Labor and Delivery Overview

True vs. False Labor

• True labor involves regular, painful contractions increasing in intensity and resulting in cervical dilation.
• False labor, Braxton Hicks, involves irregular, often painless contractions that do not lead to cervical changes.

When to Go to the Hospital for Labor

• First-time mothers (Primiparous): Go to the hospital when contractions are 5 minutes apart for 1 hour.
• Multiparous mothers: Go to the hospital when contractions are 10 minutes apart for 1 hour.
• Hospitalization is also recommended if vaginal bleeding occurs, water breaks, or changes in fetal movement are noted.

Station 0, +1, +2

• Station 0: The baby's head is at the ischial spines (engaged).
• Station +1 or +2: Indicates the baby is descending further down the birth canal, moving closer to delivery.
• The ischial spines serve as a reference point to track the baby's descent.

Ischial Spine (Station 0)

• Ischial spines are a reference point for assessing the baby's descent in labor.
• Station 0 means the baby's head is aligned with the ischial spines, indicating engagement.
• Positive numbers (+1, +2) indicate further descent; negative numbers (-1, -2) signify the baby's head is above the spines.

Betamethasone Use

• Betamethasone is a steroid administered to pregnant women at risk of early delivery to help the baby's lungs develop faster.
• It's typically given between 24 and 34 weeks of pregnancy.
• The goal is to reduce the risk of breathing problems and other complications in preterm babies.

VEAL CHOP and Interventions

• VEAL CHOP is a mnemonic to remember fetal heart rate patterns and their causes:
  • V: Variable decelerations - Cord compression
  • E: Early decelerations - Head compression
  • A: Accelerations - Okay (normal)
  • L: Late decelerations - Placental insufficiency.
• Interventions vary based on the fetal heart rate pattern identified.

Meconium-Stained Fluid

• Meconium-stained fluid occurs when the fetus passes stool into the amniotic fluid.
• This can indicate fetal distress and increase the risk of respiratory issues if aspirated.

Stages of Labor

• First stage: Cervical dilation from 0-10cm (latent, active, transition phases).
• Second stage: Delivery of the baby.
• Third stage: Delivery of the placenta.
• Fourth stage: Immediate postpartum recovery.

Interventions for Hypovolemic Shock or Postpartum Hemorrhage

• Massaging the uterus to reduce bleeding.
• Administering uterotonic medications.
• Providing IV fluids.
• Monitoring vital signs and oxygen levels closely.

Late Signs of Hemorrhage

• Late signs of hemorrhage (24-6 weeks postpartum) include signs of shock:
  • Pale skin,
  • Clammy skin,
  • Rapid breathing,
  • Weak, fast pulse.
• Thirst, and pink then turns red bleeding indicating increased risk.

Placenta Previa

• Placenta previa involves the placenta covering part or all of the cervix.
• It presents with painless, bright red vaginal bleeding.

Cervical Ripening Agents

• Prostaglandins help soften the cervix and prepare it for dilation.
• Examples: Dinoprostone (Cervidil, Prepidil) and Misoprostol (Cytotec).

Preterm Labor Interventions

• Activity limitations, such as bed rest, may reduce the risk of preterm labor.

Thrombophlebitis Signs and Symptoms

• Thrombophlebitis symptoms include pain, tenderness, swelling, redness, and warmth over the affected vein, and a possible Homan's sign (calf pain upon dorsiflexion).

Mastitis and Nursing Care

• Mastitis is an infection of the breast tissue.
• Nursing care includes ensuring the breast is emptied, applying warm compresses, and managing pain and inflammation.

Standard Care When Weaning from Breastfeeding

• Gradual weaning is recommended to prevent engorgement and mastitis.
• Mothers should slowly reduce breastfeeding sessions and introduce formula or other foods.

Postpartum Hemorrhage Assessment

• Monitor for signs such as excessive bleeding, decreased blood pressure, and increased heart rate.
• Interventions include fundal massage (uterus massage) and uterotonic drugs.

Soft Uterine Fundus

• A soft or boggy uterine fundus indicates uterine atony (failure of the uterus to contract appropriately after childbirth leading to postpartum hemorrhage).
• Massage is indicated to firm up the uterus.

Uterine Atony

• Uterine atony is the failure of the uterus to contract, resulting in postpartum hemorrhage.
• It's treated with fundal massage and medications like oxytocin. - Causes include overdistention, retained placental fragments, prolonged labor or drug use (relaxes the uterus).

Nursing Care Immediately After Birth

• Monitor for hemorrhage
• Vital signs, skin color, uterine fundus firmness, lochia, and pain.
• Comfort measures (e.g., warmth, ice packs).

Identifying the Baby

• Ensure the mother's and baby's identification bands match to prevent mix-ups.

Caloric Intake During Lactation

• Lactating mothers need an additional 500 calories per day to support milk production.

Immediate Newborn Care

• Establish an airway.
• Maintain thermoregulation to prevent hypothermia (Think ABCs - Airway, Breathing, Circulation).

VBAC (Vaginal Birth After Cesarean) Concerns

• After a cesarean, vaginal birth presents risk of uterine rupture.
• Careful monitoring is critical.

Apgar Score

• Apgar score assesses a newborn's health at 1 and 5 minutes post-birth (heart rate, respiration, muscle tone, reflex, and skin color).
• Scores of 7-10 are considered normal; 4-6 are low; 3 or below is critical.

Signs of Hypoglycemia in Newborns

• Symptoms of hypoglycemia in newborns include jitteriness, poor muscle tone, sweating, respiratory difficulty, low temperature, poor suck, and high-pitched cry.
• Tachycardia is an early sign.

Baby Blues, Postpartum Depression, Postpartum Psychosis

• Baby blues are mild mood swings, sadness, anxiety, or overwhelm resolving within a few weeks.
• Postpartum depression involves severe mood swings, difficulty bonding with the baby, and thoughts of harm, lasting longer than a few weeks.
• Postpartum psychosis is a rare, severe condition involving hallucinations, delusions, and thoughts of harm.

Ensuring Baby Is Getting Enough to Eat

• Monitor for urination (6-8 wet diapers/day) and stools.
• Assess baby's happiness.

Preventing Thrombophlebitis

• Encourage early ambulation.
• Use compression stockings or devices.
• Ensure proper hydration.
• Use prophylactic anticoagulant medication where appropriate.

Types of Formula Preparations

• Ready-to-feed formula.
• Concentrated liquid formula.
• Powdered formula.

Childbirth Pain

• Childbirth pain is unique because it involves rhythmic contractions for a specific purpose (delivering the baby).

Stimulating Contractions

• Contractions can be stimulated by various methods, including walking, sitting up, nipple stimulation, or administering synthetic oxytocin.

Increased Contractions During Breastfeeding

• Breastfeeding stimulates oxytocin release, causing uterine contractions and helping the uterus return to its pre-pregnancy size.

Epidural Side Effects

• Epidural side effects include urinary retention and hypotension (low blood pressure).

Meconium-Stained Fluid and Prolapsed Cord

• Meconium-stained amniotic fluid can indicate fetal distress.
• Prolapsed cord requires immediate action to relieve pressure on the cord.

Rubella Vaccine (MMR)

• The MMR vaccine is given postpartum to non-immune women, but not during pregnancy to avoid fetal risk.