Stages of Labor and Birth

• Labor and birth are complex processes involving physiological and psychological adaptations for the woman, fetus, and family.
• Nurses play a crucial role in supporting women during labor and birth.
• Nursing care focuses on assessment, comfort measures, emotional support, and advocacy.

Stages of Labor

• The first stage starts with regular contractions and concludes with full cervical dilation, reaching 10 cm.
  • The latent phase involves cervical effacement and early dilation, ranging from 0-3 cm, characterized by mild and infrequent contractions.
  • The active phase sees more rapid cervical dilation, from 4-7 cm, with contractions becoming stronger, longer, and more frequent.
  • The transition phase involves a slowing of cervical dilation from 8-10 cm; contractions are intense, creating a strong urge to push.
• The second stage begins with complete cervical dilation and ends with the birth of the baby.
  • It includes latent (calm) and active pushing phases
• The third stage starts immediately after the baby's birth, ending with the expulsion of the placenta.
• The fourth stage is the initial 1-4 hours after placental expulsion, a period of physiological stabilization.

Physiological Changes During Labor

• In the cardiovascular system, there's increased cardiac output and a rise in blood pressure during contractions.
• The respiratory system experiences increased oxygen consumption.
• The gastrointestinal system sees a decrease in gastric motility.
• The renal system exhibits increased bladder sensitivity.
• The endocrine system undergoes a decrease in progesterone, an increase in prostaglandins, and oxytocin stimulates contractions.

Factors Affecting Labor (The 5 P's)

• The passenger refers to the fetus and placenta.
  • Includes fetal size, fetal presentation, fetal lie, fetal attitude, and fetal position.
• The passageway is the birth canal, including the pelvis and soft tissues.
  • Pelvic shape can be gynecoid, android, anthropoid, or platypelloid.
  • It also involves the ability of soft tissues to stretch and distend.
• Powers are uterine contractions and maternal pushing efforts.
  • Includes frequency, duration, and intensity of contractions and effectiveness of maternal pushing.
• Position refers to maternal positions during labor.
  • Affects comfort, labor progress, and fetal descent.
• Psychological Response is the woman's emotional and psychological state.
  • Anxiety, fear, fatigue, sense of control, and support all play a role.

Fetal Assessment During Labor

• Fetal Heart Rate (FHR) Monitoring includes examining baseline rate, variability, accelerations, and decelerations.
  • Normal FHR ranges from 110-160 bpm.
  • Variability refers to fluctuations in the baseline FHR, indicating fetal well-being and can be absent, minimal, moderate, or marked.
  • Accelerations are abrupt increases in FHR above the baseline, often associated with fetal movement.
  • Decelerations are decreases in FHR below the baseline.
    • Early Decelerations are a gradual decrease, mirrors contractions, and is usually benign, indicating fetal head compression.
    • Late Decelerations show a gradual decrease, begins after the peak of the contraction, which can be concerning, indicating uteroplacental insufficiency.
    • Variable Decelerations are an abrupt decrease, not related to contractions, which can be concerning and signals umbilical cord compression.
• Fetal Position: Leopold maneuvers determine fetal presentation and position.
• Amniotic Fluid is assessed for color, odor, and amount.
  • Meconium-stained amniotic fluid may indicate fetal distress.

Maternal Assessment During Labor

• Vital Signs: Monitor temperature, pulse, respiration, and blood pressure.
• Contractions: Assess frequency, duration, and intensity.
• Cervical Dilation and Effacement: Measured in centimeters (0-10 cm) and percentage (0-100%).
• Fetal Descent: Station (relationship of presenting part to ischial spines).
• Pain Level: Assessed using a pain scale.
• Emotional Status: Assess anxiety level, coping mechanisms, and support system.

Pain Management During Labor

• Non-Pharmacological Methods:
  • Breathing techniques.
  • Relaxation techniques.
  • Position changes.
  • Massage.
  • Hydrotherapy.
  • Application of heat or cold.
• Pharmacological Methods:
  • Analgesics: Systemic medications (e.g., opioids) reduce pain.
  • Anesthesia: Regional anesthesia (e.g., epidural, spinal) blocks pain.
  • Local Anesthesia: Used for episiotomy or laceration repair.

Nursing Interventions During Labor

• Give emotional support and encouragement.
• Monitor maternal and fetal well-being.
• Assess labor progress.
• Administer medications as prescribed.
• Assist with comfort measures.
• Provide education and information.
• Advocate for the woman's preferences and needs.
• Prepare the delivery room.
• Assist with delivery.
• Promote bonding between mother and baby.

Potential Complications During Labor

• Fetal Distress:
  • Non-reassuring FHR patterns.
  • Meconium-stained amniotic fluid.
• Prolapsed Umbilical Cord:
  • The umbilical cord precedes the fetal presenting part.
• Shoulder Dystocia:
  • Difficulty delivering the fetal shoulders after the head has been delivered.
• Postpartum Hemorrhage:
  • Excessive bleeding after delivery.
• Uterine Rupture:
  • Tearing of the uterine wall.
• Amniotic Fluid Embolism:
  • Amniotic fluid enters the maternal circulation.
• Precipitous Labor:
  • Labor lasts less than 3 hours from the start of contractions to delivery.
• Dystocia:
  • Difficult or slow labor.

Nursing Care During the Second Stage of Labor

• Support woman's pushing efforts.
• Monitor fetal descent and well-being.
• Prepare for delivery.
• Assist with delivery.
• Provide immediate newborn care.

Nursing Care During the Third Stage of Labor

• Monitor for signs of placental separation.
• Administer oxytocin as prescribed to contract the uterus.
• Assist with placental delivery.
• Assess the placenta for completeness.

Nursing Care During the Fourth Stage of Labor

• Monitor vital signs.
• Assess uterine fundus (firmness, location).
• Assess lochia (color, amount, odor).
• Assess perineum (edema, hematoma, lacerations).
• Encourage breastfeeding or bottle-feeding.
• Promote bonding between mother and baby.
• Provide pain relief.
• Monitor for complications (e.g., hemorrhage).
• Encourage voiding.

Cultural Considerations in Labor and Delivery

• Be aware of cultural beliefs and practices related to childbirth.
• Respect the woman's preferences and choices.
• Provide culturally sensitive care.
• Use interpreters as needed.

Ethical and Legal Considerations in Labor and Delivery

• Informed consent.
• Patient autonomy.
• Confidentiality.
• Scope of practice.
• Standards of care.
• Documentation.

Newborn Care After Delivery

• Immediate Assessment includes the Apgar score (Appearance, Pulse, Grimace, Activity, Respiration) at 1 and 5 minutes.
• Thermoregulation involves drying the baby, placing skin-to-skin with the mother, and using a radiant warmer.
• Airway Maintenance involves suctioning the mouth and nose.
• Identification: Apply identification bands.
• Umbilical Cord Care involves clamping and cutting the umbilical cord.
• Medications: Vitamin K injection, erythromycin eye ointment.
• Assess for Congenital Anomalies through a physical assessment to check for abnormalities.
• Promote Bonding by encouraging skin-to-skin contact.