Nursing Management of Labor PDF

NURSING MANAGEMENT OF LABOR  Objectives At the end of this lecture, the students will be able to: Discuss the appropriate nursing management for each stage of labor ▪ The laboring and birthing process is a life changing event for many women. ▪ Nurses need to...

NURSING MANAGEMENT OF LABOR  Objectives At the end of this lecture, the students will be able to: Discuss the appropriate nursing management for each stage of labor ▪ The laboring and birthing process is a life changing event for many women. ▪ Nurses need to be respectful, available, encouraging, supportive, and professional in dealing with all women.  Management of 1 st Stage of Labor ▪ Nutrition ▪ Advocacy ▪ Assessment ▪ Room environment ▪ Support for the partner ▪ Comfort measures ▪ Hygiene ▪ Providing the highest ▪ Emotional support quality care ▪ Partograph ▪ Information and instruction ▪ Preparation and care  Management of 1 st Stage of Labor ▪ Assess maternal vital signs and ▪ Identify risk factors that ▪ Evaluate maternal pain, which are primary may contribute to a pain and the components of the physical decrease in utroplacental effectiveness of pain examination. circulation during labor management strategies ▪ If there is no vaginal bleeding on admission, a vaginal examination is performed to asses cervical diltation Management of 1 st Stage of Labor Assessment ❑ Full history: ✓ Complete obstetric history. ✓ History of the present pregnancy. ✓ History of the present labor(e.g.: labor pains, vaginal bleeding, gush of fluid &fetal movement). ❑ Examination ✓ General: -pallor, edema, abdominal scar Management of 1 st Stage of Labor Assessment ❑ Abdominal examination: ✓ Presentation, position and engagement ✓ Auscultate fetal heart ✓ Monitor uterine contractions ❑ Pelvic examination: ✓ Cervix: dilatation (cms),effacement(%) ✓ Membrane: intact or ruptured(if ruptured exclude cord prolapse) ✓ Amniotic fluid:(after R.O.M.):either clear, meconium stained or blood stained. ✓ Presenting part :position, station. Management of 1 st Stage of Labor Assessment ❑ Investigations: ✓ Urine: protein, sugar, ketones ✓ Blood: CBS, RBS, grouping, cross matching for high risk patients Management of 1 st Stage of Labor Preparation and care ✓ Nutrition: Light Snacks; Frozen berries, Dried fruit, Jelly, Water. ✓ Continuous labor support ✓ Hydrotherapy ✓ Ambulation ✓ Slow-dancing ✓ Exercise ✓ Maternal position changes ✓ Focusing and imagery ✓ Therapeutic touch and massage ✓ Breathing techniques ✓ Encourage to empty bladder (1 -2 hours) ✓ Nurses should first provide the non-pharmacologic measures before moving to the pharmacologic interventions. Management of 1 st Stage of Labor Partograph To assess the: ▪ Condition of fetus: ✓ FHR by Doppler ✓ CTG (cardiotocograph) ✓ Amniotic fluid ▪ Progress of labor: cervical dilatation and contractions ▪ Condition of mother: medications (oxytocin), intravenous fluids, vital signs  Management of 2 nd Stage of Labor ▪ Conduct of delivery ▪ Preparation ▪ Observation ▪ Delay pushing, ▪ Continuous ▪ Continuous spontaneous (non- coaching and assessment of directed) pushing support FHR ▪ Maternal choice positions Management of 2 nd Stage of Labor Preparation: ▪ Position: varies from the standard lithotomy position to side-lying to squatting to standing or kneeling depending on the woman’s preference. ▪ Perineal cleansing: clean the perineum with antiseptic solution, drape and create a sterile field around the vagina. Management of 2 nd Stage of Labor Observation: ✓ Maternal Condition( hourly-pulse and BP) ✓ Fetal Condition ( FHR and amniotic staining) ✓ Uterine Condition( strength, duration and frequency) ✓ Progress of Descent (every 30 minutes) Management of 2 nd Stage of Labor Conduct of delivery ✓ Delay pushing, spontaneous (non-directed) pushing ✓ Episiotomy if needed ✓ One the fetal head has emerged, the primary care provider explores the fetal neck to see if the umbilical cord is wrapped around it. ✓ Suction the baby’s mouth and nose. (support the woman throughout the cardinal movements) ✓ Skin to skin contact/ Encourage breastfeeding  Management of 3 rd Stage of Labor Delivery of placenta Examination of placenta Repair of episiotomy Management of 3 rd Stage of Labor ▪ Delivery of placenta: ✓ Delivery of placenta within 5 minutes up to 30 minutes after the delivery of the infant. ▪ Signs of placental separation: ✓ Lengthening of cord ✓ Change in shape of uterus-hard and globular ✓ Gush of blood from vagina Management of 3 rd Stage of Labor ▪ Examination of placenta ✓ The placenta, membranes and umbilical cord should be examined for completeness and anomalies. ✓ The perineum, valval outlet and vagina should be examined for lacerations. ✓ Administering an oxytocin after placental expulsion. ✓ Providing warmth by replacing warmed blankets over the women ✓ Applying an ice pack to the perineal area.  Management of 4 th Stage of Labor Observe Check Management of 4 th Stage of Labor The 2 hours after delivery is a critical period , postpartum hemorrhage can occur due to relaxation of uterus ▪ Observe for : -Bleeding, Blood pressure and Pulse every 15 minutes ▪ Check ✓ Uterus: -make sure it is firm and not relaxing ✓ Bladder: it should be empty (it may interfere with uterine retraction) Thank You