Care of the Client During Childbirth - Current Issues in Newborn Nursing - Lecture Slides, Slides of Nursing

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Lecture Eight: Care of the

Client During Childbirth

Maternal Assessment

• Review prenatal Hx
• Present complaint
• Vital signs
• Weight
• Lungs
• Fundus
• Edema
• Hydration
• Perineum
  • Labor/ Fetal status
  • Laboratory evaluation
  • Cultural assessment
  • Preparation for childbirth
  • Response to labor
  • Anxiety
  • Sounds during labor
  • Support system

Vital signs

• BP < 130 systolic and < 85 diastolic or no more than 15-20 mm Hg rise in systolic pressure over baseline BP in early pregnancy
• Pulse 60 – 90 bpm
• Respirations 14 – 22
  • Pulse ox 95% or greater
  • Temperature 98 – 99.6 F
  • Weight: 25 – 30 lbs greater than pre- pregnant weight (weight gain > 30 lbs edema, obesity)

System Assessment

• Lungs: auscultate, normal breath sounds

clear and equal

• Fundus: Measure in cms, at 40 weeks’

gestation located just below xiphoid

process

• Edema: Slight amount dependent edema
• Reflexes: Check deep tendon reflexes for

hyperactivity, check clonus

• Hydration: Normal skin turgor

Sterile Vaginal Examination

• Perineum: Assess for leaking fluid or

ruptured bag of water (BOW), vaginal

bleeding, bloody show

• Assess cervical dilatation (fingertip to 10

cms), effacement (0% to 100%), station

(-4 to +4), Ballotment, position (ROA,

ROP, etc.).

• Assess membranes: Intact, leaking, or

ruptured.

Assess Membranes

• If rupture BOW is suspected, do a nitrazine and fern test prior to vaginal examination.
• Nitrazine tape will not turn if not ruptured or leaking. Nitrazine will turn blue or blue green if fluid is leaking. Checks pH-amniotic fluid is alkaline. Ferning will appear under microscopic exam.
• Check color and odor: Green means meconium; foul odor means amnionitis

Laboratory Evaluation

• CBC: Hgb…12-16 g/dL; Hct.. 38% - 47%
• RBC: 4.2 – 5.
• WBC: 4500 – 11,000 ( may be 20,000)
• Platelets: 150,000 – 400,
• Urinalysis: WNL
• Serologic testing: Positive may require

follow-up titre

• Rh factor

Cultural Assessment

• Do you have a birth plan?
• Who would you like to remain with you

during your labor and birth?

• What would you like to wear during labor?
• What activity would you like during labor?
• What position would you like for birth?
• Is there anything special you would like?
• Remember privacy.

First Stage of Labor: LATENT Phase

• 0 – 3 cms dilation
• Q 3 – 30 min, contraction (ctx) frequency
• 20 – 40 sec, ctx duration
• Mild to moderate intensity on palpation;

25 – 40 mmHg with Intrauterine Pressure

Catheter (IUPC)

• Baseline Sterile Vaginal Exam (SVE)

Care During the First Stage: Latent Phase

• May ambulate if membranes intact
• Evaluate physical parameters: Maternal temperature every 4 hrs unless the temperature is > 99.6 or RBOW
• BP, P & R every 1 hr. If abnormal, increase monitoring and notify MD/CNM
• Evaluate FHR every 30-60 minutes
• Encourage frequent change of position
• Encourage to void every 2 hrs
• Offer fluid in the form of ice chips, clear liquids

Care During the First Stage: Active Phase

• Encourage side-lying position, pillows for support
• Evaluate physical parameters: Maternal temperature every 4 hrs unless the temperature is > 99.6 or RBOW.
• BP, P & R every 30 min - 1 hr. If abnormal, increase monitoring and notify MD/CNM
• Evaluate FHR every 30 minutes
• Encourage breathing patterns, back rubs, sacral pressure, effleurage.
• Encourage to void every 2 hrs
• Offer fluid in the form of ice chips, clear liquids
• Change chux frequently.
• Pharmacologic support may be administered.

First Stage of Labor: TRANSITION Phase

• 8 – 10 cms dilation
• Q 1 1/2 – 2 min, contraction (ctx)

frequency

• 60 – 90 sec, ctx duration
• Moderate to strong intensity on palpation;

70 – 90 mmHg with Intrauterine Pressure

Catheter (IUPC)

• If BOW ruptures, assess FHR

The Second Stage of Labor

• 10 cms dilation (Complete)
• Pushing with contractions
• Q 1 1/2 – 2 min, contraction (ctx) frequency
• 60 – 90 sec, ctx duration
• Moderate to strong intensity on palpation; 70 – 90 mmHg with Intrauterine Pressure Catheter (IUPC)
• SVE increase to check progress
• Nullipara’s ready with a bulge, Multips sooner

Care During the Second Stage (pg.567- 568)

• Encourage side-lying position, pillows for support
• Evaluate physical parameters: BP, P & R every 5 - 15 min. If abnormal, increase monitoring and notify MD/CNM
• Evaluate FHR every 5 - 15 minutes.
• Assist with positioning ; Left lateral, Squatting, Semi Fowlers, & Hands and knees.
• May need straight catheterization
• Offer fluid in the form of ice chips, ointment for lips.
• Perineal massage with lubricant may be used.
• Encouragement and assurance is important.
• Pushing begins.