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• Module 3 covers maternal adaptations to labor, factors affecting labor, and interventions.
• Module 4 includes complications in pregnancy.
• Module 5 goes over postpartum and newborn care.
• Complications in labor & delivery are also covered.

True vs. False Labor

• True labor involves regular contractions and cervical changes, leading to dilation and effacement.
• False labor contractions are irregular and do not cause significant cervical changes.

True Labor Signs

• Contractions can start irregular, but become regular.
• Contractions get stronger and last longer over time.
• Discomfort felt in the lower back, radiating to the abdomen.
• Walking increases contraction intensity.
• Cervix has progressive dilation and effacement.
• Cervix moves to an anterior position.
• Bloody show.
• Fetus's presenting part engages in the pelvis.

False Labor Signs

• Contractions are often painless, irregular, and intermittent.
• Walking or position changes decrease the contractions.
• Discomfort felt in the lower back or abdomen above the umbilicus.
• Often stops with sleep or comfort measures.
• Cervix shows no significant change in dilation or effacement.
• Cervix often remains in a posterior position.
• No significant bloody show.
• Fetus's presenting part may not engage in the pelvis.

5 P's of Labor

• Passage, passenger, powers, position, and psyche are the major factors that affect the labor process.
• Passageway focuses on the pelvis and surrounding tissues.
• Passenger refers to factors of the fetus like size, presentation, lie, and attitude.
• Powers are contractions, both involuntary and voluntary pushing.
• Position affects the individual's anatomy and comfort.
• Psyche refers to the psychological aspect of labor.

Passenger Considerations

• Size, presentation (vertex, scapula, buttocks, sinciput, brow)
• Lie (relation of fetal spine to mom's) - longitudinal, transverse, oblique
• Attitude (relation of fetal parts) - flexion, extension
• Position - occiput, sacrum, mentum (chin), sinciput
• Fetus and placenta.

Passageway Classifications

• Gynecoid is round and optimal for vaginal delivery.
• Android is heart-shaped and increases the risk of cesarean birth.
• Anthropoid is oval and increases the chance of an occipital posterior position.
• Platypelloid is rare and has a strong association with cesarean birth.

Powers Explained

• Primary powers are involuntary contractions that cause cervical changes.
• Strength is affected by whether labor is spontaneous or induced with oxytocin.
• Secondary powers are voluntary pushing efforts without effect on cervical change.
• Pushing power frequency and duration cause fetal expulsion.

Stages/Phases of Labor

• First stage lasts from the onset of labor until 10 cm.
• Latent phase is 0–3 cm.
• Active phase is 4–7 cm.
• Transition phase is 8–10 cm.
• Second stage is from 10 cm until delivery of the baby.
• Third stage is delivery of the baby until delivery of the placenta.
• Fourth stage is delivery of the placenta until about 2 hours postpartum.

SROM Assessment

• First and second nursing labor interventions include SROM (spontaneous rupture of membranes) assessment.
• Assess FHR first for possible umbilical cord prolapse with amniotic fluid gush.
• To verify ptH presence of alkaline amniotic fluid using nitrazine paper (turns blue, pH 6.5-7.5).
• Amniotic fluid sample viewed on a slide microscope shows ferning pattern, is clear, and the color of water, with no odor.

Fetal Heart Rate (FHR) Categories

• Identify and intervene with Fetal Heart Rate Categories I, II, and III.
• Category one includes a baseline FHR of 110–160/min, moderate variability, and the presence or absence of accelerations and early decelerations.
• Category 2 includes all FHR tracings not in category 1 or 3, Tachycardia/Bradycardia baseline rate, minimal/absent/marked FHR variability, and episodic or periodic decelerations.
• Category 3 includes either sinusoidal pattern or absent baseline FHR variability with recurrent variable/late decelerations or bradycardia.

Nursing Interventions for Labor Dystocia

• Labor dystocia interventions include assisting with fetal scalp electrode, encouraging regular voiding, position changes, ambulation, hydrotherapy, counterpressure, pushing positions, operative vaginal birth preparation, and continuous FHR monitoring.

Role of the Nurse During Labor

• Assess the client's labor status before admission.
• Review antenatal care and birth plan.
• Monitor FHR and contractions for 20–30 min.
• Obtain mother's vitals and check amniotic membranes.
• Orient the client and partner, perform maternal and fetal assessments.
• Avoid vaginal exams with bleeding or placenta previa.
• Cervical dilation is the single most important indicator of the progress of labory.
• Progress of labor relies on the various factors surrounding the birthing person as well as fetal position etc.

Stages of Labor

• First stage: Perform Leopold maneuvers and vaginal exam as indicated.
• Encourage slow deep breaths before the vaginal exam.
• Monitor cervical dilation and effacement, station, and fetal presentation.
• Teach relaxation measures.
• Encourage upright positions, voiding every 2 hours.
• Active phase: Provide client and fetal monitoring. Encourage frequent position changes. Offer pain relief.
• Second stage: Look for perineal lacerations and continue monitoring.

Third and Fourth Stage Managment

• Third stage: Instruct client to push once placental separation findings are present.
• Administer oxytocics and analgesics.
• Fourth stage: Assess BP and pulse every 15 min for first 2 hours and fundus and lochia every 15 min for first hour.

Pain Management Strategies

• Epidural interventions use analgesics like fentanyl and sufentanil.
• Nursing actions for epidurals include safety precautions, assessing for nausea, monitoring vitals, and monitoring FHR.
• Non-pharmacological includes gate-control theory and cognitive strategies.
• Sensory stimulation strategies - aromatherapy, imagery, music
• Cutanoeus stimulation strategies - Back rubs, massage, walking, rocking, hydrotherapy, acupressure, position changes.
• IV options - Butoprhanol and nalbuphine

GDM Screening

• Glucose screening test/1 hour glucose tolerance test a 50 g oral glucose load followed by plasma glucose analysis 1 hour later performed at 24-28 weeks gestation.
• No fasting is necessary
• A positive result is 130-140 or greater, additional 3 hour OGTT is indicated.
• Oral glucose tolerance follows overnight fasting with a 100 g glucose load.
• Serum glucose levels are determined at 1, 2, 3 hour following glucose ingestion.

High-Risk Pregnancy Factors

• Presence of ketones in urine, BPP, amniocentesis, nonstress test
• Include maternal age, first pregnancy, extreme obesity, multifetal gestation, chronic disease, and family history.
• Other conditions - DM, rheumatoid arthritis, systemic lupus erythematosus, Hyperemesis gravidarum, Urinalysis, chemistry profile, thyroid test, and CBC completed

Diabetes Mellitus in Pregnancy

• With GDM, managed initially by diet and exercise - if glucose is persistently high, insulin is begun.
• Recommend to perform daily kick counts and adhere to appropriate diet, exercise, and self-administration of insulin.

Pathophysiology of Preeclampsia

• Organs affected result in outwards s/sx.
• Traditionally diagnosed when proteinuria occurs with GH although it can happen without it.
• Abnormal placenta where uteroplacental arteries become fibrous and narrow and pro-inflammatory proteins go into mothers circulation and kidney glomerular damage.

Preeclampsia Manifestations

• Organ manifestations include cortical brain spasm, retinal anterior spasm, impaired liver function, pulmonary edema, and liver ischemia.
• Signs and symptoms include headache, epigastric pain, and visual disturbances.

Hypertensive Conditions Management

• Hypertensive conditions - Chronic (elevated blood pressure, superimposed preeclampsia) and Gestational (begins after the 20th week of pregnancy)
• Report of headaches, assessments of BP/edema/DTR's/Clonus/proteinuria .
• Magnesium sulfate (prevent seizures) - if suspected, stop administering it and administer antidote calcium gluconate.
• HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome needs to be managed

Miscarriage Variations

• Miscarriages: threatened (cramping, FHT's present), inevitable, complete, incomplete, missed.
• Placenta Previa or Abruptio placentae require careful management.
• Placeta previa = risk factors can be AMA, multipara, previous c-section etc
• Abruptio can be caused by cociane use

Preventing Preterm Labor

• Preterm labor risk factors include the social determinants, genetic predispositions, cervix length, fetal fibronectin, and having multiples.
• Medications include magnesium sulfate, betamethasone, and terbutaline (tocolytic).

Cervical Ripening

• Cervical Ripening uses bishop scoring (induction vs augmentation), oxytocin, and Cytotec

Labor Dystocia

• Labor dystocia is a prolonged and difficult labor.
• It can be caused by fetal scalp electrode and/or intrauterine pressure catheter with amniotomy.
• Manage by: position changes, ambulation, hydrotherapy

OB Emergencies

• Chorioamnionitis: What is it, manifestations and treatment?
• Infection of membranes (amnion and chorion) that surrounds fetus during pregnancy
• Signs and symptoms include fever, fast HR and uterine pain

Postpartum Changes

• Anatomic and physiologic postpartum changes include lochial flow and uterine involution.
• Lochia assessment - amount, color, odor; check at least every 4 hours for the first 24 hours postpartum.
• Postpartum assessment includes a BUBBLE-LE assessment including abnormal findings and potential complications.
• Uterus - displaced or boggy - uterine atony or retained placenta (PPH)- involution process
• Bowel - gas pain or constipation.
• Bladder - urinary retention or UTI or pylenophrenitis.
• Episiotomy/lacerations - inflammation or pain /sepsis
• Les - clots and swelling/DVT
• Stage 1: dependent phase, 1st 24 hours
• Stage 2: dependent/independent phase, 10 days to several weeks

Postpartum Interventions/Complications

• Ensure Postpartum care, including 1stand 4th degree lacerations Provide Perineal lacerations care Provide pharmacological & non-pharmacological comfort measures
• PPH causes: tone 70%, Trauma 20%, Thrombin 1% etc
• Treatment of Postpartum hemorrhage medications -(Oxytocin) Pitocin, Methergine, Cytotec, Hemabate
• Postpartum infections - Endometritis and mastitis antibiotic.
• Can start as soon as 2 weeks postpartum or as late as 1 year postpartum

Newborn Adaptations

• Newborns make physiologic and behavioral adaptations to the extrauterine environment.
• Address Cold stress and minimize heat loss.

Hyperbilirubinemia

• Hyperbilirubinemia is caused when the newborn has with an immature liver
• A major source of hyperbillrubinemia are is bruising and feeding.

Newborn Assessment

• Includes a quick initial assessment to observe for life threatening abnormalities and respiratory issues.
• Physical assessment of their skin to check for deviations

Newborn Resuscitation

• Perform Initial steps neonatal resuscitation by suctioning passages
• Be aware of Newborn respiratory distress using Intercostal or subcostal muscles
• Newborn heat less using radiation

Infant Nutrition

• Instruct BF basic teaching/care
• Women need an additional 450-500 kcal/day over their pregnancy diet