Nursing Care of Mother and Infant During Labor

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Questions and Answers

Which factor is NOT typically associated with the preparation for labor?

Maternal emotional support

Presence of medical professionals

Spider veins in the mother (correct)

Informed birth plan

Which uterine contraction intensity is considered to be ideal for effective labor progression?

Unpredictable

Variable

Mild

Firm (correct)

What are the four components of the birth process known as?

The four influences

The four P's (correct)

The four stages

The four roles

Which statement about fetal heart rate patterns is true when monitoring during labor?

Persistent tachycardia in fetal heart rate can signify distress. Signup and view all the answers

In evaluating fetal baseline patterns, an abnormal fetal heart rate could indicate which type of complication?

Nuchal cord Signup and view all the answers

What is the recommended frequency for monitoring the fetal heart rate during active labor in the first phase?

Every 30 minutes Signup and view all the answers

Which of the following indicates a concern when monitoring fetal heart rate patterns?

Sudden spikes in heart rate Signup and view all the answers

What is an essential nursing responsibility during labor regarding the fetus?

Monitor the fetal heart rate and respond to any abnormalities Signup and view all the answers

Which fetal heart rate characteristic suggests the fetus may be experiencing distress?

Tachycardia Signup and view all the answers

In true labor, how do contractions typically develop over time?

They increase in length and intensity Signup and view all the answers

What is the purpose of monitoring fetal condition during admission to the labor unit?

To ensure the fetus is not in distress Signup and view all the answers

What is the significance of bloody show during labor?

It may suggest cervical effacement and dilation has occurred Signup and view all the answers

If a patient experiences decreased fetal movement, what is the most appropriate nursing action?

Initiate fetal heart rate monitoring Signup and view all the answers

What is considered a reassuring fetal heart rate pattern?

Stable fetal heart rate with moderate variability Signup and view all the answers

Which fetal heart rate pattern requires prompt reporting to the healthcare provider?

Any heart rate outside normal limits Signup and view all the answers

How is fetal bradycardia defined in the monitoring context?

Consistent <110 beats/min Signup and view all the answers

What does marked variability in fetal heart rate indicate?

There are significant fluctuations in the heart rate Signup and view all the answers

What component of fetal heart rate monitoring must be evaluated to assess fetal well-being?

Baseline fetal heart rate variability Signup and view all the answers

What is the recommended observation for contractions during labor?

Frequency greater than every 2 minutes Signup and view all the answers

In cases of variable decelerations of the fetal heart rate, what is notable?

Rapid fluctuations in fetal heart rate patterns Signup and view all the answers

What should be monitored closely during contractions?

Fetal heart rate patterns and variability Signup and view all the answers

What is a common sign of fetal distress during monitoring?

Bradycardia with decreased variability Signup and view all the answers

Which of the following indicates a need for further intervention during fetal monitoring?

Persistent tachycardia above 160 beats/min Signup and view all the answers

What uterine contraction characteristics are considered abnormal during labor monitoring?

Relaxation intervals shorter than 60 seconds Signup and view all the answers

What is assessed along with fetal heart rate patterns for a comprehensive evaluation?

Amniotic fluid characteristics Signup and view all the answers

What does a sudden change in fetal heart rate variability typically indicate?

Potential fetal compromise Signup and view all the answers

In fetal monitoring, what does absent variability suggest?

Likely fetal distress or compromise Signup and view all the answers

Study Notes

Chapter 6: Nursing Care of Mother and Infant During Labor and Birth

This chapter covers nursing care for mothers and infants during labor and birth.

Lesson 6.1 Objectives

Define key words related to labor and birth.
Discuss cultural beliefs that may influence labor care.
Compare advantages and disadvantages of different childbearing settings (hospital, freestanding birth center, home).
Describe the four components (powers, passage, passenger, and psyche) of the birth process.
Detail how the four Ps of labor interrelate to result in infant birth.

Cultural Influences on Birth Practices

A woman's role in labor and delivery can be influenced by cultural preferences.
Cultural preferences related to labor and delivery require flexibility from the nurse.
The role of the father or partner in labor and delivery is also shaped by cultural practices.

Components of the Birth Process

The four Ps of labor are: powers, passage, passenger, and psyche.

Factors that Influence the Progress of Labor

Preparation
Position
Professional
Place
Procedures
People

Uterine Contractions

Contractions affect the cervix in several ways, including duration, intensity, and frequency.
Contractions have phases: increment, peak, and decrement.
Contraction's intensity can vary from mild to moderate to firm.
Maternal pushing is a component of labor.

Psyche

A woman's mental state influences the course of labor.
Cultural and individual values influence how a woman copes with childbirth.

Lesson 6.2 Objectives

Explain normal childbirth processes (premonitory signs, mechanisms of birth, stages, and phases of labor).
Explain the differences between false labor and true labor.

Signs of Impending Labor

Braxton Hicks contractions
Increased vaginal discharge
Bloody show
Rupture of membranes
Energy spurt
Weight loss

Mechanisms of Labor

Descent
Station
Engagement
Flexion
Internal rotation
Extension
External rotation
Expulsion

When to Go to the Hospital or Birth Center

Contractions
Ruptured membranes
Bleeding (other than bloody show)
Decreased fetal movement
Any other concern

Admission Data Collection

Three major assessments are conducted upon admission: fetal condition, maternal condition, and impending birth.

Admission Procedures

Permits and consents
Laboratory tests
Intravenous infusion
Perineal prep
Determining fetal position and presentation

Comparison of False and True Labor

False Labor	True Labor
Irregular contractions	Contractions develop a regular pattern
Walking relieves contractions	Contractions become stronger and more effective with walking
Bloody show usually not present	Bloody show often present
No change in effacement or dilation of cervix	Progressive effacement and dilation of cervix
Discomfort in lower back or abdomen	Discomfort in lower back or abdomen

Lesson 6.3 Objectives

Determine appropriate nursing care for intrapartum patients (including those in false labor and those having a vaginal birth after cesarean).
Explain nursing responsibilities during labor and birth.
Describe care for newborns immediately after birth.

Nursing Care Before Birth

After admission to the labor unit, nursing care consists of: monitoring the fetus, monitoring the laboring woman, and helping the woman cope with labor.

Monitoring the Fetus

Fetal heart rate (FHR) is monitored.
Monitoring frequency varies based on the stage of labor and risk factors.
Intermittent auscultation and continuous electronic fetal monitoring are methods used.

Fetal Heart Rate Outside Normal Limits

Any FHR outside normal limits or persistent slowing after a contraction should be reported to the healthcare provider.

Evaluating Fetal Heart Rate Patterns

Baseline FHR (110-160 beats/min)
Fetal bradycardia (<110 beats/min)
Fetal tachycardia (>160 beats/min)
Baseline variability
Moderate, marked, or absent variability
Accelerations
Early, variable, and late decelerations

Reassuring and Nonreassuring Fetal Heart Rate Patterns

Reassuring patterns include stable FHR, moderate variability, accelerations, and uterine contractions with proper frequency and duration.
Nonreassuring patterns include tachycardia, bradycardia, decreased or absent variability, little fluctuation in rate, late decelerations, and variable decelerations.

Inspection of Amniotic Fluid

Color (normal is clear, may have white vernix, green-stained indicates meconium passage)
Odor (should not smell; if it does, may indicate infection)
Amount (scant, moderate, or large)

Monitoring the Woman

Vital signs
Contractions
Progress of labor
Intake and output
Response to labor
Breathing and relaxation techniques

Stages and Phases of Labor

First stage: dilation and effacement (4-6 hours)
Second stage: expulsion of fetus (30 minutes to 2 hours)
Third stage: expulsion of placenta (5-30 minutes)
Fourth stage: recovery

Helping the Woman Cope with Labor

Labor support
Teaching
Providing encouragement
Supporting the partner (teach how labor affects behavior and attitude)
Adapt responses to the partner's behavior
Discuss emotional responses
Effects of epidural analgesia

Vaginal Birth After Cesarean (VBAC)

Main concern: uterine scar rupture
Can disrupt placental blood flow
Leads to hemorrhage
Women may need more support compared to other laboring women
Nurse provides empathy and support

Nursing Responsibilities During Birth

Preparing delivery instruments and equipment
Perineal scrub
Administering medications
Providing initial care to the infant
Assessing Apgar score
Assessing infant for abnormalities
Examining the placenta
Identifying mother and infant
Promoting parent-infant bonding

Immediate Postpartum Period (Third and Fourth Stages of Labor)

Third stage: expulsion of the placenta (Schulze or Duncan method)
Fourth stage: nursing care includes identifying and preventing hemorrhage, evaluating and intervening for pain, observing bladder function and urine output, evaluating recovery from anesthesia, providing initial care to the newborn, and promoting bonding between the infant and family.

Nursing Care Immediately After Birth (1 of 2)

Mother care includes observing for hemorrhage, vital signs, skin color, location and firmness of the uterine fundus, lochia, and pain. Comfort measures include keeping warm and offering ice to the perineum.

Nursing Care Immediately After Birth (2 of 2)

Newborn care includes initial care (phase 1: birth to 1 hour in the delivery room; phase 2: 1 to 3 hours in nursery or postpartum unit; phase 3: 2 to 12 hours in postpartum unit if breastfeeding).

Phase 1: Care of the Newborn

Initial care includes maintaining thermoregulation and cardiorespiratory function, observing for urination and meconium passage, identifying the mother, father, and newborn, performing a brief assessment for major anomalies, and encouraging bonding and breastfeeding.

Apgar Scoring

Factors include heart rate, respiratory effort, muscle tone, reflex response to stimulation, and skin color.

Observe for Major Anomalies

Assess for head trauma, symmetry and equality of extremities (length and vigor of movement), and digits of hands and feet (webbing or abnormal number of digits).

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Description

This quiz focuses on nursing care for mothers and infants during labor and birth. It covers key terms, cultural considerations, and the four essential components of the birth process known as the four Ps. Enhance your understanding of how these factors interrelate in the context of maternal care.