Intrapartum Care

Maternal and child Nursing

NUR 362

Lecture 7
Intrapartum care

Intrapartum period extends from the

beginning of contractions that cause
cervical dilatation to the first 1 to 4
hours after delivery of the newborn and
placenta.
Factors affecting the intrapartum
experience
Experience
Culture
Prepregnant health & biophysical
preparedness for childbearing
Motivation for childbearing
Socioeconomic readiness
Age of mother
Phenomena and process of labor and
delivery
Onset of labor
labor is the process by which the fetus and
products of conception are expelled as the
result of regular ,progressive frequent and
strong uterine contractions.

Theoretically ,labor is thought to result from:

a- progesterone depriviation.
b- oxytocin stimulation.
c- fetal endocrine control.
d- Uterine decidua activation
 Factors affecting labor
1-passageway: The adequacy of the pelvis and
birth canal allowing fetal descent

2-passenger: refer to the fetus

Size of fetal head.
Fetal presentation.
Fetal position.
Fetal attitude-the relationship of fetal parts to
one another
Fetal presentation-the part of the fetus that enters
.the maternal pelvis first
Fetal
position
Factors affecting labor
3- power: Frequency, duration and strength
of the uterine contractions to cause
complete cervical effacement and
dilatation.

4-placental factors.-site of placenta.

5-Psyche: clients psychological state

Signs and symptoms of impeding
labor

1-lightening:
The descent of the fetus and uterus
into the pelvis cavity 2 to 3 weeks
before the onset of labor.
Signs and symptoms of impeding
labor

2-Braxton Hicks contractions:

Irregular ,intermittent contractions
that have occurred throughout the
pregnancy ,become uncomfortable
and produce a drawing pain in the
abdomen.
Signs and symptoms of impeding
labor

3-Cervical changes: include softening

4-Rupture of the amniotic membrane

5-Burst of energy or increased tension and

fatigue.

6- weight loss: about 1 to 3 pounds may

occurs 2 to 3 days before the onset of labor.
 True and false labor
False labor
-contractions may be
irregular.
-decrease in frequency
and intensity.
-longer interval
between contractions.
-activity has no effect or
decrease contractions
True labor
-regular contractions
-progressive frequency
and intensity.
-shorter interval
between contractions.
-activity increase
contractions.
 False True
Contractions contractions
-disappear while -continue while
sleeping. sleeping.

-sedation decrease -sedation does not

or stop contractions. stop contractions.

-bloody show usually -bloody show usually

not present. present.

-no appreciable -progressive thinning

changes in the and opening of the
cervix. cervix.
Stages of labor

1-First stage. begins with the onset of regular

contractions.

Latent phase: dilation of cervix to3 to 4 cm.

contraction become increasing

Active phase: dilation continues from 3 to 4 cm

to 7 cm. Contraction become stronger and
painful

Transition phase: cervix dilates from 8 to 10 cm

Stages of labor
2- Second stage. (expulsive stage)-
begins with complete dilatation of the
cervix and ends with delivery of the
newborn.

-it should be complete within one hour

after complete dilatation.
Cont, second stage

-Movements..
1. descent.
2. flexion.
3. internal rotation.
4. extension.
5. external rotation.
6. expulsion.
Cont, second stage

-crowning occurs when the newborns

head or presenting part appears at the
vaginal opening.

-Episiotomy surgical incision in the

perineum-may be done to facilitate
delivery and avoid laceration of the
perineum.
3-Third stage (placental stage)

-This stage begins with delivery of the

newborn and ends with delivery of
placenta.

-It occurs in two phases placental

separation and placental expulsion.
4-Fourth stage
-It lasts from 1 to 4 hours after birth.

-the mother and the newborn recover from

physical process of labor.

-systems readjustment.

Newborn body systems begins to adjust to

extrauterine life.
-Intrapartum pain experience.

-overview of pain.

-factors affecting perception of intrapartum pain.

-physiologic causes of intrapartum pain.

-uterine anoxia.
-compression of the nerve ganglia in the cervix.
-stretching of the cervix.
-traction on, stretching of the perineum.
-pressure on the urethra, bladder and rectum
during fetal descent.
- distension of the lower uterine segment.
- Intrauterine pain management

-overview of goals.

-none pharmacologic pain management.

-pharmacological pain management.

-narcotic analgesics.
-barbiturates.
-tranquilizers.
-regional anesthesia.
- general anesthesia.