Birth-Related Procedures

• Birth-related procedures include interventions and assessments during labor, delivery, and the immediate postpartum period.
• These procedures maintain the safety and well-being of both mother and newborn.

Amniotomy

• Amniotomy, or artificial rupture of membranes (AROM), induces or accelerates labor.
• A sterile hook or similar instrument is used.
• Amniotomy is indicated when the cervix is ripe to induce labor, to augment slow labor, and to allow internal fetal monitoring.
• Risks include infection, prolapsed umbilical cord, and fetal injury.
• Nursing considerations include assessing fetal heart rate before and after the procedure, monitoring the color, odor, and amount of amniotic fluid, and documenting the time of rupture.

External Cephalic Version (ECV)

• ECV turns a breech baby to a head-down position before labor.
• It involves applying external pressure to the mother's abdomen.
• ECV is typically performed after 36 weeks of gestation.
• Contraindications include placenta previa, uterine abnormalities, multiple gestations, and non-reassuring fetal status.
• Maternal vital signs and fetal heart rate should be monitored before, during, and after ECV.
• Rh-negative mothers need Rho(D) immune globulin (RhoGAM).

Induction of Labor

• Induction of labor artificially stimulates the uterus to begin labor.
• Indications include post-term pregnancy, preeclampsia, gestational diabetes, and intrauterine growth restriction (IUGR).
• Cervical ripening uses medications like prostaglandins or mechanical methods like a Foley catheter.
• Oxytocin (Pitocin) is administered intravenously to stimulate uterine contractions.
• Risks include uterine hyperstimulation, fetal distress, and failed induction requiring cesarean birth.
• Nursing considerations include monitoring maternal vital signs, fetal heart rate, and contraction patterns.

Episiotomy and Laceration Repair

• Episiotomy is a surgical incision in the perineum to enlarge the vaginal opening.
• Lacerations are spontaneous tears in the perineum during childbirth.
• First-degree episiotomies involve the perineal skin and vaginal mucosa.
• Second-degree episiotomies extend into the perineal muscles.
• Third-degree episiotomies extend into the anal sphincter muscle.
• Fourth-degree episiotomies extend through the anal sphincter muscle and into the rectal mucosa.
• Nursing care includes assessing the perineum for infection, hematoma, and edema.
• Pain relief measures include ice packs, sitz baths, and analgesics.
• Perineal hygiene should be encouraged to prevent infection.

Forceps and Vacuum-Assisted Delivery

• Forceps and vacuum-assisted deliveries are operative vaginal deliveries that assist birth when labor is prolonged or pushing is ineffective.
• Forceps are metal instruments with curved blades applied to the fetal head.
• A vacuum extractor uses suction to attach to the fetal head.
• Indications include fetal distress, maternal exhaustion, and a prolonged second stage of labor.
• Maternal risks include perineal trauma, hemorrhage, and infection.
• Newborn risks include scalp lacerations, cephalohematoma, and intracranial hemorrhage.
• Nursing considerations include monitoring maternal vital signs and fetal heart rate, and assessing the newborn for trauma.

Cesarean Birth

• Cesarean birth is the surgical delivery of a baby through incisions in the abdomen and uterus.
• Indications include fetal distress, breech presentation, placenta previa, and previous cesarean birth.
• A low transverse incision is a horizontal incision across the lower uterine segment and is most common.
• A classical incision is a vertical incision in the upper uterine segment and is rarely used.
• Preoperative teaching includes explaining the procedure, risks, and expected recovery.
• Intraoperative care involves monitoring maternal vital signs and fetal heart rate.
• Postoperative care includes providing pain relief, monitoring for complications, and promoting bonding.

Postpartum Hemorrhage Management

• Postpartum hemorrhage (PPH) is excessive bleeding after childbirth.
• PPH is a leading cause of maternal mortality worldwide.
• Causes include uterine atony, retained placental fragments, lacerations, and coagulation disorders.
• Nursing interventions include assessing the amount and nature of bleeding.
• Uterine massage promotes contraction.
• Uterotonic medications like oxytocin, misoprostol, and methylergonovine are administered.
• Vital signs and oxygen saturation are monitored.
• A Foley catheter is inserted to keep the bladder empty.
• Preparation for possible blood transfusion or surgical intervention is needed.

Newborn Resuscitation

• Newborn resuscitation assists newborns not breathing or with a low heart rate at birth.
• Provide warmth by drying the newborn under a radiant warmer.
• Clear the airway by suctioning the mouth and the nose.
• Stimulate breathing by tapping or rubbing the newborn's back or feet.
• Administer supplemental oxygen if needed.
• Chest compressions are performed if the heart rate is below 60 bpm.
• Administer epinephrine if the heart rate remains low, despite other interventions.
• Monitoring the newborn's vital signs and oxygen saturation is crucial.
• Document all interventions performed.
• Provide emotional support to the parents.

Pain Management During Labor and Delivery

• Pain management involves both non-pharmacological and pharmacological methods.
• Non-pharmacological methods include breathing techniques like slow, deep breathing.
• Relaxation techniques include progressive muscle relaxation and visualization.
• Massage includes counterpressure on the lower back.
• Hydrotherapy includes warm showers or baths.
• Position changes encourage the woman to find comfortable positions.
• Pharmacological methods include epidural anesthesia via injection into the epidural space.
• Spinal anesthesia uses injection into the spinal fluid.
• Systemic analgesics include opioid medications administered intravenously or intramuscularly.
• Assess the woman's pain level and response to interventions.
• Provide education about pain management options.
• Monitor for medication side effects.

Fetal Heart Rate Monitoring

• Fetal heart rate (FHR) monitoring assesses fetal well-being during labor.
• Intermittent auscultation uses a Doppler or fetoscope at regular intervals.
• Continuous electronic fetal monitoring (EFM) uses external transducers or internal fetal scalp electrodes.
• Baseline FHR is the average FHR over 10 minutes, excluding accelerations, decelerations, and marked variability.
• Variability is fluctuations in the FHR baseline.
• Accelerations are abrupt increases in the FHR above the baseline.
• Decelerations are decreases in the FHR below the baseline.
• Early decelerations mirror uterine contractions and are usually benign.
• Late decelerations begin after the peak of the uterine contraction and may indicate distress.
• Variable decelerations vary in timing and shape and may indicate umbilical cord compression.
• Interpreting FHR patterns and identifying signs of fetal distress is vital.
• Interventions to improve fetal oxygenation include repositioning the mother, administering oxygen, and increasing intravenous fluids.
• Communicating FHR patterns and interventions to the healthcare provider is important.

Overview of birth-related procedures including amniotomy and external cephalic version (ECV). Amniotomy involves artificial rupture of membranes to induce or accelerate labor. ECV turns a breech baby to a head-down position before labor using external pressure.