus is at +1 station. The nurse is aware that the fetus' head is: A.) Not yet engaged B.) Entering the pelvic inlet C.) Below the ischial spines D.) Visible at the vaginal opening
C.) Below the ischial spines
The nurse observes the client's amniotic fluid and decides that it appears normal, because it is: A.) Clear and dark amber in color B.) Milky, greenish yellow, containing shreds of mucus C.) Clear, almost colorless, and containing little white specks D.) Cloudy, greenish-yellow, and containing little white specks
C.) Clear, almost colorless, and containing little white specks By 36 weeks' gestation, normal amniotic fluid is colorless with small particles of vernix caseosa present.
A maternity nurse is preparing to care for a pregnant client in labor who will be delivering twins. The nurse monitors the fetal heart rates by placing the external fetal monitor: A.) Over the fetus that is most anterior to the mother's abdomen B.) Over the fetus that is most posterior to the mother's abdomen C.) So that each fetal heart rate is monitored separately D.) So that one fetus is monitored for a 15-minute period followed by a 15 minute fetal monitoring period for the second fetus
C.) So that each fetal heart rate is monitored separately
False Labor
Can go on and on for days Braxton Hicks Contractions-These irregular uterine contractions are perfectly normal and might start to occur from your fourth month of pregnancy
Fetal Monitoring During Labor: Variable Decelerations
Can happen anywhere with contractions; caused by umbilical cord compression (wrapped around fetal neck=nuchal cord), short umbilical cord, prolapsed umbilical cord, and/or Oligohydraminos; Careful watch of FHR baseline because the fetus FHR will slow down and then try to over compensate and become tachycardic; typically not treated right away; treatment is to lay mother on her left side to reduce pressure on the vena cava, administer oxygen by mask 8-10 L/min, discontinue Pitocin IV if being infused, increase rate of IV fluid administration to give mom more fluid to decrease dehydration
True Labor
Cervical change is the only sign of true labor Assessed by vaginal exam -Progressive change in dilation and effacement -Moves to anterior position -Bloody show
Possible Causes of Labor Onset: Progesterone Withdrawal
Close to the 40 week gestation a drop in Progesterone happens Progesterone is released in the early weeks of pregnancy to maintain that pregnancy In theory we believe the drop in Progesterone causes the onset of labor
A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which of the following assessments is noted? A.) The client begins to expel clear vaginal fluid B.) The contractions are regular C.) The membranes have ruptured D.) The cervix is dilated completely
D.) The cervix is dilated completely The second stage of labor begins when the cervix is dilated completely and ends with the birth of the neonate.
A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of: A.) Hematoma B.) Placenta previa C.) Uterine atony D.) Placental separation
D.) Placental separation As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears. These are normal variations of indication of placental separation
A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client's hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following? A.) A loud mouth B.) Low self-esteem C.) Hemorrhage D.) Postpartum infections
D.) Postpartum infections Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage.
A client in labor is transported to the delivery room and is prepared for a cesarean delivery. The client is transferred to the delivery room table, and the nurse places the client in the: A.) Trendelenburg's position with the legs in stirrups B.) Semi-Fowler position with a pillow under the knees C.) Prone position with the legs separated and elevated D.) Supine position with a wedge under the right hip
D.) Supine position with a wedge under the right hip Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and the fetus. The best position to prevent this would be side-lying with the uterus displaced off of abdominal vessels. Positioning for abdominal surgery necessitates a supine position; however, a wedge placed under the right hip provides displacement of the uterus.
Surgical Interventions: Vacuum-Assisted
Cup-like suction device that is attached to the fetal head- traction is applied during contractions to assist in the descent and birth of the head, after which, the vacuum cup is released and removed preceding delivery of the fetal body Can cause scalp lacerations to the fetus, subdural hematoma, cephalohematoma, caput succedaneum (molding) which is normal and should resolve within 24 hours, and or maternal lacerations This is done if the fetus is vertex presentation and or ruptured membranes
A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery? A.) The umbilical cord shortens in length and changes in color B.) A soft and boggy uterus C.) Maternal complaints of severe uterine cramping D.) Changes in the shape of the uterus
D.) Changes in the shape of the uterus Signs of placental separation include lengthening of the umbilical cord, a sudden gush of dark blood from the introitus (vagina), a firmly contracted uterus, and the uterus changing from a discoid (like a disk) to a globular (like a globe) shape. The client may experience vaginal fullness, but not severe uterine cramping.
A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa? A.) Disseminated intravascular coagulation B.) Chronic hypertension C.) Infection D.) Hemorrhage
D.) Hemorrhage Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding
A nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is most appropriate? A.) Encourage the client's coach to continue to encourage breathing exercises B.) Encourage the client to continue pushing with each contraction C.) Continue monitoring the fetal heart rate D.) Notify the physician or nurse midwife
D.) Notify the physician or nurse midwife A normal fetal heart rate is 120-160 beats per minute. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the physician or nurse midwife needs to be notified.
A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which of the following assessments is noted? A.)The client begins to expel clear vaginal fluid B.) The contractions are regular C.) The membranes have ruptured D.) The cervix is dilated completely
D.) The cervix is dilated completely The second stage of labor begins when the cervix is dilated completely and ends with the birth of the neonate.
Which of the following findings meets the criteria of a reassuring FHR pattern? A.) FHR does not change as a result of fetal activity B.) Average baseline rate ranges between 100 - 140 BPM C.) Mild late deceleration patterns occur with some contractions D.) Variability averages between 6 - 10 BPM
D.) Variability averages between 6 - 10 BPM Variability indicates a well oxygenated fetus with a functioning autonomic nervous system. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats per minute. Late deceleration patterns are never reassuring, though early and mild variable decelerations are expected, reassuring findings.
Fetal Monitoring During Labor: Late Decelerations
Drop in FHR late into or between contractions; caused by uteroplacental insufficency causing inadequate fetal oxygenation; considered fetal distress and can result in an emergency c-section; treatment is to lay mother on her left side to reduce pressure on the vena cava, administer oxygen by mask 8-10 L/min, discontinue Pitocin IV if being infused, increase rate of IV fluid administration to give mom more fluid to decrease dehydration
Surgical Interventions: C-Section
Elective vs. Emergency
Fetal Monitoring During Labor
External: two belts on moms belly; one for measuring the contractions and the other to measure the fetal heart rate Internal: to determine fetal well-being; a spiral electrode is applied to the fetal scalp to monitor fetal heart rate; prior to electrode placement, cervical dilation and rupture of membranes must occur Intermittently: if mom wants to walk around or shower you can monitor FHR every 15 minutes Continuous: if mom is on Pitocin she needs continuous monitoring Baseling FHR: 110-160 Variability: the beat to beat of the FHR Duration: is the start of one contraction to the end of the same contraction Frequency: is the start of one contraction to the start of the next contraction
Stages of Labor: Second Stage
From complete dilation to delivery of the fetus Progression to intense contractions every 1-2 minutes As fetal head descends into the pelvis there's a strong urge to push, crowning occurs when fetal head is at perineum and is visual=pressure on perineum; fetus moves along birth canal by cardinal movements
Stages of Labor: Third Stage
From the delivery of the fetus to the delivery of the placenta Contractions stop for a brief period and then resume once the placenta has separated from the uterine wall Lochia scant to moderate
Stages of Labor: First Stage
From the onset of true labor to complete dilation of the cervix 3 Phases: -Latent: 0-3cm dilated; irregular, mild, to moderate contractions; frequency 5-30 minutes; duration 30-45 seconds; some dilation and effacement; client is talkative and eager -Active: 4-7cm dilated; more regular, moderate to strong contractions; frequency 3-5 minutes; duration 40-70 seconds; rapid dilation and effacement; some fetal descent; client has feelings of helplessness, anxiety, and restlessness increase as contractions become stronger; membranes can rupture at this point but they do not have to -Transition: 8-10cm dilated; strong to very strong contractions; frequency 2-3 minutes; duration 45-90 seconds; client is tired, restless, and irritable, they can also have a feeling of out of control and cannot continue; may have nausea and vomiting; strong urge to push; increased rectal pressure and feelings of needing to have a bowel movement; the most difficult part of labor
Stages of Labor: Third Stage: Signs of Separation of the Placenta
Lengthening of the umbilical cord Gush of blood Fundus appears globular and kind of comes up Placenta is typically delivered 30 minutes after the delivery of the fetus Schultz: fetal side is delivered first Duncan: maternal side is delivered first Crede-Fundal Massage: to help increase how fast the placenta will be delivered
Critical Factors of Labor: Psyche
Play into the mothers labor Exhibit signs of anxiety, pain, fatigue Includes coping mechanisms, breathing techniques, and the mother's support system(s)
Critical Factors in Labor: Passage
Route fetus travels which includes the maternal pelvis and soft tissues Diagonal conjugate 12.5cm-12cm Obstetric conjugate 4-5cm Clinical Pelvimetry: a process used to assess the size of the birth canal by means of the systematic vaginal palpation of specific bony landmarks in the pelvis and an estimation of the distances between them. Internal pelvic diameters are not accessible to direct measurement; they must be inferred. Usually performed by a midwife or an obstetrician during the first prenatal examination of a pregnant woman
Critical Factors in Labor
The 5 P's Passage: through the pelvis Passenger: the fetus Powers -Primary: uterine contractions -Secondary: the mothers positioning Psyche: mothers emotions towards the labor Placenta
Stages of Labor: Second Stage: 7 Cardinal Movements of the Fetus
The fetus starts in a anterior position in most cases; if the fetus starts in the posterior position there is severe back pain for the mom 1. Engagement: the fetus is at level with the ishcial spines 2. Descent: fetus is further into the pelvis; measured in stations (positive means below the ischial spines; negative means above the ishcial spines) 3. Flexion: the fetus flexs the head closer to the fetal chest 4. Internal Rotation: fetus turns a little bit to a lateral anterior position so the shoulders are no longer oblique 5. Extension: the fetus extends the head away from the fetal chest 6. External Rotation (Restitution): after the head is born, the fetus turns a little bit again facing transverse 7. Expulsion: the fetus comes out of the mother
Critical Factors in Labor: Passenger
This refers to the fetus Fetal Lie: refers to the long axis of the fetus -Longitudinal Lie -Horizontal Lie -Transverse Lie Attitude: refers to the degree of flexion that the fetus has and affects the progress of labor- there's a little bit of flexion of the fetal head Presentation: refers to what body part is presenting first -Cephalic or head presenting first -Breech: feet or buttocks is presenting first -Transverse: hand presenting first Station: refers to the relationship of the presenting part to the ischial spine -Above the ischial spine is negative number -Below the ischial spine is positive number Engagement: refers to at what level is the fetal head in relation to the ischial spines Crowing: refers to the fetal head is on the perineum and is visualized
Surgical Interventions: Forceps-Assisted
Two curved spoon-like blades to assist in delivery of the fetal head- traction is applied during contractions Can cause damage to the fetal head and/or fetal facial nerves which could cause bell's palsy if the forceps are not placed correctly (either side of the ears) on the fetal presenting part This is done if the fetus has abnormal presentation or is in breech position requiring delivery of the head or the fetus is resisting rotation
