Nursing care for the laboring patient

• Strong UC, become longer, frequent and more regular over time
• UC consist of abdominal tightening or often back pain
• UC rarely >60 sec
• not reduced by change in maternal activity
• GI-frequent bowel movements, nausea, vomiting, diarrhea
• UC=progressive cervical change(both effacement/dilation changes)
• intact membranes feel tense on SVE (sterile vaginal exam)

Oxytocin regulatory mech. unknown-nerve impulses from Uterus "may" cause release of oxytocin. Contractions continue after birth to prevent post-partum hemorrhage and to accomplish uterine involution.

12-18 hours

6-10 hours

degree of distension causes muscle fibers to release prostaglandin causing cervical ripening and stimulating UC.

• May cause drop in maternal progesterone levels rendering the uterus more sensitive to oxytocin.
• also the aging placenta may not work as well towards the end of pregnancy which causes the adrenal glands from the fetus to produce labor inducing "substance"

• Increased vaginal secretions
• Loss of mucous plug (bloody Show)
• Ripening
• Dilation of cervix
• effacement-cm of cervical length
• cervical status: 3/100%/-1—Dilatation/effacement/station

• Power: physical forces of labor
• passage: maternal pelvis
• Passenger: fetus
• Relationship: of passenger and passage
• Psyche: personality and emotional forces

• UC-backache, menstrual cramps
• contractions should be palpated 
• slowly the UC open the cervix to allow passage

• 3-4cm-(10cm) of dilation
• Time of most rapid CD(cervical dilation)
• Progressive effacement and presentation of part

• 1.2cm/hr=primipara
• 1.5cm/hr=multipara

• each phase shorter and more intense
• UC 60-90 sec long, 1-2 min apart making it hard to cope
• Do not leave a laboring pt in transition alone

• Effleurage
• Massage
• Water therapy
• Aroma therapy
• Hypnosis

• IV narcotic administration
• Epidural anesthesia
• Spinal anesthesia
• Local anesthesia
• General anesthesia

• ligamentum flavum and the dura matter of L3-L4 of the spine
• Medication blocks sodium channels and prevent continuation of nerve impulses to decrease pain and allow lower doses of pain meds.

• BP rises-later recumbent position will help prevent rises in BP
• Check other parameters of pre-eclampsia
• Check BP between UC
• Metabolism increases=increased body temp, respirations, pulse, cardiac output and fluid loss.
• Renal: Polyuria common, proteinuria 2+ is abnormal. evaluate bladder q2 to insure empty bladder and allow the presenting part of baby to progress.
• GI: gastric juices severely reduced-inability to digest food during active labor-limit to fluids NV common.
• Hematological: hemoglobin increases (1.2gm/100ml)-coagulation time decreases-to help prevent post-partum hemorrhage, WBC increase to around 15,000-consider infection if sustained or further elevated. BG drops with muscle activity.

Also caused rest and descend depending on the mother and baby. waiting on passage to vagina/pelvis

surgical incision mediolateral to help with passage.

• after birth, waiting on placenta to be delivered should be <30mins.
• UC continues with less intensity to help with delivery of placenta and to prevent post partum-hemorrhage.
• Inspect cord and placenta after delivery
• Critically important that uterus remain contracted after placental delivery, functions as tourniquet(up to 4L loss)-frequent check of fundus for firmness to confirm contraction.
• Never massage uterus before placental delivery-helps return to contracted state.

• BP stable? pre-eclampsia/hypovolemia?
• respiratory changes? pulmonary embolism?
• Vaginal bleeding? just a trickle is considered abnormal

• Close observation of both patients freq. assessments, vitals should stabilize, slight elevated temp-normal is <2 degree.
• Insure bladder emptied-full bladder can impair uterine contraction.

• Flexion of baby head to chest
• engagement internal rotation to mothers side
• descent-throughout first and second stage
• internal rotation baby facing maternal coccyx
• extension birth of head
• restitution-untwists the fetal neck to realign with shoulders
• external rotation fetal shoulders into the AP diameter of the pelvis
• expulsion of entire body