Stages of Labor

2nd degree laceration

epidermal layers and muscle fascia (laceration)

3rd degree laceration

extends into rectal sphincter (laceration)

4th degree laceration

extends through rectal muscles (laceration)

Open Glottis

laboring woman encouraged to hold breath for only 5-6 seconds during pushing and to take several breaths between each bearing down effort

Stage Two

10 cm cervical dilation to delivery of baby

Stage Four

First 1-4 hours after deliver (recovery)

Indicates excess blood or clots have pooled in uterus.

If the uterus feels soft "boggy" what may this indicate?

1. examines uterus 2. Assess blood vaginal discharge (lochia) noting color, amount, and presence of clots 3. Assess mother VS frequently, every 5-15 minutes times four and then every 30 minutes times two hours 4. temperature taken to rule out infections 5. monitor urine output (distended bladder can displace uterus and impede ability to contract, resulting in hemorrhage) 6. provide meal, juice, ice water

Nursing Interventions Forth Stage of Labor (6)

1. monitor VS, (Especially BP and HR) 2. Any part of placenta missing report (lead to post partum depression)

Nursing assessment for placenta separation (2)

Ferguson Reflux

The urge to push is stimulated by what reflux?

IV meds, Epidural (mid-active phase)

What are the recommendations during the active phase?

Second stage of labor

- 10 cm dilated, rapid fetal descent (urge to push) and birth. -averages 1 hour for primigravidas and 15 min for multipara -commences with full dilation of cervix and ends with birth of the infant

Active Phase

-contractions become more frequent (every 3-5 minutes) lasting 60 seconds, moderate to severe -woman becomes more focused on each contraction and tends to draw and inward attempt to cope with increasing demands of labor - 4 to 7 cm dilated -increased anxiety and discomforts, unwilling to be left alone

Latent Phase

-establishment with regular contractions -contractions are five minutes apart and last 30-45 seconds (mild) -woman excited about labor and remains chatty and sociable -0 to 3 cm dilated -can last as long as 10-14 hours as contractions are mild and cervical changes occur

Forth Stage

-maternal physiological adjustment that occurs from time of delivery of placenta through first 1-2 hours after birth -physician examines mother' perineum, cervix, and vagina for evidence of tearing -episiotomy or laceration are repaired -initiate breast feeding with first hour

Transition Phase

-most intense stage of labor -frequent, strong contractions that occur every 2-3 minutes and last 60-90 seconds - feel that can no longer continue or question ability to cope with much more -changed behavior (sudden nausea, extreme irritability, and unwillingness to be touched) -from 8-10 cm dilated, contractions severe

Third Stage

-period of time from birth of the baby to complete delivery of the placenta -lasts 5-10 minutes, can last up to 30 -once baby is born, uterine cavity immediately becomes smaller

Precipitous Delivery

-reassure and support mother (don't leave client) -send axillary personal for help and emergency OB pack -delivery of infant ( support perineum by applying gentle counter pressure against the perineum)

Assessment for Second Stage

1. FHR with every contraction (positioning and oxygen) 2. Observe for increase bloody show, bulging perineum and anus, visibility of the presenting part (crowning) 3. palpate bladder for distention (empty if needed) 4. assess amniotic fluid for color and consistency

Nursing Care for Third Stage Labor

1. uterus palpated to determine the risk upward as well as characteristic change in shape 2. 30 minutes passes and no placental discharge, considered "retained" 3. oxytocic medication administered to deliver placenta 4. monitor for signs of placental separation (globular shaped uterus, uterine volume shrinks, protrusion umbilical cord)

1. VS every 15 minutes between contractions 2. continuous FHR 3. teach client with positioning (squat, lithotomy, side to side pushing) 4. teach client to hold breath for no longer than 5 seconds during pushing 5. set up delivery table (bulb syringe, cord clap, ID bands), baby warmer turned on 6. Record the exact delivery time

Nursing interventions for Second Stage of labor (6)

1. Bed rest 2. offer bedpan every 2 hrs (bladder dimmed labor) 3. patterned-paced breathing exercise and abdominal massage 4. provide mouth care, ice chips 5. pericare as needed 6. offer anesthesia/analgesia in mid-active phase

Nursing interventions for first stages of labor (7)

1. encourage mom to relax while waiting for placenta to deliver 2. immediate care of newborn 3. encourage family bonding 4. document time of placental delivery, appearance, intactness, estimated blood loss 5. administer oyocic agent as ordered

Nursing responsibilities for third stage of labor (5)

Shultz Mechanism "shiny schultz"

Occurs when the placenta separates from the inside to the outer margins with the shiny, fetal side of the placenta presenting first

1. physiologic readjustment 2. thirsty and hungry (provide meal and juice) 3. shaking (warm blanket, keep warm and dry) 4. bladder is often hypotonic 5. uterus remains contracted

Physiologic change of maternal mother in fourth stage?

Oxytocin

Stimulate uterine contractions, minimizing bleeding from placental attachment site and reducing risk of postpartum hemorrhage -IV 10-20 minutes -IM 10 units -excessie blood loss 40mg

1. uterus becomes spherical in shape 2. uterus rises upward in the abdomen due to the descent of the placenta into the vagina 3. umbilical cord descends further through vagina

What are the clinical indicators that the placenta has separated from the uterus? (3)

1. latent phase 2. active phase 3. transition phase

What are the three first stages of labor?

1. closed glottis "directed pushing" 2. open glottis "involuntary pushing"

What are the two methods of pushing?

appears bright red

What does first lochia appear like?

minimize the bleeding that results from open blood vessels left at placental attachment

What is it important that the placenta continues to contract after it separates?

Immediately massage uterus until it becomes firm

What nursing action should take place for "boggy" uterus?

Encourage relaxation, rest, patterned-paced breathing

What should the nurse recommend during the latent phase?

Stage one

beginning of regular contractions or rupture of membranes to 10cm cervical dilation

Stage Three

birth to delivery of placenta

Lacerations

may occur during childbirth, 3rd and 4th most common after midline epistomy is performed

Duncan Mechanism "dirty duncan"

occurs when the placenta separates from the outer margins inward, rolls up, and presents side ways

1st degree laceration

only the epidermal layers (laceration)

First Stage

referred to as stage of dilation, begins with onset of regular contracts and ends with complete dilation of cervix. Contractions start slowly and are fairly tolerable, over time in frequency, duration, and intensity. Most often longest stage.

Closed Glottis

traditional method, woman encouraged to begin pushing at full cervical dilation regardless urge to bear down (take deep breath and hold for at least 10 seconds while pushing as hard and as long as she is able through contraction)