Care of the Family in Childbirth

1
Care of the Family in Childbirth

• Linda L. Franco RN MSN NE-BC
• Green need to know
• Blue History
• Red Important to know

2
Reasons to come to the Hospital

• Rupture of membranes
• Regular, frequent uterine contractions
• Primigravida 5 minutes apart for 1 hour
• Multigravidas 6-8 minutes apart for 1 hour
• Any vaginal bleeding
• Decreased fetal movement

3
Admission

• Initial encounter sets tone
• Explanation of procedures and policies
• Intrapartal Assessment vaginal exam, FHR,
  uterine contractions
• Urine - protein (1 or more sign of
  preeclampsia), glucose
• Lab HH (she has enough blood cells to carry
  the oxygen), Blood type crossmatch, platelets
• ID bands
• Notify physician

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First Stage of Labor

• First Stage From the beginning of labor to the
  full opening of the cervix to about 4 inches or
  10 centimeters.
• Initial (Latent) Phase Contractions
  become progressively stronger. Discomfort is
  minimal. Cervix thins and opens to about 4 cm.
  May last an average of 12 hours in first
  pregnancy and 5 hours in subsequent pregnancies.
• Active Phase Cervix opens from 4 cm to 10
  cm. The presenting part of the baby begins to
  descend into the womans pelvis. The woman begins
  to feel the urge to push. This phase lasts about
  3 hrs in 1st pregnancy and 2 hrs in subsequent
  pregnancies.

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Nursing Care First Stage

• Integration of Family Expectations
• Safety of mom baby
• Specific expectations birth plan
• Nursing support
• Emotional support
• Comfort measures
• Information and advice
• Advocacy
• Support of partner
• Cultural Beliefs
• Modesty
• Pain expression
• Specific Beliefs

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Assessments of First Stage

• Latent
• VS, Temp Temp q4 hours unless ROM
• FHR, fetal activity
• Assess Uterine contraction
• NPO ice chips
• Active
• VS q 1 hour,
• Pain control
• Bladder status
• FHR
• ROM and increased bloody show, prolapse of cord
• FHR monitoring
• Every 30 mins for low risk women and every 15
  mins for high risk
• Transition
• Changes in Mood (moms)
• Assistance with breathing - monitor for
  hyperventilation

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Promotion of Comfort First stage

• Identify goals
• General comfort measures
• Anxiety
• Client teaching
• Supportive Relaxation techniques
• Breathing techniques

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Second Stage of Labor

• From complete opening of the cervix to delivery
  of the baby. This stage averages about 45 to 60
  minutes in the first pregnancy and 15 to 30
  minutes in subsequent pregnancies

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Nursing Care Second Stage

• Provision of care
• Complete Dilatation
• More frequent VS
• Assist with positioning, breathing, pushing
• Promotion of Comfort
• Rest between UCs (uterine contractions)
• Assisting during birth
• Room prepared
• Birthing positions
• Cleansing the Perineum

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Third Stage of Labor

• From delivery of the baby to delivery of the
  placenta. This stage usually lasts only a few
  minutes but may last up to 30 minutes

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Apgar Scoring
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Nursing Care Third Stage

• Initial Care of the Newborn
• Placed on mothers abdomen or under radiant
  warmer
• Apgar
• Done at 1 min and 5 mins
• Assess Umbilical cord for 3 vessels
• Number of vessels is recorded on the chart. Clamp
  on babys cord before they cut it, removed about
  24 hours after birth when the cord has started to
  dry up
• Cord blood banking
• Some people save it for blood collection
• Physical assessment
• Newborn ID
• Mom and dad both get id bands along with baby.
  Typically come in sets of 4, one on wrist and
  ankle of baby, one on mom and one on dad. They
  cant pick up baby without these
• Try not to use oxygen on these guys if we dont
  need to, does effect their eyes (esp if its long
  term), and deep suctioning can hurt them

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Birth of Placenta

• Uterus rises up in abdomen
• Umbilical cord lengthens
• Trickle of blood
• Uterus shape changes from a disk to a globe
• Sometime pitocin (sp?) is given to clamp down on
  the uterine muscles and help deliver the placenta

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Nursing Care Fourth Stage

• Placenta inspect for missing pieces
• Episiotomy repair
• Uterus midline and firm
• Cleanse perineum with warm H2O and place ice to
  perineum
• Monitor maternal VS
• Warm blankets
• Moms may be shaking, hormone and blood flow
  changes
• Enhancing attachment

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Nurse Attended Birth Preciptious Birth

• Remain with patient
• Amniotic sac intact must rupture
• Apply gentle pressure to head to prevent tears to
  perineum
• Check for nuchal cord after head delivered
• Fishhook your fingers and pull the cord over the
  head and away from around the neck of the baby
• Suction mouth nose
• Gentle traction on anterior shoulder then upward
  pressure on the posterior shoulder
• Hold securely and place on mothers abdomen
• Clamp cord and cut
• Watch for signs of placenta delivering
• Precipitous birth occurs when labor and delivery
  occurs in 3 hours or less