The Process of Birth

1
The Process of Birth
2
Assessment And Responsibilities During
Labor and Birth

• Goal of Care To provide for a safe labor and
  birth of a healthy baby and to promote maternal
  comfort in the process..
• 1. Comfort Measures
• 2. Physical Needs
• 3. When to call the Physician
• Responsibilities of the Attendants at the Birth

3

• Immediate Care of the Newborn
• Assessments
• Vital Signs /Color of Infant
• Apgar Scores
• Check Cord
• Assess Infant Weight
• Assess U/A and G.I. Systems

4
Assessments (Cont.)

• Protect against infection
• Identification of Infant
• Prevent hypothermia
• Promote parental attachment

5
Managing the Pain of Labor and Delivery
6
Labor Pain-Introduction

• Historical Perspective
• Management Strategies
• 1.Non- Pharmaceutical Measures
• 2. Pharmaceutical Choices
• The Challenge to Nurses!

7
What Exactly is Labor Pain ????
8
Factors Affecting The Woman in Labor

• 1.Parity Age
• 2.Racial/Cultural
• 3.Coping Strategies
• 4.Relaxation Measures
• 5.Emotional/ Attitude
• 6.Knowledge base

• 7.Confidence level
• 8.Support Systems
• 9. Environment
• 10.Fatigue/length of labor
• 11.N/V Diarrhea
• 12. Maternal Fetal Positions
• 13.Pain Level

9
Non-Pharmacologic Methods of Pain Relief

• Hydrotherapy
• Application of heat /cold
• Acupressure
• Imagery/Visualization
• Effleurage
• Comfort Measures
• Distraction
• Breathing Techniques

10
Pharmacological Methods of Pain Relief
11
Goal of Administering Systemic Medication

• Three Factors to be Considered in the use of
  Systemic Medication
• 1.Effect on The Mother
• 2. Effect on the Fetus
• 3. Effect on Labor contractions

12
Analgesia/Anesthesia

• Analgesics
• (Opioids,Tranquilizers Sedatives)
• Common Ones
• Demerol
• Stadol
• Nubain
• Fentanyl
• Morphine

13
Demerol (Meperidine)

• Action
• Usual dose
• Pros
• Cons Maternal
• Cons Neonatal

14
Stadol (Butorphanal)

• Usual dose
• Action
• Pros
• Cons Maternal
• Cons Neonatal

15
Nubain (Nalbuphine)

• Usual dose
• Action
• Pros
• Cons Maternal
• Cons Neonatal

16
Fentanyl (Sublimaze)

• Usual dose
• Action
• Pros
• Cons Maternal
• Cons Neonatal

17
Morphine (Duromorph)

• Usual dose
• Action
• Pros
• Cons Maternal
• Cons Neonatal

18
Nursing Considerations with Opioids

• Opioid Antagonist
• NALOXONE (Narcan)
• Reverses opioid induced Resp.Depression
• Dose Neonate 0.01mg/Kg IV,IM or SC q 2-3min.
• Mother 0.1-0.2mg IVQ 2-3min
• Have Crash Cart Handy!!!!

19
Anesthesia 1. Local Infiltration

• 2.Regional
• Pudendal Block
• Epidural Block
• Goal
• Procedure
• Complications
• 1. Maternal
• 2 .Neonatal

• Nursing Considerations
• Advantages vs Disadvantages

20
Spinal Block (Subarachnoid) Intrathecal)Goal

• Procedure
• Pros
• Complications
• Nursing Responsibilities/Considerations
• General Anesthesia

21
Fetal Response to Labor Intrapartal Fetal
Assessment

• Electric Fetal Monitor ( EFM)
• Purpose
• Factors that Impact Fetal Oxygenation
• 1. Maternal Bld. O2 Saturation
• 2. Normal flow of oxygenated bld. thru the
  Placenta
• 3. Normal Utero-Placental exchange
• 4. Patent umbilical cord vessels (AVA)
• 5. Normal Fetal circulation and oxygen-carrying
  function

22
Types of Intrapartal Fetal Assessments

• 1. Low -Tech Approach
• 2. EFM
• a. Equipment
• 1. External ( Indirect)
• Uses two Transducers Pressure and ultrasound
• 2. Internal (Direct )
• Uses a Fetal Scalp Electrode

23
Evaluating Fetal Monitoring Strips

• Fetal Heart Rate
• Baseline
• Tachycardia
• Causes
• Bradycardia
• Causes
• Variability
• Presence of Periodic Changes
• Accelerations?
• Decelerations?

24
Decelerations/Types Early,Late or Variable

• Early Decelerations
• Characteristics
• Pattern
• Cause
• Rx

• Late
• Decelerations
• Characteristics
• Pattern
• Cause
• Rx

25
Variable Decelerations

• Characteristics
• Pattern
• Cause
• Treatment
• AN OMINOUS SIGN-
• LATE DECELERATION and DECREASED VARIABILITY OF
  FETAL HEART RATE!!!!

26
Significance of Fetal Heart PatternsReasssuring
vs. Non-Reassuring

• Reassuring Patterns of FHR
• 1. Show signs of fetal well being
• 2. Fetus is compensating
• Non-Reassuring Patterns of FHR
• 1. Associated with Hypoxia and Acidosis
• 2. Suggest some level of Fetal
  compromise !

27
THE END

• GOOD LUCK To All Of YOU !!!!!