Caring for a Woman During Vaginal Birth PDF

1 1 False Contractions True Contractions False Contractions True Contractions ó Begin and remain ó Begin irregularly but irregular become regular and óDo not increase in óIncrease in...

1 1 False Contractions True Contractions False Contractions True Contractions ó Begin and remain ó Begin irregularly but irregular become regular and óDo not increase in óIncrease in predictable duration, duration, ó Felt 1st abdominally ó Felt 1st in lower back frequency, or frequency, and and remain confined and sweep around to intensity intensity to the abdomen and the abdomen in a groin wave óDo not achieve óAchieve cervical cervical dilatation dilatation ó Often disappear w/ ó Continue no matter ambulation and sleep what the woman’s level of activity Suboccipitobregmatic (9.5 cm) Occipitofrontal (12 cm) Occipitomental (13.5 cm)  Fetus born fastest in these 2 positions 77 78 Passage of a fetus thru the birth canal involves a number of different position changes  cardinal movements of labor to keep the smallest diameter of the fetal head (in cephalic presentations) always presenting to the smallest diameter of the birth canal Chapter 15 (Part 2) Usually accomplished during the 2nd stage of labor  downward movement of the biparietal diameter of the fetal head w/in the pelvic inlet Full Descent – occurs when the fetal head extrudes beyond the dilated cervix and touches the posterior vaginal floor head bends forward occurs because of pressure on the onto the chest, fetus by uterine fundus making the smallest anteroposterior head pressure of fetal head on sacral diameter nerves @ the pelvic floor causes (suboccipitobregmati c diameter) the mother to experience a pushing presenting part to the sensation birth canal Full descent may be aided by aided by abdominal muscle contraction abdominal muscle contraction as during pushing the woman pushes Suboccipitobregmati c (9.5 cm) During descent, the head enters Occipitofrontal (12 cm) the pelvis w/ the fetal anteroposterior head diameter* in a diagonal or transverse position Occipitomental (13.5 cm) Begins @ the level of Head flexes as it the maternal vulva touches the pelvic As the occiput is floor, and the occiput born, the back of the rotates until it is neck stops beneath the pubic arch and superior, or just acts as a pivot for below the symphysis the rest of the head pubis – bringing the Head extends, and the foremost parts of head into the best the head, the face relationship to the and chin, are born outlet of the pelvis*  Its face begins to After delivery of the “look @ one of head of the infant, mother’s leg” the head rotates* The anterior back to the diagonal shoulder is born or transverse first, assisted position of the early perhaps by part of labor* downward flexion of Fetus resumes its the infant’s head normal face-forward Put pressure on the position* perineum to prevent lacerations Once shoulders are born, the rest of the baby is born easily and smoothly because of its smaller size End of the 2nd stage of labor Presentation of a body part other than the  Membranes more apt to rupture early vertex could put a fetus @ risk: = ing possibility of:  Implies a proportional difference bet. the fetus and maternal pelvis = pelvis too narrow Infection to allow fetus to pass thru C/S birth Fetal anoxia and  Labor is invariably longer* meconium staining – complications that lead ineffective descent of the fetus, to respiratory distress @ birth ineffective dilatation of the cervix, or  Longer labor the more it tires both irregular or weak uterine contractions woman and fetus = reducing excitement of the experience* vaginal birth after complicated labor: Combined abdominal inspection  £ed risk for perineal tears or cervical and palpation (Leopold’s lacerations w/c may also Maneuvers)  £ woman’s disability and Vaginal Examination  Possibly interfere w/ her future childbearing Auscultation of fetal heart tones If labor is threatening and Ultrasound unsatisfactory:  Interfere w/ maternal-child bonding  Supplied by the fundus of the uterus Implemented by uterine contractions – process causes cervical dilatation and then expulsion of the fetus from the uterus After full dilatation of the cervix – The mark of effective uterine primary power is supplemented by contractions is rhythmicity and use of abdominal muscles progressive lengthening, and intensity Advise woman not to bear down w/ abdominal muscles until cervix is fully dilated – may impede primary force and could cause fetal and cervical damage Begin @ a “pacemaker” point located in the myometrium near one of the anterotubal junctions then sweeps down over the uterus as a wave w/ rest periods in between contractions In early labor: contractions are not synchronized (sometimes strong/weak and irregular) but improves after a few hours Some women: contractions originate in the lower uterine segment rather than the fundus =  reverse; ineffective contractions;  may actually cause tightening rather than dilatation of cervix Increment – intensity of As labor progresses, the uterus gradually contraction increases; Crescendo differentiates itself into two distinct functioning Acme – contraction is @ its areas: 1. Upper portion becomes strongest; peak; Apex thicker and active – preparing it to be able to Decrement – intensity decreases; exert strength necessary to expel fetus Decrescendo 2. Lower portion becomes thin-walled, supple, and passive – to accommodate fetal head and fetus can be pushed out of the uterus easily  In a difficult labor (if fetus is larger than Physiologic Retraction Ring – boundary the birth canal), round ligaments of the bet. the 2 portions becomes marked by a uterus become tense and may be palpable on the abdomen ridge on the inner uterine surface; Pathological Retraction Ring (Bandl’s normal in labor Ring) – The elongation of the uterus exerts  common in obstructed labor; pressure against the diaphragm and  retraction ring is indented deeply and palpable as a mass in the middle of the causes the often-expressed sensation abdomen that a uterus is “taking control” of a  Danger sign – signifies impending rupture of woman’s body the lower uterine segment if the obstruction is not relieved Effacement shortening and thinning of cervical canal  Nly: 1 – 2 cms long  w/ effacement – canal virtually disappears  Primiparas: effacement before dilatation  Multiparas: both come simultaneously or dilatation comes ahead (before effacement) - before fetus can be safely pushed thru cervical canal – otherwise, cervical tearing could result Dilatation – refers to the enlargement or 1. uterine contractions gradually increase widening of the cervical canal from an the diameter of the cervical canal opening a few mm wide to one large lumen by pulling the cervix up over the enough (approx. 10 cm) to permit presenting part of the fetus passage of a fetus 2. Fluid-filled membranes press against the cervix  If membranes are intact – they push ahead of fetus and serve as an opening wedge  If ruptured – presenting part serves this same function As dilatation begins = increase amount of vaginal secretions (show) because last of the operculum in the cervix is dislodged and minute capillaries in the cervix rupture Refers to the psychological state or feelings that a woman brings into labor  Woman must have a strong sense of self-esteem and a meaningful support with them  Encourage pregnant women during prenatal visits to ask questions and  to attend preparation for childbirth classes – to prepare them for labor