birth related procedures 10

Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen

Birth-Related Procedures

Learning Outcome

Explain the methods, purpose, and contraindications of external and podalic

versions that determine nursing care management.

External Version

• May be done after 36 weeks’ gestation to change breech presentation to cephalic presentation

• Physician applies external manipulation to maternal abdomen

• Fetal part must not be engaged

External Version

• Reactive NST performed to establish fetal well-being

• Tocolytic given during procedure to relax the uterus

Internal Version

• Podalic version – used to turn second twin during vaginal birth

• Used only if second fetus does not descend readily and heartbeat is not assuring

• Physician reaches into uterus and grabs feet of fetus and pulls them down through cervix

Internal Version

• Tocolytic given during procedure to relax uterus

Learning Outcome

Describe the use of amniotomy and the nursing care management of woman and

fetus.

Purpose of Amniotomy

• Stimulate or induce labor• Apply internal fetal or contraction monitors• Obtain fetal scalp blood sample for pH

monitoring• Assess color and composition of amniotic

Learning Outcome

Compare the methods for inducing labor, explaining their advantages and

disadvantages in determining the nursing management for women during labor

induction.

Cervical Ripening

• Consists of effacement and softening of the cervix

• May be used at or near term to enhance success of and reduce time needed for labor induction when continuing pregnancy is undesirable

• May hasten beginning of labor or shorten course of labor

Cervical Ripening

• May cause hyperstimulation of uterus• Pharmacologic agents include Cytotec and

prostaglandin agents – can cause uterine stimulation after insertion

Stripping of the Membranes

• Mechanical method: Gloved finger inserted into internal os and rotated 360 degrees twice – separating amniotic membranes lying against lower uterine segment

Stripping of the Membranes

• Does not require monitoring or other assessments – often done as outpatient service

• May not induce labor – if labor is initiated, it typically begins within 48 hours

• May cause bleeding

Pitocin Infusion

• Usually effective at producing contractions – may cause hyperstimulation of the uterus

• Requires small, precise dosage• Maximum rate and dosing interval based

on facility protocol, clinician order, individual situation, and maternal-fetal response

Pitocin Infusion

• Palpating uterus essential, unless IUPC in place

• May initially decrease blood pressure

Learning Outcome 23-4

Describe the measures to preventepisiotomy, the types of episiotomy and associated nursing care management.

Episiotomy Types

• Surgical incision of perineal body to enlarge outlet – commonly used to avoid spontaneous laceration

Episiotomy Types

• Two types– Midline: Incision begins at bottom center of

perineal body and extends straight down midline to fibers

– Mediolateral: Incision begins in midline of posterior fourchette and extends at 45 degree angle downward to right or left

• Episiotomy usually performed with regional or local anesthesia

Types of Episiotomy

Nursing Care

• During procedure, provide mother with support and comfort

• Use distraction if needed – if procedure is uncomfortable, act as advocate for mother

• Document type of episiotomy in records and report to subsequent caregivers

• After procedure, provide comfort and apply ice pack

Nursing Care

• Assess perineal area frequently – inspect every 15 minutes during first hour after birth for redness, edema, tenderness, ecchymosis, and hematomas

• Apply ice pack immediately in fourth stage• Instruct mother in perineal hygiene and

comfort measures

Learning Outcome

Explain the indications, maternal and neonatal risks that impact nursing care

management during forceps-assisted birth.

Indications

• Maternal heart disease• Maternal pulmonary edema• Maternal infection• Maternal exhaustion• Fetal stress

Indications

• Premature placental separation• Need for shorter second stage of labor• Heavy regional block with ineffective

pushing

Applications of Forceps

• Newborn may experience– Bruising– Edema– Facial lacerations– Cephalhematoma– Transient facial paralysis– Cerebral hemorrhage

• Woman may experience– Vaginal or perineal lacerations– Infection secondary to lacerations– Increased bleeding– Bruising– Perineal edema

Learning Outcome

Describe the use of and risk of vacuum extraction use to assist birth.

Vacuum Extractor

• Assists birth by applying suction to fetal head

• Should be progressive descent with first two pulls, procedure should be limited to prevent cephalhematoma – risk increases if birth not within six minutes

• Increases risk for jaundice – due to reabsorption of bruising at cup attachment site

Vacuum Extractor

Learning Outcome

Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing

Indications

• Most common indications for cesarean birth– Fetal distress– Active genital herpes– Multiple gestation (three or more fetuses)– Umbilical cord prolapse– Tumors that obstruct birth canal– Lack of labor progression

Indications

• Most common indications for cesarean birth– Maternal infection– Pelvic size disproportion– Placenta previa– Previous cesarean section

Preparation

• Preparation for cesarean birth requires– Establishing IV lines– Placing indwelling catheter– Performing abdominal prep

Teaching

• Teaching needs include– What to expect before, during, and after

delivery– Why it is being done– What sensations the woman will experience– Role of significant others– Interaction with newborn

Nursing Care

• Routine postpartal care including:– Fundal checks– Care of incision– Monitoring Intake & Output and maintaining IV

access– Administer and teach about post-op

medications– Assessment of respiratory system– Assessment of bowel sounds

Uterine Incisions for Cesarean Birth

Learning Outcome

Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth

following cesarean birth.

Vaginal Birth After Cesarean Birth

• Can occur after trial of labor in cases of nonrecurring indications for cesarean birth

• Most common risks are– Hemorrhage– Surgical injuries– Uterine rupture– Infant death or neurological complications

Nursing Care

• Continuous EFM• Internal Monitoring• IV fluids• Avoid Pitocin if at all possible• Classic or T uterine incision is

contraindication to VBAC

Nursing Care

• Important for nurse to support couple, explore their feelings, and provide information throughout labor

birth related procedures 10

learning outcome

nursing management

types of episiotomy

impact nursing care

vaginal birth

maternal abdomen fetal

maternalfetal response

labor induction

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