Labor and Delivery Overview

Study Notes

Labor and Delivery and Postpartum

Labor has two phases: Latent (0-5 cm) and Active (6-10 cm).
Labor has four stages: First (0-10 cm), Second (10 cm to delivery of baby), Third (after baby is delivered, includes delivery of placenta), Fourth (after placenta delivery, 4 hours of recovery).
Cervical exams are subjective.
Cervical exam includes dilation (how thin the cervix is, measured in %) and effacement (how thin the cervix feels measured in percentages), and station (position of ischial spine in cm relative to the ischial spine).
Pain management in labor includes pharmacological and nonpharmacological options.
Amniotomy is the artificial rupturing of the membranes.
Spontaneous or artificial methods are used for amniotomy. A sterile plastic hook. shaped like a crochet needle, is used for artificial amniotomy.
Risk of infection increases after the amniotic sac is ruptured.
Second-stage labor is from 10 cm to baby delivery.
Patient-driven vs directed pushing is part of second stage.
Providers involved in labor and delivery include midwives (CNM), MDs, support people, and doulas.
Retained placenta/placental pieces must be watched carefully; this can lead to postpartum hemorrhage.
Postpartum care is from birth to six weeks after birth.
Puerperium is the time of physical changes and adjustment after childbirth.
Important things right after delivery include frequent vital signs, close observations, and fundal checks for bleeding.
Newborns are in a transitional period, first time responsible for oxygen supply.
First two hours after delivery include head-to-toe assessments.
Focus assessment halfway through shift.
Postpartum pieces to include in assessment.
Proper identification of mom and baby is essential. Use numbered bands.
Always check numbers on bands for proper identification when separated.
BUBBLE-HEB is a method to assess mother. Includes episiotomy or lacerations, breasts, uterus, Homan's sign (emotions and bonding), lochia, bladder, and bowel.
Breast assessment considers softness or firmness, milk production, temperature increase, nipple condition (cracking, bruising, bleeding), and treatments.
Uterine assessment involves locating fundus (firm, soft, or boggy; boggy firms with massage), checking for excessive bleeding, and proper technique if boggy (support the lower segment, downward massaging motion).
Bladder assessment should be considered for full bladder, problems with uterine contractions, elevated/deviated uterus. Massage the fundus first and check for bleeding.
Bowel assessment includes constipation, slowed gastric motility, and opioid use. Stools softeners are crucial.
Lochia is vaginal discharge after childbirth. Lochia rubra is scant, light, moderate, or heavy.
Episiotomy or laceration include the degrees of the tear in vagina (first, second, third, fourth degree). Assess the site with REEDA.
Homan's sign for legs involves sharply dorsiflexing the calf; sharp pain may indicate a DVT, pain from muscle strain is possible, critical thinking is important, and consider if calf is red, sore, or inflamed.
Assessment for postpartum blues versus postpartum depression includes assessing for emotional bonding.
Culture and the postpartum family are important factors, including alertness and withholding judgment.
Textbook resources are helpful for teaching patients about self-care, including activity, nutrition, elimination, perineal care, and after-pains.
Surgical postpartum patient care includes important considerations such as lung and bowel sounds, incisional care, prevention of DVTs, and newborn care and bonding.
Transition and bonding consider changes in roles, teaching and bonding with first-time parents, knowledge deficit, bonding behaviors, and the three phases (taking-in, taking-hold, letting-go).
Adolescents and older women are special populations to consider during this postpartum care time.