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1st stage of labor - 3 phases
What are the 3 substages of the 1st stage of labor?"
(Verbalize the cm stretch within each)
Latent: 0 - 4 cm
Active: 4 - 7 cm
Transition: 8 - 10 cm (completely dilated)
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Why are Leopold's maneuvers done?
To check where the back of fetus is to place ultrasound.
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1st stage of labor: latent phase
Maternal behaviors
-can the mother ambulate/walk/laugh?
How is pain controlled?
Can some Pts remain @home for this phase?
Laboring Pt can ambulate and talk through her contractions
Pain is controlled fairly well
Pt can laugh and be social
Some patient’s are able to remain at home during this phase
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Latent Phase characteristics:
Dilation
Contractions (q ~ min. lasting ~ to ~ sec)
Effacement
Dilation: 0 – 4 cms
Contractions: q 5 to 10 mins, lasting 30 to 45 secs, (mild to palpation), effacement 0 to 40%
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Pain Control Options for the Latent Phase.
What can the mother do to alleviate pain during the Latent/Early Phase?
- Walk
- Shower
- Breath
- Focus
- Hynotherapy
- Hydrotherapy
- *No medications
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1st stage of labor - Active Phase
Maternal Behaviors
Dilation
Contractions
Effacement
Dilation: 4 – 7 cms
Contractions: q 2 - 5 mins, lasting 45 - 60 secs, (mild to palpation), effacement 40% - 70%
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With multipara, when dilation is at 4-7 in Active Phase, should medications be given?
In most cases, no.
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1st Stage of Labor –Transition
Maternal Behaviors?
(What might she say, do, or want)
N/V
Pt might feel out of control, irritated, swear, yell at her partner
Diaphoresis: Hot and want cold wash cloths on her head or cold wet towels on her body.
- “I want to go home.”
- “I can’t do this anymore.”
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1st stage of labor - Transition Phase
Dilation
Contractions
Effacement
Dilation: 8 - 10 cms
Contractions: q 1 -2 mins, lasting 60 - 90 secs, (strong to palpation), effacement 80-100%
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What is "laboring down?"
Laboring down may result from an epidural shot which may cause HYPOtn due to vasodilation.
Mother does not have to "push" for 1+ hours due to independent contractions.
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2nd Stage of Labor - aka?
Maternal Behaviors
The mother might say or do the following:
2nd Stage (@10cms-Birth of baby)
- “I need to have a BM.”
- “I have to push.”
The mother might start involuntary pushing. scream, grunt and c/o that she feels the “ring of fire"
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What is the "ring of fire", what stage is it felt?
The "ring of fire" is felt during the 2nd stage of labor (delivery of baby) due to stretching.
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2nd Stage Characteristics
Dilation
Contractions
*vasodilation w/ bolus: give epidural
Dilation–10 cms until the birth
Contractions: q 1 -2 mins, lasting 60 - 90 secs, (strong to palpation), effacement 100%
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2nd Stage of Labor
Nursing Interventions:
Maternal pushing efforts & help with contractions:
Maternal VS
- Contractions
- Frequency, duration, strength, ROM
Color
- Maternal pushing efforts & help with contractions:
- Closed glottis and open glottis pushing
FHR with pushing efforts and recovery between pushing efforts
Set up for the delivery
Call the provider to let them know that delivery is close
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What is the difference between "open" and "closed" glottis pushing?
Open: women pushes when she feels the need to.
Closed: women's pushing is "directed" or "guided".
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What is the best way to promote pushing, open or closed glottis pushing?
- The best and safest way to push your baby out is by pushing when you feel the urge to
- bear down or have a bowel movement and by not holding your breath.
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What are some non-pharmacological measures for Pain Management?
(who are the support persons during labor?)
Continuous labor support-Doula, support person
Hydrotherapy –Waterbirth
Ambulation and position changes
Hypnotherapy
Acupuncture and acupressure
Focusing and imagery
Therapeutic touch and massage; effleurage
Breathing techniques
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3rd Stage Nursing Interventions
Specific criteria for water birth?
Maternal Behaviors
Nursing Interventions
-What is lidocaine used for?
Assess for s/s of placenta separation and delivery
Abdomen balls up and becomes round, patient feels cramping and a need to push, umbilical cord lengthens, and there is a small gush of vaginal blood prior to delivery
Assist provider with delivery of placenta get a bowl to help catch the placenta
Make sure the provider has everything they need on the sterile delivery table
Sterile gloves, suture if the patient needs stitches, vaginal packs, lidocaine for perineum pain with repair
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What signifies placental separation?
Separation of the placenta is characterized by a rise in fundal height and sudden gush of blood 5 minutes after birth.
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In Stage 3 labor, what is characteristic of the delivery of the placenta?
Delivery of the placenta is characterized by a decrease in fundal height.
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When can an amniotic infection occur?
Usually 12 hours postpartum
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