Nursing care during labor and birth

• Labor and birth are complex processes requiring careful nursing care to ensure the safety and well-being of both the mother and the newborn.

Pre-Labor Assessment

• A thorough assessment of the woman's health is needed, including vital signs, weight, and pre-existing medical conditions.
• Prenatal records should be reviewed to identify any risk factors and possible complications.
• Birth plans and preferences of the woman must be discussed, including options for pain management to foster a supportive environment.
• It is important to assess the woman's emotional, psychological condition, and address any existing anxieties or fears.

Admission Assessment

• Upon admission, the first step is to confirm the woman's identity as well as obtain documented consent for treatment.
• Assess the woman's labor by checking the frequency, duration, and intensity of contractions.
• A vaginal examination is required to evaluate cervical dilation and effacement, according to the standards.
• Fetal well-being can be determined by monitoring and evaluating the fetal heart rate (FHR).
• The woman's pain level needs to be assessed, and appropriate pain interventions must be provided.

First Stage of Labor: Latent Phase

• To promote labor progress and comfort, ambulation and position changes are encouraged.
• Provide the woman and her partner with education and support by answering questions and addressing concerns.
• Encourage relaxation with techniques like deep breathing, visualization and massage.
• To maintain hydration, offer clear liquids or ice chips.
• Maternal vital signs and fetal heart rate should be regularly monitored.

First Stage of Labor: Active Phase

• Continue with encouraging ambulation and position changes, as tolerated.
• Provide pain relief with measures such as epidural analgesia or systemic medications, as requested and prescribed.
• Maternal vital signs and fetal heart rate should be monitored more frequently.
• Provide ongoing education and support, and keep the woman informed about her progress.
• To prevent bladder distention, voiding should be encouraged every 2 hours; assess the need for catheterization.

First Stage of Labor: Transition Phase

• Offer strong support and encouragement during this difficult phase.
• As the woman experiences the urge to bear down, assist with pushing techniques.
• Maternal vital signs and fetal heart rate must be monitored closely.
• Prepare the delivery room for the impending birth.
• Keep the woman informed of her progress and offer reassurance.

Second Stage of Labor

• With each contraction, encourage effective pushing techniques.
• Maternal vital signs and fetal heart rate should be continuously monitored.
• Provide perineal support during crowning in order to prevent tearing.
• Prepare for the delivery of the newborn.
• Document the time of birth.

Third Stage of Labor

• To promote uterine contraction and prevent postpartum hemorrhage, administer oxytocin as prescribed.
• Assist with the delivery of the placenta.
• The placenta should be inspected for completeness and any abnormalities.
• Assess the woman for signs of hemorrhage, like excessive bleeding or a boggy uterus.
• Initiate breastfeeding or skin-to-skin contact as desired by the mother.

Fourth Stage of Labor

• Monitor maternal vital signs every 15 minutes for the first hour, then every 30 minutes for the next hour, and then hourly for the next 2 hours.
• Assess the fundus frequently to ensure it remains firm and in the midline.
• Lochia needs to be assessed for the amount, color and odor.
• Voiding should be encouraged in order to prevent bladder distention.
• Promote bonding between the mother and the newborn.
• Provide pain relief as needed.

Fetal Monitoring

• Continuous electronic fetal monitoring (EFM) is commonly used to assess fetal well-being during labor.
• The EFM is informative, and provides details of the fetal heart rate (FHR) along with uterine contractions.
• Fetal status is determined by assessing the FHR baseline, variability, accelerations, and decelerations.
• Interventions for non-reassuring FHR patterns include changing maternal position, administering oxygen, and notifying the provider.

Pain Management

• Non-pharmacological pain relief measures include breathing techniques, massage, hydrotherapy, and position changes.
• Pharmacological pain relief options include epidural analgesia, spinal analgesia, and systemic medications.
• The nurse plays a significant role in educating the woman about pain relief options, and advocating for her choices.

Potential Complications

• Maternal complications during labor and birth include hemorrhage, infection, uterine rupture, and amniotic fluid embolism.
• Fetal complications include fetal distress, meconium aspiration, and shoulder dystocia.
• Early recognition and prompt intervention are vital in order to manage complications effectively.

Newborn Care

• Right after birth, the newborn's airway, breathing, and circulation (ABC's) must be assessed.
• Dry and stimulate the newborn to promote breathing.
• Apgar scores should be assigned at 1 and 5 minutes to assess the newborn's overall condition.
• Provide warmth to prevent hypothermia.
• Initiate breastfeeding or formula feeding as desired by the mother.
• Administer prophylactic medications, such as vitamin K and erythromycin eye ointment.

Cesarean Birth

• Cesarean birth is a surgical procedure to deliver the newborn through an incision in the abdomen and uterus.
• Indications for cesarean birth include fetal distress, breech presentation, placenta previa, and cephalopelvic disproportion.
• Preoperative nursing care includes preparing the woman for surgery, inserting a Foley catheter, and administering prophylactic antibiotics.
• Postoperative nursing care includes monitoring vital signs, assessing the incision site, managing pain, and promoting bonding between the mother and newborn.

Cultural Considerations

• Cultural beliefs and practices can influence a woman's preferences and experiences during labor and birth.
• Nurses should be aware of cultural differences and provide culturally sensitive care.
• Communication is essential to understanding a woman's needs and preferences.

Ethical Considerations

• Ethical dilemmas can arise during labor and birth, such as conflicts between the woman's wishes and medical recommendations.
• Nurses should advocate for the woman's autonomy and ensure that she receives informed consent for all interventions.
• Collaboration with the healthcare team is essential to resolving ethical dilemmas.

Documentation

• Accurate and thorough documentation is essential to providing safe and effective nursing care.
• Documentation should include maternal and fetal assessments, interventions, and outcomes.
• Legal and ethical considerations require nurses to document care accurately and objectively.

Key Nursing Interventions

• Continuous monitoring of maternal and fetal well-being
• Pain management
• Emotional support
• Education
• Advocacy
• Collaboration with the healthcare team
• Accurate and thorough documentation

Postpartum Care

• Monitor vital signs, fundal height, lochia, and perineum.
• Manage pain with analgesics or non-pharmacological methods.
• Encourage breastfeeding or formula feeding.
• Promote rest and sleep.
• Provide education on postpartum care and newborn care.

Newborn Assessment

• Assess vital signs, weight, length, and head circumference.
• Perform a gestational age assessment.
• Assess for any abnormalities or signs of distress.
• Provide routine newborn care, such as bathing and cord care.

Discharge Teaching

• Provide instructions on postpartum care, newborn care, and potential complications.
• Schedule follow-up appointments for both mother and newborn.
• Provide information on community resources and support groups.
• Review safety precautions, such as car seat safety and safe sleep practices.