process of labor and birth 3

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Prittyrick
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process of labor and birth 3
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2015-01-27 13:20:49
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  1. First Stage
    Stage 1
    latent phase
    Three Phases

    • Latent phase
    • 0-3 cm dilated
    • 0-40% effacement
    • early on
    • contractions are not close together and they are short: 30-45 sec (contraction q5-10mins)ns 
    • Intensity is mild (she may tell u differently)
    • Happy/excited in this stage (they call everyone they know)

    • Vital signs: q 30-60 minutes\
    • Temp: check q 4hrs Unless rupture of membrane
    • assess pain q hr
    • DIF
    • FHR listen as long as u get a good reactive strip and mom is on monitor for 20 mins. she can get up and walk around (this phase can be done at home)
    • light diet if she hom e
    • encourage a lot of fluid
    • Bloody show- which is the cervix which is frible and vascular
    • gravity to assist
    • encourage rest also
    • keep empty bladder: check q2h

    we need to get labs
  2. Stage 1
    phase 2 active phase
    • Assess for pain
    • dilation 4-7cm
    • 40-80% effaced
    • baby's station starts to descend into the pelvis towards the ischial spine
    • Contractions duration 40-60 sec q 2-5mins
    • more self absorbed
    • she is uncomfortable.
    • VS: q 30mins same with temp
    • pain: assess q hr
    • this is when you would probably get epidural or other pain meds
    • FHR: q 30mins we checked them by bahavior
    • if ROM: then we limit vaginal examine
    • bladder: encourage emptying q 2hrs
    • Vomit/gag bc of the vagus nerve- that means she is changing
    • she can still remain out of bed if she didn't have an epidural, pain meds,  if membranes are rupture and fetus is not engaged
    • frequent position changes side to side
    • diet: clear liquids, ice chips
    • at this stage they will need IV replacement
    • monitor BP, FHR, as the contractions get closer the baby gets more stressed.
    • FHR monitor q 5mins for the 1st 30 mins and than q 15mins
    • monitor contractions continously and document q 15mins
  3. Stage 1
    Transition phase shortest phase
    • 8-10cm
    • 100% effaced
    • primite efface quicker multi may efface during labor
    • descend at 0 station or even a plus station
    • contractions last 60-90sec and 1-2 mins apart
    • no epidural mom has no control (ask her if she wants to turn over 'i dont know', u want ice chips 'i don't know')
    • once she gets to 10cm and baby comes down she may want to push encourage to blow
    • once she gets to 10cm she is going to move into the 2nd stage
    • make sure bladder is empty: check q 2hrs
    • may ambulate if no epidural or recent pain med or ruptured of membrane with no presenting part
    • start preparing for labor
    • VS: q15-30 mins
    • temp q 4 hrs/q 1hr if rom
    • pain q 1hr
    • this is quick and intensed (1hr)
  4. Stage 2
    • 10cm 100 effaced
    • pushing
    • end of stage delivery of baby
    • Nursing
    • encouraging mom to push
    • u need to be with her
    • recommend moms do an open epiglottis push to make sure her baby are getting enough oxygen (grunt)
    • two phases
    • pelvic phase- when we push we get the baby into the pelvis
    • perineal phase- when we push we get the baby into the perineal this when u see that crowning
    • VS: 5-15 mins
    • pain
    • contraction palpate every time
    • FHR: q 15mins low risk and q5 mins high risj 
    • bladder empty
  5. Stage 3
    • from baby being delivered to the placenta being deliver
    • how do we know placenta is coming?
    • uterus lifts up and the space decreases we get a contraction- u can get a trickle of blood cause it is release..u see the cord
    • it should be released within 2-30mins
  6. Stage 4
    • restorive phase
    • moms focus on the baby
    • skin to skin
    • we need are afraid of her bleeding so we do checks frequently
    • VS: q 15mins for the first hour, q 30mins for the next hr, q 1hr for as long as necessary
    • check fundus q 15 mins for the first 1-2hr
    • boggy- massage it
    • lochia: assess q 15mins color consistency or any clots
    • check to make sure she doesn't have alot of swollen down there even if she hasn't had an episotomy cause muscle get damaged
    • bladder needs to remain empty bc u don't want to push the uterus up and over
    • Perineal assessment: q 4 mins for the 1st 1-2hr, REEDA, abdominal dressing
    • clean her, ice or perinum, explain what is going, assist out of bed initially
    • Newborn takes over care assessing baby head to toe
    • warm blankets,
  7. Pain
    • mom comes in with birth plan: do they want pain meds, breathing
    • during active stage of labor about 4cm
    • pain is visceral: cervical changes start to give you the pain
    • ischemia as it starts to dilate
    • as uterus contracts the decre blood flow causes pain it is visceral (organ)
    • referred pain: sometimes pain from uterus goes down your leg...pain moves
    • somatic pain: baby comes down from the bone structure
  8. Non pharmacological measures for pain management
    • Continous labor support
    • hydrotherapy: water bath
    • ambulation and position changes
    • acupunture (not in labor) and acupressure
    • attention focusing and imagery
    • therapeutic touch and massage
    • breathing techniques
    • positions: leaning forward to get off back, sitting in chair, excerise balls, rotate,
  9. Pharmo
    • opiate/novene
    • you would want to have neonatal narcan: antidote bc of decrease respiratory (respiratory depression)

    • fetnal given epidural
    • nausea: these meds may make u nausea

    look at the meds list
  10. epidural anesthesia
    • provides analgesia and anesthesia for labor, vaginal delivery and ceasarean birth
    • during active stage
    • position:forward and still goes into the epidural space
    • causes: hypotension, nausea, vomiting
    • what can happen to fetus: HR goes down, variability goes down
    • before you give the epidural nurse will give 1000-1500ml bolus of fluid so the mom wont have hypotension
    • if u have hypotension: turn mom, incr iv fluid, oxygen
    • a
  11. epidural anesthesia advantages/disadvantages
    • advantages:
    • ability to move lower extremities
    • keeps calm, decre pain
    • can use post op

    • disadvantage
    • if it gets into the spinal space
    • you can get spinal headache
    • itchy
    • can't move freely
    • CNS effect
    • always going to have urinary retention: nurse would put a foley catheter 
    • respiratory depress if high epidural. 
    • Hypotension
    • BP, P, R q 5mins for the 1st 30mins then q 15mins during infusion
    • temp q 2hrs if membrane is not ruptured
    • monitor bladder
    • fetal distress r/t maternal hypotension may be bradycardia
    • control delivery: infants responds more quickly than if we gave narcotics
  12. c-section
    if she needs c-section we can increase dose
  13. contraindications to epidural blocks
    • maternal refusal or inability to cooperate
    • previous hx of spinal surgery or spinal abnormalities
    • antepartum hemorrhage/hypovolemia
    • anticoagulant therapy or coagulation defects
    • infection at the injection site
    • allergy to the anesthetic drug
    • maternal hypotension
  14. Spinal
    • use this on c-section table
    • this is immediate
    • the feeling that she has is the last feeling she felt
    • adverse reaction are similar
    • IV bolus to maintain BP and prevent vasodilation
    • duramorph: analgesia for 24hr post op
    • hypotension
    • if mom says she cant breath we need to put her to sleep diapharm gets involved. (if too high)
  15. general anesthesia
    anything u need immediate or some or those epidural contraindicted
  16. local anthesthsia
    • for episotomy 
    • cardiac output goes up
  17. Maternal response to labor
    • increase heart rate, cardiac output, bp during contraction
    • incre wbc count
    • incre repiratory rate and oxygen consumption
    • decre gastric motility and food absorption (this why u don't eat)
    • decre gastric emptying and gastric PH
    • slight temp elevation
    • muscle aches/cramps
    • incr BMR
    • decreased blood glucose levels
  18. Physiologic response to labor fetal
    • Periodic FHR accels and slight deccel
    • decre in circulation and perfusion
    • incre aterial carbon dioxide pressure
    • decre in fetal breathing movements
    • decre in fetal oxygen pressure; decr in partial pressure of oxygen

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