Intrapartum care (Intraprocedure) Labor and birth process

• *assess maternal vital signs per agency protocol
• *check maternal temperature every 1 to 2 hous if membranes are ruptured
• *assess FHR to determine fetal-well being
• *assess uterine labor contraction characteristics
• *insert a solid, sterile, water-filled intrauterine pressure catherter inside the uterus to measure intreuterine pressure (displays uterine contraction pattens on monitor)

• *Electric fetal monitoring
• *spiral electrode that is applied to fetus scalp (cervical dialtion and membrane rupture must have occured before electode can be palced)

• *palpation (place hand over the fundus to assess contraction, intensity, frequency, and duration)
• *use of the external or internal monitoring

• *Displays uterine contraction patterns on monitor
• *requires the membranes to be ruputred
• Dispalys the
• frequency: established from the beginning of one contraction to the beginning of the next
• duration:time between the beginning of a contraction to the end of the same contraction
• intensity:strength of the contraction at its peak described as mild, moderate, or strong
• resting tone of uterine contractions:tone of the uterine musxle in between contractions

• Prolonged duration or too frequent contractions without sufficient time for uterine relaxation in between can reduce blood flow to the plecenta causing fetal hypoxia and decreased FHR

• performed digitally by the physician or qualified nurse to assess for
• *cervical dilaion (stretching of cervical os adequate to allow fetal passage)
• *descent of the fetus through the birth canal as measured by fetal station in centimeters
• *fetal position, presenting part, and lie
• *Membranes intact or ruptured

• True labor leads to cervical dilation and effacement
• True labor:
• *contractions:
• may begin irregularly, but become regular in frequency
• stronger, last longer, and are more frequent
• felt in lower back, radiating to abdomen
• walking can increase contraction intensity
• continue dispite comfort measures
• *Cervix (assessed by vaginal exam)
• progressive change in dilation and effacement
• moves to anterior position
• bloody show
• *Fetus
• presenting part engages in pelvis

• False Labor:
• *Contractions:
• painless, irregular frequency, and intermittent
• decrease in frequency, duration, and intensity with walking or position changes
• felt in lower back or abdomen above umbilicus
• often stop with sleep or comfort measures such as oral hydration or emptying of the bladder
• *Cervix:
• no significant change in dilation or effacement
• often remains in posterior position
• no significant bloody show
• *Fetus
• presentin part is not engaged in pelvis

the adaption of the fetus as it makes progression through the birth canal during the birthin process

• Occurs when the presenting part
• usuallly bipartietal (largest) diameter of the fetal head passes the pelvic inlet at the level of the ischial spine

*referred to as station 0

• The progress of the presenting part (preferably the occiput) through the pelvis
• measured by station during vaginal examination, as either
• *negitive (#) station measured in centimeters if superior to station 0 and not yet engaged)
• *positive (#) station measured in centimeters if inferior to station 0

When fetal head meets resistance of the cervix, pelvic wall, or pelvic floor. The head flexes bringing the chin close to the chest, presenting a smaller diameter to pass through the pelvis

The fetal occiput ideally rotates to a lateral anterior position as it progresses from the ischial spines to the lower pelvis in a corkscrew motion to pass through the pelvis

The fetal occiput passes under the symphysis pubis and then the head is deflected anteriorly and is born by extension of the chin away from the fetal chest

After head is born, it rotates to the position it occupied as it entered the pulvic inlet (restitution) in allignment with the fetal body and completes a quarter turn to face transverse as the anterior shoulder passes under the symphysis

after birth of the head and shoulders the trunk of the neonate is born by flexing it toward the symphysis pubis