Galvez, Divina D.

BSN 4-NPF 4

June 20,2011 Ms. Juvy Carame, RN, MAN

THE PROCESS OF LABOR The Four Stage of Labor a. First Stage of Labor. The first stage of labor is referred to as the "dilating" stage. It is the period from the first true labor contractions to complete dilatation of the cervix (10cm) (see figure 2-2). The forces involved are uterine contractions. The first stage of labor is divided into three phases: (1) Latent (early) or prodromal. (2) Active or accelerated. (3) Transient or transitional. b. Second Stage of Labor. The second stage of to as the "delivery or expulsive" stage. This complete dilatation of the cervix to birth of forces involved are uterine contractions plus pressure. labor is referred is the period from the baby. The intra-abdominal

c. Third Stage of Labor. The third stage of labor is referred to as the "placental" stage. This is the period from birth of the baby until delivery of the placenta. The forces involved are uterine contractions and intra-abdominal pressure. d. Fourth Stage of Labor. The fourth stage of labor is referred to as the "recovery or stabilization" stage. This period begins with the delivery of the placenta and ends when the uterus no longer tends to relax. The forces involved are uterine contractions

NEWBORN CARE (1) The nurse should cradle the infant against his (the nurse's) body with the infant's head supported by the palm of his hand and the body supported by the forearm. This method allows the nurse a free hand. (2) The infant should be held with his head tilted downward to facilitate the drainage of mucus and amniotic fluid from the upper airway. (3) The infant should be held at or below the level of the uterus until the umbilical cord stops pulsating to prevent loss of neonatal blood to the placenta. NOTE: The infant may cry or breathe spontaneously or with the clamping of the cord. (4) If the infant does not begin spontaneous respiration, he should be stimulated to breathe. You should place the infant on a flat surface and rub his back briskly. This can be achieved with the same motions required to dry the infant. Slap the soles of the infant's feet if more aggressive stimulation is required.

(5) Do not "slap" the infant's buttocks. This action may produce sufficient bruising of a large surface area and may result in compromising circulatory volume. (6) Never suspend the infant by his feet. This action hyperextends the infant's spine which has been flexed throughout fetal development. Also, it increases the intracranial pressure and may cause capillary rupture and increases the chances of dropping the infant. (7) Dry and wrap the infant immediately to prevent heat loss. In an emergency setting, place wrapped infant in the mother's arms to be held close to her body to maintain warmth. (8) Check the infant frequently to assess for regular respirations. (9) Determine one (1) and five (5) minute APGAR scores. NURSING MANAGEMENT OF THE NEWBORN AFTER DELIVERY a. assessment - mucus in nasopharynx, oropharynx - note and record apgar score - # of vessels in the umbilical stump - passage of meconium stool, urine - general physical appearance b. analysis / ND 1 ineffective airway clearance related to excessive nasopharyngeal mucus 2. ineffective breathing pattern related to CNS depression secondary to intrauterine hypoxia and prematurity 3. impaired gas exchange related to respiratory distress 4. fluid volume deficit related to birth trauma, hemolytic jaundice 5. impaired skin integrity related to cord stump 6. high risk for injury related to impaired thermoregulation (incubation & drop light) 7. ineffective thermoregulation related to environmental condition c. NCP / implementation - ensure patent airway - suction with bulb syringe - maintain body temp - identify infant - prevent eye infection

- facilitate prompt identification / vigilance for potential neonatal complications 1. history of pregnancy 2. history of delivery - facilitate prompt identification / intervention in hemolutic problems of the newborn

SIGNS OF PLACENTAL SEPARATION

1. Uterus becomes globular or firmer. It is the earliest sign to appear. Calkins Sign 2. Sudden gush of blood from the vagina 3. Lengthening of the imbilical cord, 1-5 minutes after delivery of the infant 4. Fundus rises up in the abdomen

PLACENTAL PRESENTATION

Birth of the placenta by the Schultz Mechanism (when placenta is expelled with the fetal (shiny) part presents)

a. The fetal surface of the placenta slips through the opening in the fetal membranes and appears at the introitus. b. The membranes then peel off the surface of the uterine cavity, uniformly and intact. c. The liquid blood and retroplacental clots, if any, are contained within the folded placenta and are not evident until the placenta is delivered and examined. Birth of the placenta by the Duncan Mechanism (dirty duncan because maternal (rough) part is presenting.) a. One edge of the placenta first slips through the cervix and into the vagina. The remainder of the placenta follows, and the fetal membranes are peeled from the uterus as traction is made on the edge of the placenta which follows. b. The liquid blood and retroplacental clots escape from the uterus as the maternal surface of the placenta is delivered. c. The Duncan Mechanism is more frequently followed by retained fragments of the fetal membranes. TRUE AND FALSE LABOR Characteristics of false labor 1. Contractions are irregular, occur at irregular intervals decreased frequency and intensity, longer intervals between contractions 2. contractions located chiefly in the abdomen - intensity remains the same or variable - intervals remain long 3. Walking does not intensify contractions and often gives relief - either no effect or decreases contractions 4. bloody show usually not present. If present, usually brownish in color 5. There is no cervical changes 6. Contractions disappear while sleeping 7. Sedation decreases or stops contractions 8. Discomfort in lower abdomen and groin

Characteristics of true labor 1. Contractions occur at regular intervals 2. Contractions start at the back and sweep around to the abdomen - increased intensity and duration or progressive - shortened intervals between contractions 3. Walking (activity) intensifies contractions 4. Bloody show present (pink-tinged mucus released from the cervical canal and as labor starts) 5. Contractions continue while sleeping 6. Cervix becomes effaced and dilated. -progressive thinning and opening of the cervix 7. Sedation does not stop contractions 8. Discomfort begins in the back and radiates to the abdomen