I.

INTRODUCTION

Normal spontaneous vaginal delivery refers to the delivery of a baby through the birth canal. Women will experience contractions which indicate the beginning of labor and the cervix begins to widen (dilated). When the uterus is fully dilated, the baby's head will begin to appear and the baby will come out of the vaginal canal. It is for women who do not have complications such as carrying more than one child or a carrying a baby that shows signs of distress. For vaginal delivery, hospital stay will generally last for up to 48 hours. Recovery from childbirth depends on some circumstances. The patient may experience any of the following:

Vaginal soreness - some women undergo an episiotomy, a surgical cut made by your doctor to enlarge the opening of the vagina. This wound or a natural vaginal tear will be sore after delivery and you may ice the area to relieve some discomfort.

Vaginal discharge - a discharge called lochia will occur for up to eight weeks after delivery. Sanitary pads are recommended for discharge as opposed to tampons to reduce the likelihood of infection.

Hemorrhoids - hemorrhoids are stretched and swollen veins around the anus that are common after childbirth. To relieve discomfort associated with hemorrhoids, you may soak in a warm bath or apply hazel pads to the affected area. You should eat a high-fiber nutritious diet as well.

Sore breasts - after delivery your breasts will become sore and enlarged. This is due to your breasts expressing milk for your baby.

Difficulty urinating - the tissues around the urethra and bladder may be swollen after delivery and may cause you to have difficulty urinating. Contracting and releasing the pelvic muscles can help as well as applying hot or cold packs to the area.

Woman may return to normal activities such as exercise as soon as possible to gain strength after delivery. Depending on her body, this may be two to four weeks after delivery. Start slow and gradually increase your level of activity. Avoid strenuous
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activities such as running at first. The client should wait about four to six weeks before having sexual intercourse to reduce the risk of infection and bleeding. Vaginal delivery is a natural process that usually does not require significant medical intervention. Management guided by current knowledge of the relevant screening tests and normal labor process can greatly increases the probability of an uncomplicated delivery and postpartum course. All women should be screened for group B streptococcus; women who test positive should be treated with antibiotics during labor. Routine human immunodeficiency virus screening of all pregnant women, and treatment with antiretroviral medication for those who test positive, can reduce perinatal transmission of the infection. Once a woman is in labor, management should focus on the goal of delivering a healthy newborn while minimizing discomfort and complications for the mother. In a patient who tests negative for group B streptococcus, delaying admission to the labor ward until she is in active labor decreases the number of possible medical interventions during labor and delivery. Once a patient has been admitted to the hospital, providing her with continuous emotional support can improve delivery outcomes and the birthing experience. Epidural analgesia is effective for pain control and should not be discontinued late in labor to reduce the need for operative vaginal delivery. Epidurals prolong labor, but do not increase the risk of cesarean delivery. Research has shown that labor may not progress as rapidly as historically reported; this should be considered before intervening for dystocia. Routine episiotomy increases morbidity and should be abandoned. Once the infant has been delivered, active management of the third stage of labor decreases the risk of postpartum hemorrhage. Spontaneous vaginal delivery at term has long been considered the preferred outcome for pregnancy. Because of the perceived health, economic, and societal benefits derived from vaginal deliveries, lowering the cesarean delivery rate has been a goal in the United States for more than 25 years. Although some experts now support elective primary cesarean delivery, and although the percentage of operative deliveries has increased from 21 percent in 1996 to 30 percent in 2005, most women still deliver vaginally. In 2003, nearly 3 million vaginal deliveries occurred in the United States. There were 584,100 deliveries reported to the Office for National Statistics (ONS) through the Birth Registration system as occurring in NHS hospitals in England in 2004-05. Women whose
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delivery is without such intervention may be defined as having had a normal delivery this occurred in about 48% of all NHS deliveries in England in 2004-05. In a study, 7,565 women admitted for labor and delivery in two free-standing charity birth centers established in the Philippines. The births occurred between February 8, 1996, and December 31, 2003. Midwives conducted all of the deliveries that occurred in the birth centers. The midwives were certified professional midwives (CPM) or licensed midwives (LM) from the USA, Canada and the Philippines. They supervised student midwives enrolled in the Mercy In Action College of Midwifery & Primary Health Care and dual-enrolled in the National College of Midwifery's Associate of Science in Midwifery program. These students were from all around the world. The birthing women were at higher than average risk of a poor pregnancy outcome because of demographic factors: most were poor, often malnourished and living in crowded urban slum conditions. Ninety-two percent of the women and 34% of their spouses were unemployed, and only a little over half were married. In spite of the poverty, 95% of the women had spontaneous vaginal birth; 83% had blood loss less than 500 ml; 85% of the babies required no resuscitation effort; 67% of the labors were without fetal distress or meconium staining; and 90% of the babies were of normal birth weight. Transfers to a hospital after admission occurred 7% of the time, with half taking place before delivery and half after delivery. Neonatal mortality was 4.1 per 1000. Our group adapted this case not only because we had no choice but also because we wanted to know about the real nature of NSD and its current trends and updates about it. Moreover, we would like to know about the most basic techniques on how to manage problems that may occur during this process.

Objectives Nurse-Centered: General: To broaden our knowledge about labor and delivery.

Specific: Establish therapeutic relationship with the client and their significant others. Gain new skills and apply them to the patient. Provide supportive, protective and comfort measure to the patient. Work cooperatively with other health care personnel who are involved with patient treatment. Evaluate all the nursing intervention that has been established and outcome of the patient condition. Client-centered: General: To meet the optimum health needs of the patient.

Specific: Encourage cooperation to the health process. Show signs of wellness after nursing management that was done and given for her condition. Maintain safety and client privacy. Minimize signs of complications in pregnancy.

II.

NURSING PROCESS

A) ASSESSMENT 1) Personal Data a) Demographic Data Name Age Sex Civil status Occupation Position in the Family Address Date of Birth Nationality Chief Complaint Admitting diagnosis Final Diagnosis Date and Time of Admission Date and Time of Delivery b) Environmental Status Mrs. Parturient lives in Concepcion, Tarlac. Their house is made up of concrete materials with two bedrooms, living room and kitchen. There is presence of rats, some insects and house pets. There is also presence of dust. : Mrs. Parturient : 29 y/o : Female : Married : Spa Therapist : Mother : Concepcion,Tarlac : August 1980 : Filipino : Labor Pains : G3P2 PUFT IL : G3P3 NSD an alive baby boy : February 03, 2010/07:20 am : February 03, 2010/08:25 am

She is living in a community that is free from noise. Many trees are planted around their house. As their mode of transportation, they use tricycles, jeepneys and even buses to go to other places. They have their own electric and water supplies. Drainage system is closed. Church, school, stores and health center are all available in their community. c) Lifestyle Mrs. Parturient wakes up every morning at 7 am. She always drinks a glass of milk and eats her breakfast. She is fond of watching TV, reading pocketbooks and magazines. Seldom, she talks with her neighbors. She eats her lunch at 12 noon. She also takes a nap in the afternoon. At 6 pm, she eats her dinner with her family. According to her, she does not smoke but sometimes she drinks liquor. She is taking her vitamin supplements such as Folic Acid, Ascorbic Acid and Ferrous Sulfate regularly as prescribed by her OB-Gynecologist.