Hs1088: Nursing of Childbearing Family and Children

Group Members: Hong Jiao Nanthini Syazman Fang Si Xuan Jia

Objectives
Define the common terms used in pregnancy cases. Define normal labor. Explain the signs of true labor and relate it to the case study. Explain the difference between the true and false labor. Describe the nursing interventions to manage labor pain in the first stage of labor.

Case scenario
Natalie is a 28 year old primigravida at 39 weeks of gestation. Reported experiencing her first labor pain 8 hours ago. Felt the labor pain is more painful and occurring more frequently at every 10 minutes interval. Has slight blood-stained vaginal discharge with mucus, an hour ago.

 Regular uterine contractions every 10 minutes lasting 30 seconds. Show with intact membranes. Cervix dilated to 4 cm Foetal heart rate: 140/minute Maternal vital signs:
o o o o Temperature: 36.8C Pulse rate: 86/minute Respiratory rate: 20/min Blood pressure: 130/80mmHg

Physical Examination

Breast soft with slight colostrum discharge Bladder not palpable

Definition
Gestation: The period of development in the uterus from conception until birth.

Gravida: A womans status regarding pregnancy usually followed by the number of times the woman has been pregnant.

Definition
Primigravida: A woman in her first pregnancy Para: A woman who has produced one or more viable offspring, regardless of whether the child or children were living at birth.

Definition
Primipara: A woman who has had one pregnancy that resulted in a fetus that attained a gestational age of 20 weeks, regardless of whether the infant was living

Normal Labor
Normal labour at term is characterised by regular, rhythmic, progressive uterine contractions that produce effacement and dilation of the cervix Where the estimated gestational age is accurate, it is expected that labour will begin within two weeks of the estimated date of delivery

Signs of true labour

After each contraction ,heart rate of fetus ranges from 110160 beats/min Signs of show(operculum)-a blood stained mucos plug at cervix.

As a sign of cervix dilating more painful and frequent contraction ,lasting about 10 to 30 sec.

Contractions takes place every 10-20 minutes

Signs of true labor

Burst of water bag Might have drops of water discharging. Cervix dilating from 1cm to about 6-10 cm.

Signs of true labor

Lightening- The baby settling or lowering into the pelvis just before labor.

feel the need to urinate more frequently - uterus rests on the bladder more after lightening.

Contraction False Labor Characteristics How often do the Contractions are contractions occur? often irregular and do not get closer together.

True Labor Contractions come at regular intervals and last about 30-70 seconds. As time progresses, they get closer together.

Do they change with movement?

Contractions may stop when you walk or rest, or may even stop if you change positions. How strong are Contractions are they? usually weak and do not get much stronger. Or they may be strong at first and then get weaker. Where do you feel Contractions are the pain? usually only felt in the front of the abdomen or pelvic

Contractions continue despite movement or changing positions.

Contractions steadily increase in strength.

Contractions usually start in the lower back and move to the front of the abdomen.

In case study
labor pain is more painful; more frequently at every 10min interval Lasting about 30sec. Slight blood stained vaginal discharge with mucos. Cervix dilated to 4cm . Foetal heart rate 140 beats/minute Regular uterine contractions occurring every 10 minutes lasting 30 seconds

Labor pain
Definition: rhythmic uterine contractions that under normal conditions increase in intensity, frequency, and duration, culminating in vaginal delivery of the infant.

Many physiologic , emotional, psychosocial, and environmental factors influence the nature and degree of pain experienced by the laboring woman.

Labor pain
Visceral pain : the pain from cervical changes ,distention of the lower uterine segment ,stretching of cervical tissue as it dilates ,and pressure on adjacent structures and nerves during the first stage of labor. It is located over the lower portion of the abdomen

first stage: beginning with the onset of uterine contractions through the period of dilation of the uterus. second stage: the period of expulsive effort, beginning with complete dilation of the cervix and ending with expulsion of the infant. third stage or placental stage: the period beginning at the expulsion of the infant and ending with the completed expulsion of the placenta and membranes.

Labor

First stage of labor

Can be divided in to three 3 phases : A latent stage: cervix dilates from 0 to 3 or 4 centimeters, contractions get stronger as time progresses

An active stage: cervix dilates from 4 to 8 centimeters (called the Active Phase), contractions get stronger and are about 3 minutes apart, lasting about 45 seconds.

First stage of labor

A transition stage : cervix dilates from 8 to 10 centimeters (called the Transition Phase), contractions are 2 to 3 minutes apart and last about 1 minute. You may feel pressure on your rectum and your backache may feel worse. Bleeding from your vagina will be heavier.

Pain relief method

Environment Non- pharmacological strategies

Cognitive strategies
Pharmacological strategies

environment
a. Should be safe and private ,allowing a woman to feel free to be herself as she tries out different comfort measures .
b. Appropriate light and temperature and no noise. c. The environment should have enough space for movement

environment
a. Should have equipment such as birth balls, comfortable chairs b. Enhance the familiarity of the environment by bring items from home (pillows, objects for a focal point music, and DVDs.

Nonpharmacologic strategies:
I. II. Cutaneous stimulation strategies Sensory stimulation strategies

III. Cognitive strategies

Cutaneous stimulation strategies

Counterpressure Effleurage (light massage)

Walking
Rocking Changing positions

Cutaneous stimulation strategies

Transcutaneous electrical nerve stimulation Acupressure

Water therapy
Intradermal water block Application of heat and cold

Sensory stimulation strategies

Aromatherapy (fang xiang liao fa ) Breathing techniques Music Imagery Use of focal points (jiao dian )

Cognitive strategies
Hypnosis: hypnosis is a form of deep relaxation, similar to day-dreaming ,while under hypnosis, women are in a state of focused concentration.

Pharmacologic strategies
Sedatives (relieve anxiety and induce sleep.) For first stage : o Systemic analgesia o Opioid agonist analgesics o Opioid agonist-antagonist analgesics o Epidural analgesia o Nitrous oxide o Combined spinal-epidural analgesia

Summary
We define the following terms: gestation, gravida, para, primigravida, primipara. We defined normal labor. We discussed the signs of true labor and related it in case study .

We described the nursing interventions to manage her labor pains in the first stage.

Albers, L., Schiff, M., & Gorwoda, J. G.(1996). The length of active labor in normal pregnancies. Obstetrics and Gynecology, 87(3),355-359. Association of wens Health, Obstetric,&neonatal nurses (AWHONN). (1998). Clinical competencies and education guide . Washington, DC: Author. Creehan, P. A. (1996), Expectant fathers roles during labor . In K. R. Rice & P. A. Creehan (Eds),perinatal nursing (pp. 227-245). Philadelphia: Lippincott. Enkin, M. W ., Keirse, M. J., Renfrew, M. J., &Neilson, J.P. (1995). Effective care in pregnancy and childbirth: A synopsis.Birth, 22(2), 101-110. Hodnett, E.(1996). Nursing support of the laboring woman. Journal of Obstetric, Gynecologic, and Noenatal Nursing, 23(9), 767-771. Reid L; British Journal of Midwifery, 2005 Jul; 13 (7): 426-31 (journal article) ISSN: 0969-4900 Stadlmayr W; Grob A; Journal of Reproductive & Infant Psychology, 2007 Aug; 25 (3): 190-202 (journal article - research, tables/charts) ISSN: 0264-6838

Reference

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