9 Labor and Delivery
9 Labor and Delivery
9 Labor and Delivery
labor and delivery. Purpose: 1. Assess fetal and maternal well being
2. To help the woman feel confident in her ability to control pain and the progress of
labor 3. To assist the pregnant woman to a safe delivery of the infant Indication: Pregnant woman experiencing true labor pains Client Education: 1. Provide information regarding labor pattern, progress of labor and planned intervention 2. Teach the woman about the proper breathing techniques during labor and delivery.
2. Some institutions permit the father to accompany the mother in the delivery room
3. Some physician may order enema to ensure that no stool would be expelled during delivery 4. Ambulation is allowed if the presenting part is engaged, the membranes are not rupture and the woman is not medicated
Equipments:
OB bundle (sterile gowns, 2 leggings and 3 towels) Kelly pad, Primi set (2 Kellies, 1 needle holder, 1 tissue forceps) Bandage scissors Suture scissors local anesthesia
RATIONALE To obtain baseline data and determine For any problems. Blood pressure is taken between contractions because BP rises 5-15 mm hg during a contraction. An increase in BP may Indicate the development eclampsia. A decrease in BP may indicate hemorrhage.
2. Obtain relevant data related to the pregnant woman such as LMP, AOG, and EDC. 3. Place client on a supine position with knees flexed, and measure the fundic height and perform Leopolds maneuver.(refer to the checklist)
To relax the abdomen. Performing Leopolds maneuver will determine the feral position
A full bladder may impede descent of the presenting part; over distention may cause injury as well as postpartum voiding difficulty.
This will reduce muscle tension, relieves pressure and promotes fetal descent
8.
the Attending Physician. CARING FOR A WOMAN IN THE 2ND STAGE OF LABOR 1. Wash hands. Wear mask and bonnet 2. Gather the equipments needed
Deters spread of infection Organization facilitates ease in the performance of the task
3. Transfer the woman from the labor room to the delivery room when the cervix is fully dilated. 4. Assist patient into the delivery table and place her in lithotomy position with both legs hanging in the tables stirrups
PROCEDURE 8. Arrange the instruments in the mayo table according to their uses.
RATIONALE To facilitate a systematic progression of the procedure Exhaling during contraction prevents valvalvas maneuver which could impede blood return to the heart because of increase intrathoracic pressure. This could also interfere with blood supply to the uterus. The woman is asked to push until the occiput of the fetal head is firmly at the pubic arch. Panting in between contractions can minimize the urge to push.
Supporting the perineum will prevent laceration and performing episiotomy will prevent tearing of the perineum and release pressure of the fetal head with birth.
Pressing against the incised perineum will seal the cut edges and minimize bleeding
Passing fingers along the occiput of the newborns neck determines whether a loop of umbilical cord is encircling the neck. If a loop is felt, it is gently loosed and drawn over to the fetal head. If it is tight, it must be clamped and cut before shoulders are delivered. Suctioning removes secretions and prevents aspiration
14. As the head restitute and rotates, give The downward pull allows the delivery of the
a steady, gentle downward pull and slowly give upward lift. anterior shoulder and the upward lift will deliver the posterior shoulder to slide over the perineum
PROCEDURE
RATIONALE The baby is slippery and may slip off. The time of delivery serves as the time of birth. It is the responsibility of the nurse to check and record accurate data especially the gender and time of birth.
2 clamps will prevent the flow of blood from the baby and from the placenta during cutting. Clamping the cord is a part of the stimulus that initiates the first breath.
Placing the baby on the abdomen can promote bonding and visualization of the newborn. Drying can prevent heat loss. For immediate care of the neonate and prevent complications
CARING FOR A WOMAN IN THE 3rd STAGE OF LABOR 1. Once you see signs of placental separation, deliver the placenta using a gentle touch on the cord Signs of placental separation are lengthening of the cord, a sudden gush of blood and changing of the size of the lower abdomen
2. When the placenta is coming out, twist the trailing membrane until it is completely delivered
To ascertain that placenta is intact and normal in appearance and weight. Normally, a placenta is one-sixth of the weight of the infant. To check and for bleeders and note for laceration to be repaired. To prevent contamination of the sterile field. Anesthesia provides can lessen pain sensation during the repair
RATIONALE This will remove blood stains, and promote comfort Removing Kelly pad after flushing will prevent a messy workplace To promote uterine contraction Lowering the legs simultaneously can prevent back injury. The mother may experience chill and shaking sensation. Clean gown and a warm blanket can provide her comfort.
Bloody instruments must be properly cleaned to eliminate microorganism. After care will ensure a clean environment for labor and childbirth.