2546- Labour And Delivery
5 Physiological processes of labour
1) passenger
2) Pathway
3) Power
4) Position
5) Psychosocial
Passenger: Size of head
size and rigidity effect process
Sutures allow for flexibility
Passenger: Presentation
Cephalic: head first
Breech: bum first
Shoulder: Scapula first
Passenger: Fetal Lie
Longitudinal:
Transverse: Not in line with mothers spine and vaginal delivery CANNOT occur
Passenger: Attitude
general flexion
Looks at fetus body
Passenger: Fetal Position
RLOAP Acronym looks at presenting part within pelvis
Passenger: Fetal station
Descent related to ischial spine
Station 0: at the spine
Passageway
Birth Canal
Soft tissue
Powers
Primary: Muscular contractions
Secondary: Active pushing
Position
Hands and knees
Squatting
Mechanisms of Birth: EDFIRE
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation: 45 degrees
Expulsion: once the last presenting part is delivered- time of birth is announced
Process of Labour
Prelabour: contractions are irregular and leave when pt changes position
True labour: Progressive change
regular and closer contractions
First Stage of Labour
Uterine contractions to full dilation
A) Latent
0-3cm
contractions: 5-30 lasting 30-45 sec
B) Active
4-10cm
Contractions: 2-5 lasting 40-90 sec
The second stage of labour
dilation to birth
A) Latent
The fetus descends passively and anteriorly rotates
B) Active
Lithotomy position and urge to push
Third Stage of labour
Delivery to the delivery of the placenta
bearing down
oxytocin admin
skin to skin
The fourth stage of labour
2hr after placental delivery
fundus every 15 mins
BP, O2, temp
Maternal Adaptations to Labour
increase in BP, 02, RR, pain threshold
Decrease in progesterone, BG, Stomach emptying
Fetal Adaptations to labour
FHR: 110-160
Decreased circulation
Frequency of Assessment
1st LT stage: hourly
1st AT stage: 15-30
2nd LT stage: 15-30
2nd AT stage: 5
FHR: Intermittent Auscultation
Periodic
BsFHR: 110-160
Rth; regular
Var: N/A
Dec: none
Acc: may be heard
FHR: EFM
Continous
BsFHR: 110-160
Ryth: N/A
Var: moderate : 6-25 for 40 min
Decc: none or occasional
Acc: spontaneous
Uterine Activity
No more than 5 in 10 minutes looking over 30 mins
last 45-80 seconds- no more than 90
Uterine relaxes for 35 sec
FHR Patterns
Periodic: with contractions
Episodic: Without contractions
EFM interpretation
Atypical:
100-110
baseline increases
FHR is 160<X<80
Abnormal:
Eratic
Intrauterine Resuscitation
stop oxytocin and change pt position
Modify breathing through open glottis breathing
Pharmacological Pain Management
Morphine
Nitrous oxide
Epidural
Spinal Tap
Epidural Intervention
Anesthetic &opioid
4th/5th lumbar epidural space insertion
Blocks T10-S5
Spinal Tap
3,4,5 lumbar into subarachnoid space
Provides T6-feet block
more of a motor block
Operative Vaginal delivery
Forceps
Vacuum
Cesarean section & Roles
Transabdominal inscion
elective, indicated, forced
circulating nurse
scrub nurse
Receiving baby nurse
Induction of Labour
Chemical or mechanical intiation
cervical ripening
CHEMICAL: prostaglandins
softens
delay oxytocin
MECHANICAL: balloon catheter
foley through external OS
falls out when the cervix is 3-4cm dilated
Augementation Of Labour
Stimulation of contractions through oxytocin or AROM
Oxytocin admin
Closest site
20 units in 1000ml of NS
Emergency measures: stop oxytocin and insert bolus and nitroglycerin