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The laboring

woman

This is Sara going to the Maternity Center


She is 28 years old at 37 weeks
G2

T0

P0

A1

L0

She
She is
is complaining
complaining of:
of:

pain
pain in
in her
her back
back that
that
radiates
radiates to
to the
the front
front of
of her
her
stomach
stomach

occasional
occasional nausea
nausea
when
when she
she saw
saw the
the physician
physician 4
4
days
days ago
ago she
she was
was 1cm,
1cm, soft
soft
membranes
membranes intact
intact
The
The fetus
fetus was
was noted
noted to
to be
be in
in
vertex
vertex position
position by
by Leopolds
Leopolds
maneuvers.
maneuvers.

Assessment
Lightening
Lightening

Contractions
Contractions
Leopolds
Leopolds
Maneuver
Maneuver

Gravida
Gravida
Parity
Parity

Sterile
Sterile
Vaginal
Vaginal
Exam
Exam

Membranes
Membranes

Stages
Stages of
of
Labor
Labor

True
True vs.
vs.
False
False Labor
Labor

True or False?
28 yo 1-0-0-1-0 @ 37 wks.
Symptoms:
pain in her back (radiating to
front of her stomach),
occasional nausea, 1cm, soft
(4 days ago), membranes
intact, and vertex position.

Is Sara in true or false labor?

What is that?
Four maneuvers for diagnosing fetal position by external palpation.

How can we use it?


# of Fetuses
Presenting part, fetal lie, and fetal attitude
Degree of Presenting parts descent into the pelvis
PMI

Leopold Maneuvers?

Leopold Maneuvers
How is it done?

1. Fundal Grip

2. Umbilical
Grip

3. Pawliks
Grip

4. Pelvic
Grip

For Further assessment, the nurse applies


the:

Ultrasound
Transducer
(FHR)

Tocotransducer
(Contractions)

As the nurse applies the monitors the patient


states I feel water running down my legs.

Nursing Assessment

ROM
FHR
Color

Odor
Amount
Viscosity

The nurse determines that


Sara is now

4cm dilated
80% effaced
the fetus is in vertex
position and at +1 station
FHR is noted to be 150
with moderate variability
If the US transducer detects
the FHR best at the PMI, then
why would this one be placed
here?

Psychological response of the mother

Passenger

Passage Way

Powers

Position of mother

Five Essential Factors for Labor

Passenger

Size of the fetal head


Presentation
Lie
Attitude
Position
Station
Engagement

Size of the fetal head

Fetal Presentation

Fetal lie

Fetal Attitude

Fetal Position

Fetal Station

Passageway
bony pelvis and soft tissues
4 types of Bony pelvis [table 16-2, pg.376] - Gynecoid
Android
Anthropoid
Platypelloid
Soft tissues -- lower uterine segment, cervix, pelvic
floor muscles,
vagina, & introitus.
Lower uterine segment -- distends to
accommodate
intrauterine contents
cervix -- thins and opens to allow descent into the
vagina
pelvic floor muscles -- helps rotate the fetus as it
passes
through birth canal
vagina and introitus -- dilate to accommodate the
fetus and permit passage.

Types of Bony Pelvis

Powers
Primary/Secondary

Primaryinvoluntary uterine contractions


Secondaryvoluntary pushing abdominal muscles
No effect on dilation or effacement

Affects adaptation to labor


Relieves fatigue, comfort, circulation
Promotes descent of fetus
effectiveness of contractions =
shorter labor
cardiac output = blood flow
Correctly aligns abdomen for pushing
efforts

Position and role of gravity

Stages/Phases of Labor
Stage 1 - Labor
Latent Phase
Active Phase
Transition Phase
Stage 2 - Baby
Stage 3 - Placenta
Stage 4 - Recovery

Stage 1 - Labor

4-7cm

1-3cm

8-10cm

Normal Labor Curve

Nursing Diagnoses During Labor & Birth


4. Fluid volume deficit

1. Anxiety

6. Pain

2. Knowledge Deficit

7. Loss of self control

8. Impaired Gas Exchange

3. Infection

5. Altered Urinary Status

Stage 2 -- Baby

Stage 2 -- Pushing
During a vaginal
exam, the nurse
determines that the
patient is
Complete.
She instructs the
patient to push
effectively with each
contraction.
The patients spouse

Cardinal Movements of Labor


Extension
Extension
Engagement
Engagement
Descent
Descent
Flexion
Flexion

Internal
Internal
rotation
rotation

External
External
rotation
rotation
(restitution)
(restitution)

Expulsion
Expulsion

Case Example
During the next
nursing
assessment the
patient appears
tense,
irritable and
pushes her
spouse away
from the bed.

She tells
the nurse I
want this baby
out NOW! I am
going to
PUSH!!!

What nursing action would prevent injury in this circumstance?

Nursing Assessment

Period of Relaxation

Waves

Increment

Frequency

Acme

Duration

Decrement

Intensity

Assessment of Uterine Contractions

Stage 2 - Baby

5minVaginalDelivery (1).wmv

Stage 3 -- Placenta

Stage 3
Lengthening cord
Vaginal

fullness

Sudden gush of blood


Uterine shape

changes from
oval to globular

Rise of uterus above the symphysis pubis

Stage 3

Stage 4 -- Recovery

Close observation for:

uterine

hemorrhage

atony

Stage 4
urinary retention

Psychological Response

How can a mothers response to


labor effect her labor progress?

Maternal Psychological changes

Questions?

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