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INTRAPARTUM:Labor and Birth
Maternal-Newborn and Child NursingLondon, Ladewig, Ball, & Bindler
Prepared by Mary Ann Gagen, Professor of Nursing
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“Pa…I think it’s time to go!”
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Process and Stages of Labor and Birth: Chapter 15
Critical Factors in Labor The birth passage The fetus The relationship between the passage
and the fetus Primary forces of labor Psychosocial considerations
Table 15-1: p 310
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The Birth Passage
Implications of Pelvic types for Labor and Delivery Table 15-2, p 310
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The Fetus Head
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The Fetus
Attitude Lie Presentation
Top: Fetal Attitude flexion, fetal lie longitudinal
Bottom: Fetal Attitude flexion, fetal lie transverse
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Relationship between the passage and the fetus
Engagement Station Fetal position
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The Forces of Labor
Primary Secondary Phases of Contractions
Increment Acme Decrement
Characteristics of contractions Frequency Duration Intensity
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Psychosocial Considerations
Motivation for pregnancy
Support Preparation Trust in staff Maintaining control Cultural influences Table 15-3
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Physiology of Labor
Premonitory signs of labor Lightening or quickening Braxton Hicks Contractions Cervical changes Bloody show Rupture of membranes Sudden burst of energy Other: diarrhea, nausea, etc
True vs False LaborTable 15-4: p 321
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Stages of Labor and Birth
First stage Latent Active Transition
Second stage Crowning Positional changes of the fetus
Table 15-5: Characteristics of Labor, p 323
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Stages: cont’d
Third stage Placental
separation Placental delivery
Fourth stage 1-4 hours
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Stages: cont’d
Maternal responses to labor Cardio, B/P Respiratory Renal, GI Immune/blood Pain
Causes Fetal responses
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Intrapartal Nursing AssessmentChapter 16
Admission assessment Data Collection Assessments
Assessment Guide, pp 335 - 339
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Intrapartal Nursing Assessment, cont’d
Evaluating labor progress Leopold’s Maneuvers FHR and Pattern
Accelerations Decelerations Early Late Variable
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Evaluations of FHR Tracings
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Intrapartal Nursing Assessmentcont’d
Contractions Frequency Intensity Duration
Vaginal exam
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The Family in Childbirth:Needs and Care, Chapter 17
Nursing management The admission process The first stage of labor Family expectations Cultural beliefs
Pain, modesty Promotion of comfort Clinical Pathways
pp355 - 357
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The Family in Childbirth: Needs and Care, cont’d
Nursing management Second stage
comfort Third stage
Initial care of newborn Apgar Umbilical cord Warmth Newborn identification
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The Family in Childbirth: Needs and Care, cont’d
Nursing management
Fourth stage Delivery of placenta
Enhancing attachment