Assisting and Handling a Delivery PDF

NOTRE DAME OF MARBEL NURSING DEPARTMENT UNIVERSITY Alunan Avenue, Koronadal City, South Cotabato, Philippines 9506 Assisting and Handling a Delivery NCM 107B CARE OF MOTHER, CHILD, AND ADOLESCENTS (WELL CLIENTS) RELATED LE...

NOTRE DAME OF MARBEL NURSING DEPARTMENT UNIVERSITY Alunan Avenue, Koronadal City, South Cotabato, Philippines 9506 Assisting and Handling a Delivery NCM 107B CARE OF MOTHER, CHILD, AND ADOLESCENTS (WELL CLIENTS) RELATED LEARNING EXPERIENCE Bachelor of Science in Nursing, Level II Lecturer: Verlyn C. Leal, RM, RN, LPT  Opening Prayer JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  INTENDED LEARNING OUTCOMES JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  General Objective At the end of the 2-hour discussion, the student nurses would be able to assist and handle a delivery to a client in a second stage of labor. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107B: Maternal and Child NDMU NURSING  Specific Objectives Specifically, the students can: 1.Identify the onset of the second stage of labor. 2.Discuss the different assessments Nursing diagnosis Planning, Nursing interventions and Evaluation to a client in labor. 3.Utilize the checklist in handling JMJ Marist Brothers and assisting a delivery. NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107B: Maternal and Child NDMU NURSING  Assisting & Handling a Delivery JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  What is Labor? ⮚ Labor is a series of continuous, progressive contractions of the uterus which help the cervix to open (dilate) and to thin (efface) allowing the fetus to move through the birth canal. ⮚ Labor usually starts two weeks before or after the estimated date of delivery. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Stages of labor: 1. First stage of labor – cervical dilatation stage, from onset of labor until the dilatation of cervix. 2. Second stage of labor – expulsion stage, from full dilation of cervix to birth of baby. 3. Third stage of labor – placental stage, from birth of baby to expulsion of placenta. 4. Fourth stage of labor – recovery stage, time after birth of immediate recovery baby. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor Mechanisms of Labor A series of passive, adaptive (Vertex Position) movements of the fetal head E ngagement and shoulders smallest D escent diameter to pass through F lexion the birth canal. I nternal The mechanism of labor R otation are the positional E xtension movements that the fetus E xternal R otation undergoes to E xpulsion accommodate itself to the JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY maternal pelvis. College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor Engagement The biparietal diameter of the head passes the pelvic inlet. The head is fixed in the pelvis JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor Descent Downward movement of the biparietal diameter of the fetal head to within the pelvic inlet; Progress of the presenting part JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY through the pelvis. College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor Flexion As descent occurs, the head bends forward to the chest, making the smallest anteroposterior diameter (the suboccipitobregmatic diameter) present to the birth canal. Flexion is also aided by abdominal muscle JMJ Marist Brothers contraction during pushing. NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor Internal Rotation The head enters the pelvis with the fetal anteroposterior head diameter in a diagonal or transverse position. Fetal skull rotates along axis from transverse to anteroposterior at pelvic outlet. Head passes the midpelvis. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor Extension As the occiput is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head, the face and JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY chin, are born. College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor External Rotation Almost immediately after the head of the infant is born, the head rotates (from the anteroposterior position it assumed to enter the outlet) back to the diagonal or transverse position of the early part of labor. The head rotates to full alignment with back and shoulders for shoulder delivery mechanism. To accommodate the shoulder the head goes back to it’s original position. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Mechanisms of Labor External Rotation Once the shoulders are born, the rest of the baby is born easily and smoothly because of its smaller size. When entire body of baby has emerged from mother’s body, birth is complete. This time is recorded as the JMJ Marist Brothers time of birth. NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  SECOND STAGE OF LABOR JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  Second Stage of Labor ∙ Expulsion Stage. ∙ From full dilation of cervix to birth of baby. Assessment: ∙ Signs of imminent delivery. ∙ Progress of descent. ∙ Maternal/fetal vital signs. Crowning ∙ Maternal pushing effort Birth of baby (active pushing) ∙ Vaginal distention JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY ∙ Bulging of the perineum College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  Second Stage of Labor Nursing Diagnosis: ∙ High risk of injury ∙ Non compliance related to exhaustion. ∙ Knowledge deficit JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  Second Stage of Labor Planning and Implementation: ∙ Safe delivery of living, uninjured fetus. ∙ Mother will be comfortable after tolerating delivery. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  Second Stage of Labor Nursing Interventions: ∙ Transfer mother carefully to delivery table or birthing chair; support legs equally to prevent strain on ligaments or prevent popliteal vein pressure. ∙ Help mother use handles or legs to pull on as she bears down with contractions. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  Second Stage of Labor Nursing Interventions: ∙ Clean vulva and perineum to prepare for delivery. ∙ Continue observation of vital signs. ∙ Encourage mother in sustained (5-7 seconds) pushes with JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY each contraction. College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  Second Stage of Labor` Nursing Interventions: ∙ Support fathers participation if in delivery area. ∙ Catheterized mother’s bladder if indicated. ∙ keep mother informed of delivery progress. ∙ Note time of delivery of JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY baby. College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 A: Maternal and Child NDMU NURSING  Second Stage of Labor Evaluation: ∙ Delivery of healthy viable fetus. ∙ Mother comfortable after procedure. ∙ No complication during procedure. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Second Stage of Labor Evaluation: ∙ Delivery of healthy viable fetus. ∙ Mother comfortable after procedure. ∙ No complication during procedure. JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Episiotomy Is an incision of the perineum during delivery to enlarge the vaginal opening/outlet. Types of Episiotomies: a. Median or Midline: Incision is made in the middle of the perineum and directed toward the rectum; a. Mediolateral: Incision is made laterally to avoid anal sphincter if enlargement is needed. NCM 107 A: Maternal and Child NDMU NURSING  Placental Stage – Third Stage of Labor From birth of baby to expulsion of placenta. Assessment: Signs of placental separation: a. Calkin’s sign – earliest sign of placental separation; change in shape of uterus (from discoid uterine shape to globular). b. Sudden gush of vaginal blood. c. Lengthening of the umbilical cord NCM 107 A: Maternal and Child NDMU NURSING  Placental Stage – Third Stage of Labor Types of placental delivery: a. Schultze –placenta separates from the center of the edge. Clean presentation b. Duncan – Placenta separates from the edge to the center. Dirty presentation. NCM 107 A: Maternal and Child NDMU NURSING  Placental Stage – Third Stage of Labor Nursing interventions: ⮚Trap and rotate the cord slowly so that no fragments of placenta is left in the uterus. ⮚Palpate the uterus. If “boggy” ✔Immediately massage the uterus ✔Put icepack to stimulate vasoconstriction ✔Nipple stimulation. NCM 107 A: Maternal and Child NDMU NURSING  ACTUAL STEPS IN ASSISTING AND HANDLING A DELIVERY JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Materials needed: ▪OB pack-pair of leggings, 3 ▪Bandage scissors hypotowel, 1 hand towel ▪Needle holder ▪Pair of sterile gloves ▪Tissue forceps ▪KY jelly ▪Mayo scissors ▪Lidocaine 2% ▪Surgical suture with needle ▪4x4 gauze ▪Plain NSS for irrigation 1liter ▪Straight cath ▪5cc syringe JMJ Marist Brothers ▪2 kelly forceps NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107 B: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: KNOWLEDGE 1. Define the procedure. 2.Identify the four stages of labor. 3. State the needed equipment and materials of labor and delivery. SKILLS 4. Assemble all the equipment. Open the OB pack. Ensure that principles of aseptic technique are observed. 5. Perform surgical handwashing/scrubbing. 6. Don sterile gloves. NCM 107 B: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: 7. Arrange linens and instruments on the mayo table. 8. Put on sterile leggings and sterile towels on top of the abdomen and under the buttocks. 9. Aspirate lidocaine (a local anesthetic) with the assistance of the circulating nurse this is indicated for primipara for episiotomy. NCM 107 B: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: 10. Assess for the extent of labor, once the head has crowned, the head is born by the extension of the face. 11. By the time the head is delivered, wipe the infant’s face and mouth with a gauze. 12. Check with 1 (one) finger if the cord is wrapped around the baby’s neck. 12.1 If cord is present and loose, deliver the baby through the loop of the cord or slip it over the baby’s neck. 12.2 If cord is tight, clamp it on two sides and cut the cord and unwind it from around the neck. NCM 107 B: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: 13. Allow the baby’s head to turn spontaneously and place hand on each side of the baby’s head, over the ears, and apply slow, gentle pressure downward and outward traction. 14. Move the topmost hand from the head to support the rest of the baby’s body as it slides out. (Remember that newborns are wet and slippery be careful not to drop the baby). 15. Place the baby on the mother’s abdomen and thoroughly dry the baby and cover with a sterile clean, dry cloth. NCM 107 A: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: 16. Wait 1-3 minutes before clamping and umbilical cord stops pulsating. 17. Assist the physician in delivering the placenta. Watch for signs of placental separation. 18. Note for placental delivery, presentation and inspect for completeness of the cotyledons. 19. Assist the physician in performing episiorrhaphy. NCM 107 B: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: 20. Perform perineal care with antiseptic and sterile water. Removes all traces of betadine from the patient’s skin. Dry perineal area. 21. Place maternity pad in patient’s perineum. 22. Perform aftercare. 23. Removes gloves and dispose in an appropriate receptacle. 24. Wash hands. NCM 107 B: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: 25. Document relevant data: 25.1 Note the time of delivery. 25.2 Gender of baby. 25.3 Placental delivery and presentation NCM 107 B: Maternal and Child NDMU NURSING  Checklist in Assisting and Handling a Delivery PROCEDURE: ATTITUDE 26. Maintained good nurse patient interaction. 27. Observe courtesy and tactfulness. 28. Performs the procedure efficiently 29. Appears clean and well groomed. 30. Accept corrections and criticisms counteractively. 31. Clean organized and systematic in the entire procedure. 32. Shows calmness and confidence. NCM 107 B: Maternal and Child NDMU NURSING  Are there any questions JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NCM 107B: Maternal and Child NDMU NURSING  JMJ Marist Brothers NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences NURSING DEPARTMENT Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines #BSN2 #SibolMarista NCM 107B: Maternal and Child NDMU NURSING