Chapter 13: Nursing Care During Labor And Birth

Question 1

What is the priorities for a focused assessment?

Answer 1

• Determine condition of mother & fetus

- If birth is imminent

Question 2

Focused assessment includes

Answer 2

• FHR
• Maternal VS
• Impending Birht

Question 3

Focused Assessment: FHR

Answer 3

• Intermittent auscultation for termed fetus.
• Normal rate and rhythm
• Note presence of acceleration and absconded of decelerations.

Question 4

Focused Assessment: Maternal VS

Answer 4

-Assessed to identify HTN or infection: BP and temperature

Question 5

HTN or preeclampsia in pregnancy

Answer 5

140/90 or higher

Question 6

Maternal temperature of 38 C (100.4 F) or higher suggests

Answer 6

Infection

Question 7

Impending Birth sings include

Answer 7

• Grunting sounds
• Bearing down
• Sitting on one buttock
• “Baby is coming”

Question 8

Comfort measures during labor and birth include **

Answer 8

1. Lighting
2. Temperature
3. Cleanliness
4. Mouth care
5. Bladder
6. Positioning
7. Water

Question 9

Comfort measures during labor & birth: Lighting

Answer 9

Soft, indirect lighting is soothing.

Bright overhead light is irritating.

Question 10

Comfort measures during labor & birth: Temeprature

Answer 10

• Mom is usually hot and perspiring. Cool, damp washcloths on her face and neck promote comfort.
• Electrical fan
• Socks if feet get cold

Question 11

Comfort measures during labor & birth: Cleanliness

Answer 11

Bloody show and amniotic fluid leak from the vagina during labor.

• Change sheets and gown as need, keep her dry and comfortable.
• Change the underpad regularly to reduce microorganisms that may ascend into vagina. (Folded towel or bath blanket absorbs larger quantities of amniotic fluid than the pad alone)

Question 12

Comfort measures during labor & birth: Mouth care

Answer 12

• Ice chips, frozen juice bars, and hard candy on a stick reduce discomfort from dry mouth.
• Brushing teeth and simply rinsing mouth.
• Lip balm

Question 13

Comfort measures during labor & birth: Bladder

Answer 13

Get her to empty her bladder and check her suprapubic area at least every 2 hours.

Question 14

How can a full bladder affect labor and birth?

Answer 14

• Intensifies pain during labor
• Delay fetal descent
• Cause pain that remains after epidural is started

Question 15

Comfort measures during labor & birth: Positoning

Answer 15

-Movement and frequent position changes

Question 16

Movement and frequent position changes in labor promotes:

Answer 16

1. Decrease in pain, improve maternal-fetal circulation
2. Improves the strength and effectiveness of contractions
3. Decrease length of labor
4. Facilitate fetal descent
5. Decrease perineal trauma and episiotomies.

Question 17

Six physiologic principles related to maternal positioning in labor

Answer 17

1. ) promote spinal flexion
2. ) promote an increase in the uteru-spinal drive angle
3. ) facilitate stronger expulsive forces
4. ) promote a good fit
5. ) increase pelvic diameters
6. ) facilitate occiput posterior rotation. “C” shape

Question 18

Back labor

Answer 18

Common when the back of the fetal head puts pressure on the woman’s sacral promontory. (Occiput posterior position)

Question 19

Positions that encourage the fetus to move away from the sacral promontory are:

Answer 19

• Hands-and-knees position
• Lean forward over a birthing ball (sturdy beach ball)

These two reduce back pain and enhance the internal rotation mechanism of labor.

Question 20

Women with epidural needs assisting with

Answer 20

Position changes q30-45 minutes

Question 21

Comfort measures during labor & birth: Water

Answer 21

• Can slow labor if used in latent labor.

- Breast stimulation by a shower or whirlpool often provokes contractions by secretion of natural oxytocin.

Question 22

Water should be used in

Answer 22

Active labor or if persistent

Question 23

Nonpharmacologic ???***

Answer 23

….

Question 24

While the nurse cares for the mother, minimal information can be quickly gathered if birth is imminent:

Answer 24

• Name of her physician or nurse-midwife if she had prenatal care
• Names of mother and support person(s)
• Number of pregnancies and prior births, including whether the birth was vaginal or cesarean
• Status of membranes
• Expected date of delivery
• Problems during this or other pregnancies
• Allergies to medications, foods, or other substances
• Time and type of last oral intake
• Maternal vital signs and FHR

Question 25

Women usually feel the urge to push when

Answer 25

· the cervix is fully dilated and effaced | · fetus descends to about +1 station or lower and internal rotation.

Question 26

Pushing against a cervix does not easily yield to pressure therefore

Answer 26

It can lead to cervical edema -> blocks labor progress or cervical laceration.

Question 27

What should be taught during the first stage?

Answer 27

Teach woman to exhale in short breaths if pushing is likely to injure their cervix or cause cervical edema.

Question 28

Second Stage: Laboring down

Answer 28

Technique of delaying pushing until reflux urge occurs.

Question 29

Laboring down allows for

Answer 29

- Uterine contractions to cause most fetal internal rotation and descent after full dilation naturally. - Rest before actively pushing baby out.

Question 30

Pushing vigorously sooner before onset of the reflux urge can cause

Answer 30

Birth canal injury.

Question 31

If fetal descent has not occurred after 2 hours,

Answer 31

Open glottis pushing (w/o holding breath)

Question 32

Laboring down results in

Answer 32

- Less maternal fatigue - Decreased: pushing time, risk of instrument-assisted and cesarean births - APGAR sores equivalent to those of women who pushed immediately on fully cervical dilation.

Question 33

Vertical maternal position enhances

Answer 33

Fetal descent

Question 34

Squatting

Answer 34

- Ideal position for pushing because it enlarges the pelvic outlet slightly and adds the force of gravity to the mother’s efforts - Good if she has small pelvis or fetus to large

Question 35

What are other positions that have gravitational advantage?

Answer 35

o Pushing while sitting on birthing ball o Pulling against squatting bar o Tug of war game

Question 36

What should you teach a patient while she is pushing in a sitting or semi-sitting position?

Answer 36

- Teach them to curve their body around her uterus like a “C” shape rather than arching their back. - Most effective, woman should pull on her knees, handholds, or a squat bar while pushing. - Also hold the “C” shape, in her upper body, if she is pushing on her side.

Question 37

What methods and breathing patterns should you teach your patient?

Answer 37

·Push w/ abdominal muscle while relaxing perineum area; begin by taking a breath and exhaling. Take another breath and exhale while pushing for 4-6 seconds at a time. ·Modest/woman that fear loosing control may inhibit their pushing efforts if you say “push like your taking a dump” instead tell them to push down and out under her symphysis, following the pelvic curve. · Showing them a pic or diagram will help them to visualize the curve.

Question 38

Methods that reduce BF to placenta & is fatiguing include

Answer 38

- Sustained pushing while holding a breath (valsualva maneuver or purple pushing) - Pushing more than 4x per contraction

Question 39

Encouragement during labor and delivery

Answer 39

▪Tell the woman when her labor is progressing; if she can see her efforts are effective, she has more courage to continue. · Help her touch/ see the baby’s head with a mirror as crowing occurs. · Praises the woman, reinforces her actions, which gives her a sense of control, respect and support. · If one effort doesn’t work after 3-5 contraction, encourage them to try other techniques.

Question 40

Giving to self

Answer 40

▪ Do not overlook, even independent woman may become dependent during labor and need human contact. ▪ Although mom and support person may be prepared they often welcome suggestion and affirmation from the nurse. Gentle coaching and encouragement.

Question 41

Offering pharmacological measures

Answer 41

▪Be informative but neutral when explaining about available pain medication ▪She may feel disappointed and guilty because she took medication despite her planned unmediated birth ▪This should be done as early in the labor as possible while the woman is still in control and can think critically

Question 42

When offering pharmacological measures, include

Answer 42

· Include the option for the woman to change her mind and how that will be communicated · Although the event may not be what she wanted, encouraging the woman to express her feeling helps her put it into perspective.