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Questions and Answers
What marks the beginning of the first stage of labor?
During the latent phase of the first stage of labor, how much dilation typically occurs?
Which of the following is a characteristic of the active phase of the first stage of labor?
What is identified when the fetal presenting part is at the level of the ischial spines?
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Which nursing action is fundamental when a mother is admitted to the hospital during labor?
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What relationship does 'presentation' refer to during the assessment of labor?
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Which of the following types of presentation is indicated by the vertex of the fetus being the presenting part?
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Which phase of the first stage of labor represents the mother's increased fear of losing control?
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What is a sure sign that the baby is about to be born?
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At what cervical dilation is a primigravida typically transported to the delivery room?
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What characterizes the transition period during labor?
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What is the primary purpose of amniotomy during labor?
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What nursing action can relieve discomfort during contractions?
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During the second stage of labor, what is considered the important focus?
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What emotional response is commonly observed during the transition period?
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How long does it generally take for a primigravida to deliver after the transition period?
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What is the purpose of the Brandt-Andrews maneuver during placental delivery?
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What should be the maximum time frame for delivering the placenta after the baby?
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Which nursing action is the first if the uterus is found to be boggy or non-contracted?
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What can help contract the uterus in addition to manual massage?
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Which degree of laceration involves the muscles, vaginal mucous membranes, and skin, as well as the external sphincter of the rectum?
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Why are oxytocins not administered before placental delivery?
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What is the primary purpose of packing in vaginal episiorrhaphy?
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What should be done first to facilitate drainage of secretions in an infant?
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Which category of laceration involves only the vaginal mucous membranes and skin?
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Why is it important to postpone cutting the umbilical cord until pulsations have stopped?
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What is indicated by Calkin’s sign during placental separation?
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Which type of placental separation presents the maternal surface and appears 'dirty'?
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What should not be done to hasten placental expulsion?
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Which sign indicates that the placenta is separating?
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What is a crucial reason for wrapping the infant in a sterile diaper?
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What should a nurse be careful about during the third stage of labor?
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What is the recommended position for a newly-delivered mother to prevent dizziness?
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How often should the fundus be assessed during the first hour postpartum?
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What indicates a full bladder during postpartum assessment?
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What is the purpose of administering lactation-suppressing agents postpartum?
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Which of the following is true regarding lochia immediately after delivery?
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What is the main concern during the first 1-2 hours after delivery?
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What common condition may cause a newly-delivered mother to complain of chills?
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What is the expected physical condition of the perineum immediately postpartum?
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Study Notes
Infant Care After Delivery
- Head-down position: When the infant is held, ensuring the head is lower than the rest of the body should be prioritized to allow for drainage of secretions.
- Crying: Never stimulate a baby to cry without ensuring secretions are drained first.
- Sterile Diaper: Wrap the baby in a sterile diaper for warmth, as chilling increases the body's oxygen demand.
- Maternal Abdomen: Place the infant on the mother's abdomen as the baby’s weight will aid in uterine contraction.
- Cord Cutting: Postpone cutting the cord until pulsations cease due to the significant blood flow from the placenta to the baby (around 50-100 ml). Then, clamp the cord twice, an inch apart, and cut in between.
- Presenting the Baby: Show the baby to the mother, inform her of the sex and time of delivery, and then transfer the baby to the circulating nurse.
Third Stage (Placental Stage)
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Signs of Placental Separation:
- Calkin's Sign: The uterus becomes firm and rises to the level of the umbilicus, signifying the earliest sign of placental separation.
- Sudden Blood Gush: A sudden surge of vaginal blood.
- Cord Lengthening: The umbilical cord extends from the vagina.
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Placental Delivery Types:
- Schultz: 80% of placentas separate with the fetal surface facing outwards, appearing shiny.
- Duncan: 20% of placentas separate with the maternal surface facing outwards, showcasing a raw, red, irregular surface.
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Nursing Care:
- Don't Force Placenta: Avoid forceful pulling of the cord or fundal push to prevent uterine inversion.
- Brandt-Andrews Maneuver: Slowly tract the cord, winding it around the clamp until the placenta detaches naturally.
- Placental Time: The placenta should be delivered within 20 minutes after the baby’s birth. If it takes longer, inform the doctor immediately.
- Complete Cotyledons: Thoroughly inspect the placenta to ensure all parts are present, as fragments left can cause bleeding and even death.
- Uterine Contraction: Palpate the uterus to assess its contraction level. If it's relaxed, massage gently and properly. Apply an ice cap to the abdomen, as cold causes vasoconstriction, aiding uterine contraction.
- Oxytocin Injection: Post-placental delivery, administer oxytocin (Methergin or Syntocinon) IM to maintain uterine contractions and prevent hemorrhage. Never administer before placental delivery to avoid placental entrapment.
Lacerations
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Classification:
- First Degree: Involves the vaginal mucous membranes and skin.
- Second Degree: Extends beyond the vaginal mucous membranes and skin, involving the muscles.
- Third Degree: Damages the muscles, vaginal mucous membranes, and skin, including the external sphincter of the rectum.
- Fourth Degree: Includes third-degree damage, plus the mucous membranes of the rectum.
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Episiorrhaphy: Assist the doctor in repairing episiotomy or lacerations.
First Stage of Labor (Stage of Dilatation)
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Labor Pains: Begins with the onset of true labor pains and lasts until the cervix fully dilates.
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Power/Forces: Involuntary uterine contractions drive the process.
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Phases:
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Latent: Early stage characterized by:
- Minimal cervical dilatation as effacement occurs.
- Dilatation of 3-4cm only.
- Short-duration contractions occurring every 5-10 minutes.
- The mother is excited, possibly apprehensive, and can still communicate.
- Lasts for about 8 hours of the 12-hour first stage.
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Active/Accelerated: This phase features:
- Cervical dilatation reaches 4-8cm.
- Rapid increase in contraction duration, frequency, and intensity.
- The mother may feel overwhelmed.
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Latent: Early stage characterized by:
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Nursing Care:
- Hospital Admission: Provide privacy and reassurance from the start.
- Obstetrical Assessment: Gather personal data, determine the estimated delivery date (EDC), assess the obstetrical score, the nature and amount of show, and whether the membranes have ruptured.
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Physical Examination: Perform general physical examination, including internal exam and Leopold's maneuvers to assess:
- Effacement and dilatation.
- Station: The fetal presenting part's position relative to the ischial spines.
- Station 0: Presenting part at the level of the ischial spines, signifying engagement.
- Station -1: Presenting part above the level of the ischial spines.
- Station +1: Presenting part below the level of the ischial spines.
- Station +3 or +4: Marks crowning, the largest diameter of the fetal head is encompassed by the vulvar ring.
- Presentation: Fetal position relative to the mother's body (also known as lie).
- Presenting Part: The fetal part entering the pelvis first, covering the internal os.
Presentation Types
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Vertical:
- Cephalic: The head is the presenting part.
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Management of Cephalic Presentation Challenges:
- Fetal Bradycardia: Turn the mother to the side, elevate her legs, and administer vasopressors and oxygen as ordered.
- Decreased Maternal Respirations: Turn the mother to the side, elevate her legs, and administer vasopressors and oxygen as ordered.
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A Sure Sign of Impending Birth is the bulging of the perineum.
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Transport Times: Primigravidas are typically transported from the Labor Room (LR) to the Delivery Room (DR) upon full cervical dilatation or when the perineum bulges; multiparous women are transported at 7-8 cm cervical dilatation.
Transition Period
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Characteristics:
- Ruptured Membranes: When the membranes are still intact, a sudden gush of amniotic fluid marks this period as the fetus is pushed into the birth canal. If spontaneous rupture doesn't occur, amniotomy (controlled puncture of the amniotic sac) is done to allow amniotic fluid drainage, preventing fetal aspiration. Amniotomy is contraindicated if the presenting part is still "minus," as it can lead to cord compression.
- Prominent Show: Show becomes more noticeable.
- Urge to Push: There's an uncontrollable urge to push with contractions, signaling the imminent start of the second stage of labor.
- Physical Reactions: Profuse perspiration, distended neck veins, nausea, and vomiting are observed.
- Delivery Timeline: Primis typically deliver within 20 contractions (40 minutes), while multis deliver within 10 contractions (20 minutes).
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Nursing Actions:
- Comfort Measures: Provide comfort through measures such as sacral pressure, proper breathing techniques, and emotional support.
Second Stage (Stage of Expulsion)
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Complete Dilatation: Begins with full cervical dilatation, ending when the baby is born.
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Note: Vaginal packs need to be removed after 24-48 hours.
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Nursing Care:
- Perineal Care: Ensure comfort through perineal care using a clean sanitary napkin applied snugly.
- Postpartum Bed Position: Place the mother flat on the bed without pillows to prevent dizziness due to decreased intra-abdominal pressure.
- Chills Management: Provide extra blankets to combat chills, which may result from the sudden pressure drop, fatigue, or cool delivery room temperature.
- Initial Nourishment: Offer milk, coffee, or tea, as the mother's energy stores will be depleted.
- Allow Sleep: Facilitate a peaceful sleep experience for the mother to regain lost energy.
Fourth Stage
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Critical Stage: The first 1-2 hours after delivery are considered the most critical for the mother due to unstable vital signs.
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Assessment:
- Fundus: Monitor every 15 minutes for the first hour, then every 30 minutes for the next 4 hours. The fundus should be firm, located in the midline, and slightly above the umbilicus during the first 12 hours postpartum. If the uterus is not contracted, massage it gently is the first nursing action.
- Lochia: Lochia should be moderate in amount. If a perineal pad is fully saturated after 30 minutes, this is an immediate concern.
- Bladder: A distended bladder is indicated by the fundus shifting right of the midline, dark red bleeding with clots.
- Perineum: Expect tenderness, discoloration, and edema. Ensure the area is clean and sutures are intact.
- Blood Pressure and Pulse Rate: May be slightly elevated initially due to excitement and delivery efforts but should normalize within an hour.
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Lactation Suppression: Estrogen-androgen preparation is given within the first few postpartum hours to prevent breast milk production in mothers who won't or can't breastfeed. These drugs have the unintended effect of increased uterine bleeding and delayed menstrual return.
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Rooming-In Concept: Mother and baby stay together in the hospital. This fosters early family bonding by giving parents constant access to their newborn, facilitating positive parent-child relationships.
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Description
Test your knowledge on the essential practices of infant care immediately after delivery. This quiz covers crucial aspects such as the head-down position, managing secretions, and the importance of sterile diapers. Additionally, learn about cord cutting and maternal bonding with the newborn.
