Stages of Labor and Childbirth

• Labor and childbirth are physiological processes where a pregnant woman expels the fetus and placenta
• Nursing care during this period is centered on ensuring a secure and favorable experience for both mother and newborn

Stages of Labor

• The first stage is marked by the onset of regular uterine contractions and concludes with full effacement and dilation of the cervix.
  • The latent phase involves cervical dilation from 0-3 cm, contractions range from mild to moderate and are irregular,
  • The active phase includes cervical dilation from 4-7 cm, with contractions occurring more frequently and with greater intensity
  • The transition phase is defined by cervical dilation from 8-10 cm, featuring contractions that are very strong and frequent
• The second stage extends from full cervical dilation to the birth of the fetus
  • It has a latent phase, known as "laboring down," and the active pushing phase
• The third stage spans from the birth of the fetus to the expulsion of the placenta
• The fourth stage starts after placental expulsion and lasts 1-4 hours postpartum
  • It is a crucial period for the mother's physiological stabilization

Nursing Assessment During Labor

• Maternal vital signs should be monitored regularly, including blood pressure, pulse, respirations, and temperature
• Contractions should be monitored for frequency, duration, intensity, and resting tone
• Fetal heart rate (FHR) should be monitored, including baseline rate, variability, accelerations, and decelerations
• Cervical examinations should be performed to assess dilation, effacement, and fetal station
• Amniotic fluid should be assessed for color, odor and amount if membranes rupture
• Maternal pain level should be assessed using pain scales to provide appropriate pain relief measures

Pain Management During Labor

• Nonpharmacological methods include
  • Breathing techniques that provide guidance on patterned breathing exercise for relaxation and pain relief
  • Relaxation techniques like massage, aromatherapy, and guided imagery should be encouraged
  • Position changes should be assisted in order to find comfortable positions to promote progress and reduce pain
  • Hydrotherapy using warm showers, baths, and applying warm or cool compresses to relieve pain
• Pharmacological methods involve
  • Analgesics such as opioids to reduce pain
  • Anesthesia using epidural or spinal blocks for pain relief
  • Monitor maternal and fetal response to medications and anesthesia

Fetal Heart Rate Monitoring

• Baseline FHR refers to the average FHR over a 10-minute period, typically between 110-160 bpm
• Variability indicates fluctuations in the FHR baseline, reflecting fetal well-being
  • Moderate variability, ranging from 6-25 bpm, is considered normal
• Accelerations are abrupt increases in FHR above the baseline, signaling fetal movements and well-being
• Decelerations are decreases in FHR below the baseline
  • Early decelerations show a gradual decrease in FHR mirroring uterine contractions, caused by fetal head compression
  • Late decelerations involve a gradual decrease in FHR starting after the peak of a contraction, indicating uteroplacental insufficiency
  • Variable decelerations show an abrupt decrease in FHR that can occur anytime, caused by umbilical cord compression
• Interventions are required for abnormal FHR patterns
  • Repositioning the mother, administering oxygen, increasing IV fluids, and notifying the healthcare provider

Nursing Interventions During Labor

• Emotional support is needed to provide encouragement, reassurance, and information to the woman and her partner
• Comfort measures should be promoted, like back rubs, cool cloths and lip balm
• Voiding regularly should be encouraged every 1-2 hours to prevent bladder distention
• Monitoring labor progress frequently to assess cervical dilation, effacement, and fetal station
• Assisting with pushing by providing guidance and support during the second stage
• Preparing for delivery by setting up the delivery room and gathering needed equipment
• Giving immediate care to the newborn, including drying, warming, and stimulating

Complications During Labor

• Dystocia is difficult or prolonged labor
• Fetal distress is abnormal FHR patterns indicating fetal hypoxia
• Shoulder dystocia is difficulty delivering the fetal shoulders after the head has been delivered
• Prolapsed umbilical cord is when the umbilical cord precedes the fetus, leading to cord compression
• Uterine rupture is the tearing of the uterine wall
• Amniotic fluid embolism is when amniotic fluid enters the maternal circulation, causing a severe allergic reaction
• Postpartum hemorrhage is excessive bleeding after delivery

Cesarean Birth

• It is a surgical procedure where the fetus is delivered through an incision in the abdomen and uterus
• Indications include
  • Fetal distress, dystocia, malpresentation, placenta previa, abruption placentae, and previous cesarean birth
• Nursing care includes
  • Preoperative care, preparing the woman for surgery, including NPO status, IV insertion, and fetal monitoring
  • Intraoperative care, assisting with the surgical procedure and monitoring maternal and fetal status
  • Postoperative care, providing pain relief, monitoring for complications, and promoting bonding with the newborn