Intrapartum Nursing Care

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  1. Only way to measure internal intensity of contraction inside the uterus:
    • IUPC (internal pressure catheter)
    • *must be <20mm of mercury
  2. Standard of Care during Intrapartum Nursing:
    AWHONN states having continuously available labor support by RN is critical to achieving improved birth outcomes

    *RN assessment and management of physiological and psychological processes of labor, providing physical comfort measures

    *Evaluate fetal well-being: Assess, interpret, and intervene related to EFM interpretation patterns

    *Instruct on labor process

    *Be an advocate for pts and collaborate with healthcare team

    *Provide emotional support: calm and attentive to the patient; being present and assist with breathing and relaxation techniques

    *Role Modeling: facilitate family participation during birth
  3. ***Main assessments in all phases of the 1st stage of labor:
    • Maternal vital signs
    • Woman's response to labor and pain
    • FHR and UC monitoring
    • Cervical Changes
    • Fetal Position and Descent in pelvis
  4. Goal and Outcome of the 1st Labor Stage:
    Safe delivery for mother and fetus that have been admitted
  5. Nurse's Responsibilities of Intrapartum Care During the 1st stage of Labor:
    Perform Admission procedures and orient to facility and room

    Review prenatal records

    Maternal and Fetal Assessments: FHR& Uterine Activity (q15-30 min), Maternal BP, P, R every hour and temp every 2 hours (ROM q 1hour)

    Pain assessment: every 30 min or PRN

    Insert IV access- placement in case of emergency (hemorrhage)

    Monitor I&O- providing oral versus IV hydration

    Assist with ambulation/maternal positioning

    Provide non-pharm comfort measures

    Discuss pain pharm options as requested (analgesia meds prn, assist with placement of anesthesia prn)

    Provide ongoing assessment of labor process

    Assess amniotic fluid status!!! (note date/time water breaks)

    Perform SVE (ONLY if maternal or fetal status indicates)

    Request OB/GYN or midwife to bedside immediately PRN
  6. Admission Criteria for Labor and Delivery Unit
    Break in Water,

    Regular Contractions occurring with cervical dilation

    Maternal/Fetal complications and high risk
  7. How often is the FHR and Uterine activity assessed in the 1st stage of labor:
    Every 15-30 minutes
  8. How often is Maternal BP, P, R checked in the first stage of labor:
    Every Hour
  9. How often is the maternal temperature checked in the 1st stage of labor:
    Every 2 hours
  10. How often is pain assessed in the 1st stage of labor:
    Every 30 mins or PRN
  11. If delivery is eminent, skip _____ on admission

    (first thing to be done is assess baby and make sure it is not coming, then vitals, then paperwork)
  12. A mom that has had previous kids is always more at risk for ______ because her uterus is stretched out
    • Hemorrhage
    • (make sure they have IV access!!!!)
  13. What is important to assess about amniotic fluid?
    **NOTE the date and time water broke

    Color, Amount, Odor, New onset of fluid changes toward meconium presence
  14. What should be assessed immediately after SROM or AROM?
    Fetal Heart Tones
  15. Have _____ in room at help with baby if there is a risk of meconium aspiration
  16. Preferred position of the baby to be delivered in
    OA- occipital Anterior
  17. Knee-Chest position works best with delivery of a baby that is presenting:
    OP- occipital at risk for bruising
  18. How often should a nurse assess FHR monitor in a Low Risk patient in the 1st stage of labor?
    Intermittent/Continuous Monitor!

    • Latent phase: every hour
    • Active phase: every 5-30 min
  19. How often should a nurse assess FHR in a low risk patient in the second stage of labor:
    Intermittent/Continuous monitor!

    Every 5-15 minutes! (pushing phase)
  20. How often should a nurse assess FHR in a high risk  patient in the 1st stage of labor:
    Continuous Monitoring!

    • Latent phase: every 30 min
    • Active phase: every 15 min
  21. How often should a nurse assess FHR in a high risk  patient in the 2nd stage of labor:
    Continuous monitor!

    Every 5 minutes! (during pushing)
  22. A mom with any anesthesia will be on ______
    Continuous monitoring!
  23. What do we assess for when assessing UCs?
    • Frequency
    • Duration
    • Intensity
    • Resting Tone
  24. A "toco" (external UC monitoring) can determine everything except:
    Intensity (abdomen must be palpated)
  25. Grades of manual UC "intensity" palpations:
    • Mild 1+ = easily indented (nose tip)
    • Mod 2+ = slightly indent (chin)
    • Strong 3+ = cannot indent (forehead)
  26. Monitor that can assess everything needed for UCs and can also determine "intensity" and "resting tone" (<20mmHg)
    Internal UC monitor (IUPC)
  27. Exam done as indicated by maternal/fetal behaviors and FHR patterns to assess labor progression
    Sterile Vaginal Exam
  28. Assessments done for Rupture of Amniotic Membranes
    • *Note the date and time water broke!
    • Nitrazine test (blue = positive)
    • Fern test- provider only
    • Amnisure test
    • Observation of "gross rupture of fluids"
  29. Small amount of bleeding that occurs with cevix during changes of labor
    • Bloody Show
    • (any period-like blood is abnormal...could be abruption)
  30. What does WHO recommend women do regarding their carb intake:
    Dictate their oral intake of carbohydrates to decrease maternal ketosis (dehydration risk)

    • *Typically once admitted, most med orders limit PO intake to clear liquids
    • *Encourage PO fluid intake if possible
  31. Hospital admission orders regarding diet/hydration status usually include:
    • Routine IV (at least 1 access site)
    • Clear Liquids- if low risk and no anesthesia used
    • NPO/Ice Chips- typically after epidural placement
    • Regular Diet- usually NOT given until after delivery
  32. If your pt is receiving medication, she MUST have:
    IV access in case of emergency!
  33. Most common type of IV fluid used to manage pts hydration status:
    • Lactated Ringers
    • (avoid large IV fluids with dextrose)
  34. A full bladder can do what to fetal head descent?
    SLOW fetal head descent
  35. Why do we encourage elimination in labor?
    • Full bladder can slow fetal head descent
    • Decrease risk for bladder, bowel, or urethra injury and pressure

    Allows for an increased pelvic room- I&Os!
  36. During a normal labor, the bladder can become _____, leading to decreased motor function and urinary retention
  37. With non-medicated birthing, natural labor, voiding is encouraged how often
    every 2-3 hours
  38. Medicated birthing "IV med use or epidural", voiding is by:
    Straight Cath or Foley
  39. When is bedside presence required for nurse?
    • Pre/Post epidural placement procedures
    • Continual presence near delivery time (1:1)
    •    -2nd and 3rd stages
    •    -procedures/concerns over FHR patterns
  40. When is bedside presence recommended for a nurse?
    Anytime throughout the day to decrease maternal stress and possibly facilitate labor progress
  41. Water Births are only for:
    LOW risk patients!!!

    • No decels, intermittent monitoring, no medications
    • *ROM is allowed and does not indicate risk for infection
  42. Use of water (hyrotherapy) can promote
    relaxation and pain control
  43. Benefits of Hydrotherapy and Waterbirths:
    • Releasing endorphins
    • Decreasing muscle tone
    • Promoting circulation
    • Less need for pain meds/anesthesia
    • Fewer episiotomies
    • Facilitates fetal positions
    • Decreased BP and edema (> diuresis)
    • Increased maternal birthing satisfaction
  44. Cochrane Review Shows what 2 key Benefits to doing waterbirths and hydrotherapy:
    • Less use of anesthesia
    • Less reported pain
  45. Pharm Approaches to pain management during labor:
    Analgesia- short/long acting opiods

    • Local Anesthesia- before/after episiotomy 
    •    -LIDOCAINE

    • Regional (block) anesthesia:
    •    -Epidural (labor, vaginal and C/S births)
    •    -Pudendal (imminent vag delivery)
    •    -Spinal (C/S if she was originally going natural)

    General Anesthesia- emergent C Section use ONLY
  46. Types of Regional Anesthesia: (block)
    • Epidural (labor, vaginal, c/s)
    • Pudendal (imminent vag delivery)
    • Spinal (c/s if originally going natural)
  47. How should analgesics be given during labor?
    give slowly over 2-3 UC's to decrease amount crossing the placenta...avoid giving if birth is imminent
  48. Short Acting Labor Analgesic given in active labor phase: (q 1-2 hours)
  49. Side Effects/ Complications of Fentanyl
    • Risk of FHR changes
    • Hypotension (very potent)
    • Maternal/Neonatal CNS and respiratory depression
  50. Long Acting Labor Analgesics used in early/latent labor phase: (q 3-4 hours)
    • Nubain
    • Morphine
  51. When are long acting analgesics used in labor?
    • Early/Latent phase of labor
    • Every 3-4 hours
  52. When are short acting analgesics used?
    • Active Labor 
    • Every 1-2 hours
  53. Side Effects/Complications of Nubain (long acting)
    Risk of sudden maternal/neonatal withdrawal symptoms if hx maternal drug abuse
  54. S/E and Complications of Morphine:
    Risk of CNS depression and neonate resp. distress
  55. Safety protocols enforced once labor analgesics are given:
    • Side Rails up!
    • Narcan available...antidote??
  56. Never withhold pain medication based on:
    Hx of drug abuse
  57. Advantages to Narcotic Analgesics (parenteral opioids):
    Ease of availability

    Ease of administration

    Cost effective

    Decreases perception of pain "a blunting effect" by encouraging relaxation

    May allow rest in between UCs
  58. Disadvantages to Narcotic Analgesics (parenteral opioids)
    More difficults for the mother to maintain sense of control (hx of drug abuse)

    Crosses placental barrier

    Accumulative effect on fetus with multiple doses

    May interfere breast-feeding
  59. Risks to using narcotic analgesics:
    Maternal/Newborn respiratory depression

    **Neonatal risk is highest within 1 hour before delivery
  60. Anesthetic injected into "epidural space" of the back via epidural cath
    Epidural block
  61. Location of where the epidural cath is placed
    Between dura and spinal column
  62. When is an epidural block done?
    Typically inserted in 1st and 2nd stages of labor

    (most common is active phase of labor...used in either vaginal or C-section deliveries)
  63. There is a ____% potential for pain blockage with epidural
  64. RN's role when an epidural block is given to pt:
    Assist MD/CRNA with positioning patient for placement, monitoring of maternal VS and FHR, and interventions implemented to minimize complications
  65. Advantages to Epidural Block:
    • Less labor pain
    • Allows for total relaxation/rest before delivery
    • Alert/Active participant in delivery
    • Allows continuous/intermittent administration of medication (takes away pain but not the pressure as fetal head descends")
  66. A pt with an epidural is always at risk for:
  67. Disadvantages to an Epidural Block
    • Maternal Hypotension (MOST COMMON)
    • Fetal distress
    • Decreased labor- prolonged 2nd stage
    • Mother non-mobile
    • Maternal Hyperthermia
    • Urinary retention-- will need catheter
    • Epidural HA or backache
    • Respiratory depression
    • GI s/e and itching
  68. Pre-Epidural nursing responsibilities:
    • Assess pain level and provide procedure info
    • Notify OBGYN/Midwife and Anesthesia Team
    • Obtain consent for epidural procedure
    • Administer IV hydration prior to epidural procedure:preload pt with 1000 ml IV fluid 
    • Obtain Hgb, Hct, Plt counts
    • Encourage voiding before
    • Provide support/positioning
    • Monitor maternal BP, Pulse, FHT
    • SVE to check labor process
  69. How much fluid should be given bolus to pt before getting epidural
    1000ml IV fluid bolus
  70. Goal positioning of epidural placement:
    create a "C" with back, head down, knees to chest
  71. Post Epidural Nursing Responsibilities:
    Monitor Maternal BP, Pulse, O2, FHTs every 5-15 min

    Assess for maternal hypotension and resp distress

    Repositioning: onto back with pillow wedge and head low until stable BP...every 1-2 hours reposition!

    Assess effectiveness of epidural

    Assess urinary retention (straight cath every few hours, place foley prn)

    Monitor for itching and GI s/e and complications (h/a and sedation)

  72. How often is maternal BP, P, O2 and FHTs checked after an epidural placement
    every 5-15 min
  73. How often should pt be repositioned after epidural placement:
    every 1-2 hours
  74. Complications of Epidural:
    • Itching
    • GI s/e: nausea and vomiting
    • Post procedure H/A and sedation
    • Sedation
    • Respiratory distress
    • Maternal hypotension
  75. Anesthetic injected in the the subarachnoid space that can last up to 3 hours
    Spinal Block Anesthesia
  76. A Spinal Block is _____ and blocks 100% sensation and motor function
    Rapid Acting
  77. A spinal block has a higher ____ than epidural
    anesthetic level
  78. A spinal block is typically used only for:
    C-Section deliveries (rare use in 2nd stage of labor)
  79. Post Procedural interventions and adverse effects of Spinal Block
    • Spinal H/A
    • Monitor for CSF leakage or hematoma at site
  80. A cord prolapse is an:
    Obstetrical Emergency
  81. A cord prolapse typically occurs with:
    SROM or AROM
  82. Cord compression causes:
    Fetal Bradycardia (check immediately if you see abrupt drop in hr)
  83. PTs at highest risk from a cord prolapse:
    Multiple gestation

    High parity (due to stretched uterus)

    Malpresentations: transverse lie and breech (footling breech- common type)

    Vertex: presenting part un-engaged, ballotable: out of the pelvis

    • Rupture of membranes:
    •    -polyhydramnios--has pregnancy complication of excessive amniotic fluid; then SROM occurs
  84. Interventions of a Cord Prolapse:
    SVE: Lift Head off Cord!!!

    STAT notify providers and RN team

    Explain to pt and family = emergency!!

    Reposition pt to Knee/Chest or Trendelenburg position to relieve cord pressure (if feasible)

    O2 on and IV fluid bolus

    Stop Pitocin and give tocolytic (Terbutaline: stops UCs)
  85. Medicine given in cord prolapse to stop contractions:
  86. Deliberate stimulation to facilitate vaginal delivery
    Labor Induction
  87. Reasons to induce labor:
    maternal medical conditions

    pregnancy complications


    Premature rupture of membranes

    Post-Term pregnancy (40-42 weeks)

    Fetal concerns

    Hx of fast labors

  88. Stimulation of ineffective UCs after the onset of spontaneous labor to manage labor dystocia
  89. Reasons for Augmentation of labor:
    • Stimulation UCs
    • Shorten labor
  90. Process of physical softening and opening of the cervix to prepare for labor
    • Cervical Ripening
    • (cervical status assessed before induction)
  91. Bishop's score of cervical assessment:
    0-4 RIPEN, then do pitocin

    >6 = "more favorable cervix" for induction of labor...go straight to pitocin
  92. Image Upload 1
    Bishop Scoring for Cervical Ripening and Induction of Labor
  93. Mechanical Cervical Ripening:
    Balloon Catheters- balloon inflated after insertion to cause pressure on cervix and lower uterine segment and release prostaglandin 

    Fetal Membrane Stripping- digital separation of chorionic membrane from wall of cervix and lower uterine segment during vaginal exam to start or stimulate labor by releasing prostaglandins and maternal oxytocin
  94. How long does a Balloon Cath (Cervical Ripening) stay in place???
    6-12 hours
  95. Risk for Balloon Catheters (cervical ripening)
    Infection rate is higher with this method!
  96. Pharmacological methods of ripening:
    • Cervidil (prostaglandin E2) 10 mg every 12 hr
    • Cytotec (prostaglandin E1) 25-50 mcg q3-6 hr
    • Prepidil Gel .5 mg every 6 hr/ max 3 doses
  97. How often is cervidil (dinoprostone) inserted to ripen cervix?
    10 mg every 12 hours
  98. Function of Cervidil (dinoprostone)
    Softens and thins cervix
  99. How often/Dosage for Cytotec
    25-50 mcg every 3-6 hours up to 6 doses in 24 hours or until effective UCs are noted
  100. Benefit to cervidil:
    Easy to remove in cases of tachysystole, etc...whereas other ripening methods are irreversible
  101. Cytotec has an ______ use
  102. Adverse effects of Cytotec making it an "off label" use for ripening:
    • Tachysystole
    • Maternal GI and Fever
    • Uterine Rupture (risk if they've had previous Csection)
  103. Cytotec is helpful for what condition other than ripening?
    Postpartum Hemorrhage

    or if pt has IUFD (helps expel)
  104. How is a fetal membrane stripping performed?

    Sweeping finger around 180 degrees for cervix to separate membrane from cervix
  105. Pharmacological agents used to induction:
    • Pitocin
    • Oxytocin- most common! (but poor cevical ripening agent)
  106. Goal of pitocin
    • produce active labor contractions:
    •    5 UCs within 10 minutes, 2-3 min apart lasting 60-90 seconds

    IUPC- adequate labor measured by 180-210 montevideo units
  107. When/How is oxytocin best used
    Inducing after cervical ripening has already happened or if there is a need for labor augementation
  108. Dosage of oxytocin:
    Always start with lowest possible!

    • 1-2mu/min
    • Increase 1-2 mu/min every 30-60 min PRN for adequate labor
  109. Risks of oxytocin:
    Tachysystole and water intoxification
  110. Induction of labor can only occur at what gestation age:
    39 weeks or greater...never below!!!
  111. New guidelines by joint commission regarding induction:
    Prior to 39 weeks EGA fetal lung maturity needs to be confirmed!!
  112. A baby's brain at 35 weeks weighs only ____ of what it will weigh at 39-40 weeks
  113. What position helps make room for baby to descend through the pelvis
    Squatting Position
  114. What labor pushing position works against gravity:
  115. Most common birthing position
  116. What birthing position is associated with less tears:
  117. Which birthing position may be most comfortable and make it easier for birth attendant to guide the birth of the baby's head
  118. Most common and preferred position of baby as descending:
    • Occiput Anterior (OA)
    • Baby is looking at floor toward spine, back is facing tummy
  119. Sunny Side up position
    Occiput Posterior

    Baby's spine is lying against your spine, face is looking up/towards tummy
  120. Which position is very helpful in a OP presentation?
  121. ****"Laboring Down", waiting for fetal descent and or initiation of Ferguson's reflex before pushing beginning in the 2nd stage of labor
    Delayed Pushing-- appropriate with epidural and analgesia bc they don't feel urge to push
  122. 7 RCTs of initial period of passive descent "laboring down" vs immediate pushing in primigravidas with epidurals found that:
    • Increased incidence of Spontaneous Birth
    • Reduced risk of instrument-assisted delivery
    • Decreased active pushing time
    • No change in C-section rate
  123. Goal and Outcome of 2nd Labor Stage:
    Safe delivery fr mother and fetus
  124. What must be done more often in the 2nd labor stage?
    Maternal/Fetal assessments
  125. How often is BP, P, R assessed in 2nd labor stage:
    every hour
  126. How often is Temp taken in 2nd labor stage:
    Every 2 hours (every hour if they have ROM)
  127. How often is pain assessed in the 2nd stage of labor:
    every 5-15 minutes
  128. Nursing responsibilities during 2nd labor stage:
    • Frequent assessments
    • Provide ongoing encouragement
    • Perform SVE only if indicated
    • Encourage open glottis pushing efforts and position changes 
    • Provide ongoing comfort measures
    • Communicate with interdisciplinary team
  129. Nursing considerations of 2nd stage of labor:
    • *Biggest thing is to keep encouraging mom
    • Assist with position changes
    • Update patient and delivering providers on labor progress
    • Mirror if desired (can help as focal point)
    • Perineal cleansing
    • Encourage spontaneous bearing down
    • Encourage pt to listen to body
    • Coaching as necessary
    • Involving partner and other supportive members
  130. Anesthetic injected in pudendal nerve (close to ischial spines) via needle guide called a "trumpet"
    Pudendal block
  131. When (if) is a pudendal block done?
    • 2nd stage of labor before delivery
    • *Typically given if you know forceps will be used
  132. Advantages to Pudendal block:
    • Late 2nd stage of labor, prior to delivery
    • Relieves pain: in lower vagina, vulva and perineal areas
    • Regional block needed to prepare for foceps or episiotomy
  133. Disadvantages to Pudendal Block
    May diminish maternal bearing down effort

    Delayed sensation return to area (may lead to urinary retention)

    Risk for local anesthetic toxicity in area

    Increased vulvar edema

    Hematoma formation risk (can cause death if clot forms)
  134. Anesthetic injected usually into local tissues of the vulvar region (perineum most common)
    Local Anesthesia
  135. When is local anesthesia given
    • Before Delivery (to cut episiotomy)
    • After Delivery (repair episiotomy or perineal tissue)

    *local perineal infiltration by delivering provider
  136. Advantages to Local Anesthesia
    • Quick Administration
    • Before delivery- prior to episiotomy
    • After delivery- repair of tissues
  137. Disadvantages of Local Anesthesia:
    • Brief intense burning sensation on admin
    • Hematoma formation risk
    • Infection risk
    • Increased edema
    • Delayed return of sensation
  138. Possible sites of Episiotomy:
    • Medialateral 
    • Median (more common)
  139. Incision into perineum to provide more space for presenting part during delivery
  140. Episiotomy is associated with increased:
    • Faster Second stage of labor
    • 3rd and 4th degree lacerations
    • Pain and risk for infection
    • Healing complications
    • Possible pain with sex later on
  141. Use of KY jelly and gloved fingers to stretch tissues for presenting part during delivery:
    Perineal Massage
  142. Perineal massage is thought to reduce the need for:
  143. Perineal massage is thought to be associated with:
    decreased perineal pain postpartum
  144. Image Upload 2
    Delivery of Fetus and Placenta
  145. Used to describe labor and vaginal birth in a pt with a prior C-Section delivery
  146. There is only a ___% change of uterine rupture in a VBAC
  147. Most important thing to know about VBAC pts?
    Review of previous C-Section records!!! Must note the type of uterine internal scar
  148. What is the only uterine scar allowed for a VBAC pt?
    Low Transverse types....NEVER longitudinal!
  149. Nurse precautions and candidate status related to VBAC
    • Only 1 previous C-Section (low transverse)
    • Clinically adequate pelvis determined by provider
    • OBGYN must remain inside hospital entire labor
    • Must await spontaneous labor!!! 
    • Requires closer observation--HIGH RISK!!!!
  150. Most placentas deliver within _____
    15 minutes
  151. Nurse's Responsibilities in the 3rd Stage of Labor (Placental)
    • Assess maternal/fetal stability after delivery
    • Facilitate family bonding
    • Prepare for delivery of placenta and need for uterotonics (pitocin, methergine, cytotec)
  152. How often are maternal vs taken in 3rd stage of labor:
    every 15 minutes
  153. How often is maternal temperature taken in 3rd stage of labor:
    every hour
  154. How often is maternal pain assessed in 3rd stage:
    every 15 min. and PRN
  155. Types of uterotonics used in 3rd stage of labor:
    • Pitocin
    • Methergine
    • Cytotec
  156. Only perform Controlled Cord Traction:
    if she has had ergometrine or oxytocin
  157. How to perform Controlled Cord Traction:
    As soon as uterus feels hard, lift toward umbilicus, first pull downwards and backwards, then more anteriorly
  158. Nurse role during the placental delivery:
    Await delivery of placenta, (provider will inspect after)

    Administer uterotonics and pain meds PRN

    After placental delivery, Pitocin (oxytocin) is ordered, if pt has IV fluids = 20u/L, if pt has NO IV fluids = 10u/IM
  159. A blood loss of ____ml indicates pp hemorrhage
    500 ml (or greater than 1 pad an hour)
  160. Potential degrees of lacerations:
    • 1st degree- minor tear, no muscle
    • 2nd degree- into perineal muscle
    • 3rd degree- down to the outside of rectal capsule
    • 4th degree- into rectum
  161. Nursing Considerations to facilitate bonding:
    • Skin-to-skin contact (baby on mother's chest)
    • Assess v/s while baby is on mom's chest
    • Delay routine newborn if stable
    • Encourage breastfeeding within 1st hour and assist with teaching/latch-on
  162. When is the only time a nurse can deliver a baby:
    if baby is crowning, you've called everyone, and there is uncontrollable pushing
  163. Nursing Interventions to deliver a baby:
    Call delivering provider now and other nursing team members to bedside

    Prepare for delivery by donning sterile gloves and encouraging not to push if possible "blowing out candle" method

    Assist in semi-reclining position

    Support head with one hand and perineum with other

    • Manually check infant neck for cord:
    •    -loose cord= slip it over head/shoulder
    •    -tight cord= clamp cord and then cut between two clamps

    Support head with one hand, slight downward pressure for anterior shoulder release

    Lift infant slowly upwards (careful of neck) to assist birth of posterior shoulder

    Support infant's head and body being born

    Position infant on its side or prone on mother's abdomen (skin to skin)

    Use bulb syringe in mouth and nose

    Another RN should be drying/assessing infant

    Double clamp then cut umbilical cord

    • When signs of placenta separation are imminent (do NOT pull on cord)
    •    -gush of blood, cord lengthening, abdomen shape changes

    After placenta delivery, immediate fundal massage to firm uterus and slow bleeding

    Direct pressure on any obvious perineal lacerations/bleeding
  164. Birth involving use of soft vacuum cup placed on fetal head to facilitate delivery; gentle traction used by delivering provider
    Vacuum Assisted Delivery
  165. Indications for Vacuum assisted delivery:
    Need for immediate delivery (suspicion of immediate or potential fetal compromise; prolonged 2nd stage)
  166. Birth involving the use of instrument to assist with delivery of fetal head
    Forceps Assisted Delivery
  167. Only ___% of births are forceps assisted now

    (only used for quick delivery needed for maternal or fetal indications)
  168. Maternal indications of Forceps assisted delivery:
    • Prolonged 2nd stage (high epidural anesthesia)
    • Maternal exhaustion
    • Arrest of rotation
    • Cardiac or Cerebrovascular Disease
  169. Fetal indications for Forceps assisted delivery:
    Fetal intolerance of 2nd stage
  170. General Anesthesia is ONLY used in
    C Section Delivery (very risky though and rarely used because of the placental barrier risk and respiratory depression risks)
  171. Most common female surgery
    C Section (1/3 births)
  172. Scheduled C section indicators:
    • Previous C section
    • Fetal malpresentation (breech, transverse, face, etc)
    • Conditions for risk (HIV, cardiac, HSV)
    • Elective
  173. Unscheduled Indicators for C Section
    • Fetal intolerance to labor (FIL)
    • Cord Prolapse
    • Failure to progress
    • Maternal infection
    • Maternal cardiac/resp compromise in labor
    • Placental issues
  174. Maternal risks of C Section
    • Aspiration
    • Hemorrhage
    • Atelectasis/Pneumonia
    • Endometritis
    • Abdominal wound (dehiscence, infection)
    • UTI
    • Bladder or bowel injuries
    • DVT
    • Longer Recovery
  175. Fetal Risk of C Section
    • Unanticipated prematurity
    • Anesthesia risks (hypotension, sedation)
    • Fetal injuries (scalpel)
    • More difficult transitions (increased fluid in lungs due to lack of natural squeezing missing from not going through birth canal)
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Intrapartum Nursing Care
Intrapartum Nursing Care
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