Maternal-Newborn Nursing

The Critical Components of Nursing Care

Intrapartum Assessment and Interventions

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Objectives
The learner will be able to
Define key terms Describe the four stages of labor and the related nursing and medical care Demonstrate understanding of supportive care of the laboring woman Identify the four Ps of labor Describe the mechanism of spontaneous vaginal delivery and related nursing care

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Factors That May Trigger Labor

Maternal factors Fetal factors

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Management of Discomfort During Labor and Delivery

Pain may result due to the following factors Decreased blood supply to uterus Increased pressure and stretching of the pelvic structures Cervical dilatation and stretching

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Factors Affecting Labor (4 Ps)

Powers (the contractions) Passage (the pelvis) Passenger (the fetus) Psyche (the response of woman)

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Labor Process
Premonitory signs of labor are Lightening Braxton-Hicks contractions Bloody show Spontaneous rupture of membranes

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Mechanism of Labor
Engagement Descent Flexion Internal rotation Extension External rotation Expulsion

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Labor
Labor is the process in which the fetus, placenta, and membranes are expelled spontaneously Stages of labor Stage one Stage two Stage three Stage four

Maternal-Newborn Nursing
The Critical Components of Nursing Care

First Stage
Latent phase Cervix 0 3 cm Contraction every 5 10 min, mild intensity, lasting 30 45 sec

Medical interventions Nursing actions

Maternal-Newborn Nursing
The Critical Components of Nursing Care

First Stage
Active phase
Average dilation 1.2 cm/hr depending on gravida Dilation progresses 4 7 cm, 40 80% effacement Fetal descent Intense contraction q 2 5 mins, lasting 40 60 sec Increase in pain Medical interventions Nursing actions

Maternal-Newborn Nursing
The Critical Components of Nursing Care

First Stage
Transition phase
Dilation from 8 10 cm, 100% effacement Contractions intense, q 1 2 min lasting 60 90 sec Feels exhausted Bloody show N/V, backache, diaphoresis, and trembling Medical interventions Nursing actions

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Second Stage

Complete dilatation Sudden burst of energy Shorter duration with multips than primips Intense contraction every 2 min, lasting 60 90 sec Increase in bloody show Perineum flattens, with bulging rectum and vagina Medical interventions Nursing actions

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Third Stage of Labor

Occurs after delivery of infant Period involving separation and expulsion of placenta/membranes Last 5 20 min Medical interventions Nursing actions

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Fourth Stage
This stage begins the postpartum period Ends 4 hr after delivery Mechanism of homeostasis occurs Medical intervention Nursing actions

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Management of Discomfort During Labor

Nonpharmacological management Pharmacological management Care of a woman before and after epidural anesthesia

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Case Study Review

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Review Questions
Latent phase of labor is indicated by 1. Cervix 0 3 cm dilated with contractions every 5 10 min, of mild intensity, lasting 30 45 sec 2. Cervix 0 4 cm dilated with contractions every 5 15 min, of mild intensity, lasting 30 45 sec 3. Cervix 0 2 cm dilated with contractions every 3 10 min, of mild intensity, lasting 45 60 sec 4. Cervix 0 3 cm dilated with contractions every 5 10 min, of strong intensity, lasting 30 60 sec

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Answer
1

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Active phase of labor is indicated by 1. Average dilation 1.2 cm/hr, dilation progresses 4 7 cm 2. Average dilation 1.2 cm/hr, dilation progresses 4 10 cm 3. Average dilation 2 cm/hr, dilation progresses 4 7 cm 4. Average dilation 1 cm/hr, dilation progresses 2 6 cm

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Answer 1

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Transition phase of labor is indicated by 1. Dilation from 8 to 10 cm, contractions intense, q 1 2 min lasting 60 90 sec 2. Dilation from 6 to 10 cm, contractions intense, q 1 2 min lasting 60 90 sec 3. Dilation from 7 to 10 cm, contractions intense, q 2 4 min lasting 60 90 sec 4. Dilation from 8 to 10 cm, contraction moderate, q 1 2 minutes lasting 60 sec

Maternal-Newborn Nursing
The Critical Components of Nursing Care

Answer
1