Process and Stages of Labor and Birth
Sarah Alkhaifi
Nursing/ Midwifery intervention during
Second stage of labor
Nursing management
• Second stage of labor
• Provide privacy (curtain, draping, information)
• Encourage woman to share her feeling.
• Teach woman prenatally about benefits of upright positions
• During labor, encourage woman to change positions
frequently; suggested positions include squatting,
semi-recumbent, standing, and upright kneeling
Positioning During labor
• Allow woman to rest until she feels an urge to push
• Encourage spontaneous bearing down
• Support, rather than direct, the woman’s involuntary pushing efforts
• Discourage prolonged maternal breath holding
• Monitor fetal heart (base line, variability, aceleration, deceleration)
• Monitor the uterine contractions (intensity, duration) instruct the woman to push in according to the uterine contraction.
Nursing management
Interpret the following CTG
Nursing management
• Assess the effectively of maternal pushing through comparing the bearing down with the fetal head
descending.
• place one hand (non dominant) on the fetal head to avoid rapid extension.
• Support perineum during crowning with sterile pad.
• Assess if there is indication for Episiotomy.
Perennial support and control head
extension
As the fetal head pushes down, the perineum bulges. This sign indicates that birth is imminent. (Copyright © Barbara Proud.)
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the
shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C,
D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Episiotomy.
Nursing management
• Check if umbilical cord present around the neck of baby. (loss, tight).
• Loss the umbilical cord in case the umbilical cord around the fetal neck.
• Let the fetus’s head to rotate (external rotation)
• Place your hand in each said of baby’s head and pull the fetal head
downward to deliver the anterior shoulder ,then apply upward traction to deliver posterior shoulder.
• Deliver the rest of the newborn body, and place the fetal on the mother’s ABD.
• Inject 5 U of oxytocin IM after delivery of anterior shoulder.
• Cut and clamp umbilical cord. (technique).
• Perform APGAR assessment for the newborn.
• Perform immediate newborn care (see the lab)
• Collect umbilical cord blood (bilirubin ,blood culture, Blood gases, carbon dioxide, and pH levels, Blood sugar level, Blood type and Rh, CBC, Platelet count)
•
What do you know about late VS early umbilical cord clamping?
Normal vaginal birth sequence. A: Early crowning. B: Late crowning.
The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior
position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord.
Normal vaginal birth sequence. A: Early crowning. B: Late crowning. The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the
shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord
Normal vaginal birth sequence. A: Early crowning. B: Late crowning.
The fetal head is face down, in normal occiput anterior position. C, D: Extension of the fetal head (right occiput anterior position). E: Birth of the shoulders. F: Emergence of the rest of the fetal body, including the umbilical cord
EBP
APGAR Assessment
Third stage of labor
Third stage of labor
• From complete fetal delivery till complete separation of the placenta.
• Up to 30 minutes for placental separation
• Mechanism of separation
Firm uterine contraction
Deceasing in the uterine surface area
Bleeding and hematomah
Third stage of labor
• Signs of placental separation
1.Globular shaped uterus 2. Rise of fundus
3. Gush of blood
4. Lengthening of cord
• Do not pull on
cord !.... Why?
Placental Delivery
Placenta Delivery
• After signs of placenta separation signs the mother may bear down.
• Controlled Cord Traction(CCT).
1
2
3
Placenta (fetal side)
Placenta (Maternal side)
Nursing Intervention During
Third Stgae of Labor
Fourth Stage of Labor
Fourth Stage of Labor
• 1- 4 hrs after delivery
• Time of recovery
• After pains
• Hunger and thirst
• At risk for atony and hemorrhage
• Promote bonding and attachment
Nursing Intervention During
Fourth Stage of Labor
References
http://www.uptodate.com/contents/management-of- normal-labor-and-delivery?
source=search_result&search=management+nor
mal+labor&selectedTitle=1~150#H28
