The Labor Process

Labor is the series of events by which uterine contractions and

abdominal pressure expel the fetus and placenta from the woman’s

body.

Regular contractions cause progressive dilatation of the cervix

and sufficient muscular force to allow the baby to be pushed to the

outside.

A time of change, both ending and beginning for the woman,

fetus and family.

Woman uses all psychological and physical coping methods.

Nursing Process

Assessment

Outcome Identification and Planning

Implementation

Outcome Evaluation

Theories of Labor Onset

Unknown

Factors:

Uterine muscle stretching releases prostaglandin's.

Pressure on cervix stimulates release of oxytocin from posterior

pituitary.

Oxytocin stimulation, works together with prostaglandin to

initiate contractions.

Increasing estrogen in relation to progesterone stimulates

contractions.

Placental age, triggers contractions at a set point.

Rising fetal cortisol levels, reduce progesterone formation and

increase prostaglandin formation.

Fetal membrane production of prostaglandin which stimulates

contractions

Seasonal and time influences.

Signs of Labor

Preliminary Signs of Labor:

Before labor, the woman experiences subtle signs of labor. Teach

how to recognize these.

Lightening-descent of fetal presenting part into the pelvis.

Occurs 10 to 14 days before labor begins.

Shooting leg pains, increased vaginal discharge, urinary

frequency.

Increase in Level of Activity:

Feeling full of energy due to increase in epinephrine release

initiated by decreased progesterone produced by placenta.

Braxton Hicks Contractions:

Stronger 1 week to days before labor.

Support if not true contractions.

Ripening of the Cervix:

Internal sign seen with pelvic exam.

Cervix is butter-soft and tips forward.

Signs of True Labor

Uterine and cervical changes.

Uterine Contractions:

Surest sign that labor has begun.

Effective, productive, involuntary uterine contractions.

Show or Bloody Show:

Blood mixed with mucus when the mucus plug is expelled.

Pink tinged.

Rupture of the Membranes:

Either sudden gush or scanty, slow seeping of clear fluid from the

vagina.

Amniotic fluid continues to be produced until delivery of the

membranes.

Early rupture is good, fetal head settles snugly into the pelvis.

Risks: infection and cord prolapse.

Induce after 24 hours.

Components of Labor

Four integrated concepts:

Passage

Passenger

Power of labor

Psyche of the woman is preserved.

1. Passage:

Route the fetus must travel from uterus through cervix and

vagina to external perineum.

Diagonal conjugate-anterior-posterior diameter of the inlet.

Transverse diameter of the outlet.

Pelvis structure at fault or fetal head is presented to the birth

canal at a less than its narrowest diameter, not because the head is to

large. Avoid negative thoughts about the baby.

2. Passenger:

Fetus is the passenger and must pass through the pelvic ring.

Depends on fetal skull and alignment with the pelvis.

Structure of the Fetal Skull:

Cranium-upper portion of skull

4 superior bones-fontal, 2 parietal, and occipital are important in

childbirth.

4 at base of cranium-sphenoid bone, ethmoid bone and 2

temporal bones.

Chin-mentum can be a presenting part.

Suture lines allow cranial bones to move and overlap, thus

molding or diminishing the size of the skull so it can pass through the

birth canal.

Fontanelles are membrane-covered spaces found at junction of

the main suture lines.

Compress during birth to aid in molding of the fetal head.

Anterior fontanelle (bregma) lies a the junction of the coronal

and sagittal sutures.

Diamond shaped

Anteroposterior diameter-3 to 4 cm.

Transverse diameter-2 to 3 cm.

Posterior fontanelle-lies at junction of lambdoidal and sagittal

sutures.

Triangular shape

2 cm. across widest part.

Vertex-space between the two fontanelles

Diameters of the Fetal Skull:

Shape is wider anteroposterior than its transverse diameter.

Fetus must present transverse diameter to the smaller diameter

of the maternal pelvis.

Biparital diameter-9.25 cm.

Outlet space-9.5 to 11.5 cm.

Engagement – setting of fetal head into the pelvis.

Depends on degree of flexion of fetal head.

Inlet-12.4 to 13.5 cm.

Molding:

Change in shape of the fetal skull produced by the force of

uterine contractions pressing the vertex against the not yet dilated

cervix.

Overlap and cause head to become narrower but longer.

Lasts 1 to 2 days not permanent.

No skull molding occurs when fetus is breech; buttocks are first.

Fetal Presentation and Position:

Attitude-degree of flexion the fetus assumes during labor or

relation of the fetal parts to each other.

Good attitude-complete flexion:

Spinal column bowed forward

Head flexed forward-chin touches the sternum

Arms flexed and folded on chest

Thighs flexed onto abdomen and calves pressed against

posterior aspect of thighs

Ovoid shape

Moderate flexion-military position-chin not touching the chest.

Partial extension-brow of head presents first.

Engagement – settling of presenting part of fetus far enough into

pelvis to be at level of ischial spines, at midpoint of pelvis.

Floating-a presenting part not engaged.

Dipping-a presenting part that is descending but not yet reached

iliac spines

Assessed by vaginal and cervical exam.

Station:

Relationship of presenting part of fetus to level of ischial spines

Station 0 - presenting part at level of ischial spines (head is

engaged).

Minus station – presenting part above the spines (-1cm to - 4cm)

(floating).

Plus station – presenting part is below the spines (+1cm to

+4cm) at +3 to +4 station presenting part is at perineum and can be

seen if vulva is separated (crowning).

Fetal Lie:

Lie is relationship between long axis of fetal body and long axis

of woman’s body.

99% are longitudinal lie.

Types of Fetal Presentation:

Demotes the body part that will first contact the cervix or deliver

first. Determined by fetal lie and degree of flexion (attitude).

Cephalic presentation-head is the fetal part that first contacts

the cervix.

Four types:

Vertex-best

Brow

Face

Mentum

Caput succedaneum-edematous area of fetal skull that contacted

the cervix during labor.

Breech Presentation:

Buttocks or feet are the first body part to contact the cervix.

3% of births

Affected by attitude

Types:

Complete

Frank

Footling

Shoulder Presentation:

Transverse lie, fetus is lying horizontally in the pelvis so long axis

is perpendicular to mother.

Presenting part-shoulders, iliac crest, hand or elbow.

Fewer than 1%

Cesarean birth

Types of Fetal Position:

Relationship of presenting part to a specific quadrant of the

woman’s pelvis.

Pelvis is divided into 4 quadrants according to the mother’s right

and left.

1. Right anterior

2. Left anterior

3. Right posterior

4. Left posterior

Abbreviations: (3 letters)

Middle letter denotes fetal landmark: O for occiput, M for

mentum or chin, SA for sacrum, A for acromion process.

First letter defines whether the landmark is pointing to the

mother’s right R or left L.

Last letter defines whether the landmark points anteriorly A,

posteriorly P, or transversely T.

LOA-left occipitanterior- most common.

ROP-right occipitoposterior-second

Six common positions

Position influences the process and efficiency of labor.

Fastest-ROA or LOA

Extended-ROP or LOP-more painful

Importance of Determining Fetal Presentation and Presentation:

Presentations other than vertex puts the fetus at risk.

Implies proportional differences between fetus and pelvis.

Methods to determine position, presentation and lie:

1. Abdominal inspection and palpation

2. Vaginal exam

3. Auscultation of fetal heart tones

4. Sonography

Mechanisms of Labor (Cardinal Movements)

A number of different position changes to keep the smallest

diameter of fetal head presenting to the smallest diameter of the birth

canal.

Descent

Downward movement of biparietal diameter of fetal head to

within pelvic inlet.

Flexion

Fetal head bends forward onto chest.

Suboccipitobregmatic diameter.

Internal Rotation

Head flexes as it touches pelvic floor, and occiput rotates until it

is superior or just below the symphysis pubis, bringing head into best

diameter for the outlet of pelvis.

Brings shoulders into position to enter the inlet.

Extension

As occiput is born, back of neck stops beneath the pubic arch

and acts as a pivot for the rest of the head.

Head extends and foremost parts of head, face and chin are

born.

External Rotation

Immediately after head of infant is born

Head rotates from anteroposterior position back to diagonal or

transverse position of the early part of labor.

Anterior shoulder is born first, assisted by downward flexion of

infant’s head.

Expulsion

Once shoulders are born, the rest of the baby is born easily and

smoothly.

End of the pelvic division of labor.

Supplied by the fundus of the uterus.

Implemented by uterine contractions

A process that causes cervical dilatation

Then expulsion

After full dilatation of cervix power is abdominal muscles.

Do not bear down with abdominal muscles until cervix is fully

dilated. Could cause fetal and cervical damage.

Uterine Contractions:

Origin:

Begin at a pacemaker point located in the myometrium near one

of the uterotubal junctions.

Each contraction begins at that point and then sweeps down

over the uterus as a wave

After a short rest period another contraction is initiated.

In early labor, pacemaker is not synchronous

Pacemaker becomes more attuned to calcium concentration in

myometrium and begins to function smoothly.

Phases

1. Increment-when intensity of contraction increases.

2. Acme-when the contraction is at its strongest.

3. Decrement-when intensity decreases.

Between contractions the uterus rests 10 min.early labor, 2 to 3

min. later.

Duration increasing from 20 to 30 seconds to a range of 60 to 90

seconds.

Contour Changes

Upper-becomes thicker and active, preparing to exert strength to

expel fetus.

Lower segment-becomes thin-walled, supple, and passive so it

can be pushed out.

Physiologic retraction ring-ridge on inner uterine surface.

Contour changes to elongated.

Pathologic retraction ring (Bandl’s ring)-abdominal indentation

that is a danger sign of impending rupture of lower uterine segment.

Cervical Changes:

Effacement-shortening and thinning of the cervical canal (normal

1 to 2 cm.)

Dilatation-enlargement of cervical canal from a few millimeters

to 10 cm.

Increases diameter of cervical canal lumen by pulling cervix up

over presenting part.

Fluid filled membranes press against cervix.

Psyche

Psychological state or feelings that women bring into labor with

them.

Fright, apprehension,excitement, awe.

Debriefing time.

Stages of Labor

Divided into 3 stages:

First stage of dilatation-beginning with true labor contractions

and ending with cervix fully dilated.

Second stage-from time of full dilatation until the infant is born.

Third or placental stage-from the time the infant is born until

after delivery of the placenta.

Fourth stage-first 1 to 4 hours after birth of the placenta.

First Stage of Labor

Divided into 3 phases:

1. Latent

2. Active

3. Transition

Latent phase:

Preparatory phase-begins at the onset of regularly perceived

uterine contractions and ends when rapid cervical dilation begins.

Contractions-mild and short 20 to 40 sec.

Cervical effacement occurs

Cervix dilates from 0 to 3 cm

Phase lasts approx. 6 hours in nullipara and 4.5 hours in

multipara.

Analgesics given too early in labor will prolong this phase.

Walking, preparation for birth, packing, care for siblings.

Active phase:

Cervical dilatation occurs more rapidly, from 4 cm to 7 cm.

Contractions are stronger, lasting from 40 to 60 sec., every 3 to

5 min.

Phase lasts from 3 hours in nullipara to 2 hours in multipara.

Show and rupture of membranes may occur.

True discomfort.

Dilatation 3.5 cm in nullipara per hour to 5 to 9 cm in multipara

per hour.

Analgesics has little effect on progress of labor.

Transition Phase:

Dilatation 8 to 10 cm occur

Contractions at peak of intensity every 2 to 3 min. with duration

of 60 to 90 sec.

If membranes not ruptured, will rupture at 10 cm.

If not occurred-show will be present and mucus plug is released.

First Stage of Labor

Full dilatation and complete cervical effacement occur.

Intense discomfort and nausea/vomiting, feeling of loss of

control, anxiety, panic, irritability.

Her focus is inward on task of birthing.

Peak is identified by slight slowing in rate of dilatation when 9 cm

is reached (deceleration on graph).

At 10 cm irresistible urge to push.

Second Stage of Labor

Full dilatation and cervical effacement to birth of infant.

Contractions change from crescendo-decrescendo pattern to

uncontrollable urge to push.

N/V, she perspires, blood vessels in neck become distended.

Perineum begins to bulge and appear tense.

Anus appears everted, stool expelled, vaginal introitus opens,

fetal head visible.

Crowning – at first slitlike opening then oval, then circular, from

size of dime to that of a quarter, then half-dollar.

She can not stop pushing, all energy is directed toward birth.

Third Stage:

Placental stage begins with the birth of the infant and ends with

delivery of the placenta

Two separate phases:

Placental separation

Placental expulsion

Third Stage of Labor

After birth the uterus can be palpated as a firm, round mass,

inferior to level of umbilicus.

Uterine contractions begin again and organ assumes a discoid

shape until separated, approx. 5 min.

Placental Separation:

Occurs automatically as uterus resumes contractions.

Folding and separation of the placenta occurs.

Active bleeding on maternal surface of placenta and this helps

separate the placenta by pushing it away from its attachment site.

Signs:

Lengthening of the umbilical cord

Sudden gush of vaginal blood

Change in the shape of the uterus

Schultze-shiny and glistening side of placenta fetal surface.

(80%)

Duncan-looks raw, red irregular with ridges, maternal surface.

Third Stage of Labor

Normal blood loss-300 to 500 ml.

Placental Expulsion:

After separation, the placenta is delivered by natural bearing

down effort or gentle pressure on fundus by physician.

Never apply pressure to uterus in uncontracted state or uterus

may evert and hemorrhage.

Placenta can be removed manually.

Saved for stem cell research.

Responses to Labor

Maternal Response:

Almost all body systems are affected.

Cardiovascular

Cardiac output

Blood pressure

Hemopoietic system

Respiratory

Temperature regulation

Fluid balance

Urinary

Musculoskeletal

Gastrointestinal

Neurologic and sensory

Psychological Responses:

Fatigue

Fear

Cultural influences

Fetal responses:

Neurologic system

Cardiovascular

Integumentary

Musculoskeletal

Respiratory

Danger Signs of Labor

Fetal Danger Signs:

High or low fetal heart rate

Meconium

Hyperactivity

Fetal acidosis

Maternal Danger Signs:

Rising or falling blood pressure

Abnormal pulse

Inadequate or prolonged contractions

Pathologic retraction ring

Abnormal lower abdominal contour

Increasing apprehension

Assessment During Labor

Once a woman arrives at a birthing facility:

Initial Interview and Physical Examination:

Extent of woman’s labor

General physical condition

Preparedness for labor and birth

Ask:

Expected date of birth

Frequency, duration and intensity of contractions

Amount and character of show

Rupture of membranes

Vital signs – assess between contractions

Time she last ate

Drug allergies

Past pregnancy history and outcomes

Her birth plans (analgesia, who cuts the cord)

This establishes whether she is in active labor and needs intense

care or earlier stage of labor and interventions can be paced.

Detailed Assessment During the First Stage:

History:

Current pregnancy history

Past pregnancy history

Past health history

Family medical history

Physical Examination:

Includes pelvic exam to confirm presentation and position of

fetus and stage of dilatation.

Abdominal assessment

Estimate fetal size by fundal height (xiphoid)

Presentation and position

Palpate and percuss bladder

Abdominal scars (adhesions)

Skin turgor

Leopold’s Maneuvers:

Observation and palpation to determine fetal presentation and

position.

Assessing Rupture of Membranes:

1 of every 4 labors are spontaneous

Sterile vaginal exam

pH > 6.5 alkaline, nitrazine paper=blue or fern pattern under

microscope.

Normal color clear, green is meconium, yellow indicates blood

incompatibility.

Vaginal Examination:

Extent of cervical effacement and dilatation

Confirm presentation, position, and degree of descent.

Can be done during contractions but is more painful

Do not do exam if bleeding present.

Assessment of Pelvic Adequacy:

Not routine unless no prenatal care

Internal conjugate and ischial tuberosity size

Sonography:

Determines diameter of fetal skull, presentation, presenting part,

position, flexion, degree of descent.

Vital Signs:

T – q 4 hours if membranes ruptured q2hrs

P- q 4hours – 70 to 80 bpm

R – q 4 hours – 18 to 20/min

B/P – q 4 hours – rises 5 to 15 mm Hg with contraction

Laboratory Analysis:

Blood-H&H, VDRL, Hep B antibodies, blood type

Urine-protein, glucose, UA

Assessment of Uterine Contractions:

Length-duration-use monitor or palpate

Intensity-strength-rated as mild, moderate, strong (unable to

indent uterus)

Frequency-from beginning of one contraction to the beginning of

next one.

Initial Fetal Assessment

Auscultation of Fetal Heart Sounds:

Best heard through the fetal back

Count every 30 min. at beginning labor

Every 15 min. during active labor

Every 5 min. during second stage of labor

Electronic Monitoring

External Electronic Monitoring:

Monitors both uterine contractions and FHR continuously or

intermittently

Sensors are strapped to the woman’s abdomen. Transducer

placed over the fundus and ultrasound sensor for the fetus at the level

of the fetal chest.

Internal Electronic Monitoring:

Most precise method

Pressure sensing catheter passed through the vagina.

Inserted after membranes have ruptured and 3 cm dilated.

Monitors frequency, duration, baseline strength, peak strength

Latent phase 5 mm Hg

Active contractions 12 mm Hg

Second stage 20 mm Hg

FHR recording from scalp electrode

When fetal head is engaged, electrode is inserted vaginally and

attached to scalp.

Invasive procedure, risk of uterine infection, limits woman’s

movement.

Telemetry

Allows monitoring of both FHR and uterine contractions; free of

connecting wires.

An internal pressure uterine lead is inserted and fetal scalp

electrode is attached, a miniature radio transmitter is placed in the

vagina that signals to a monitor.

Allows the woman to ambulate.

Fetal Heart Rate Tracing:

Trace FHR and duration and interval of uterine contractions onto

paper rolls.

Uterine contractions on bottom half

FHR on top half

Count number of bold vertical lines (space between two bold

lines represent 60 sec.

Fetal Heart Rate Patterns

Evaluates 3 parameters:

Baseline rate

Variabilities in the baseline rate (long term and short term)

Periodic changes in the rate (acceleration and deceleration)

Electronic Monitoring

Baseline FHR:

Determined by analyzing a range of fetal heart beats recorded

on a 10 min. tracing obtained between contractions.

Normal 120-160 bpm

Bradycardia – below 120 bpm for 10 min.

<100 bpm is sign of hypoxia

Tachycardia – 160 or more for 10 min.

>180 bpm

Variability:

Most reliable indicators of fetal well-being.

Is variation or differing rhythmicity in heart rate over time and is

reflected on FHR tracing as a slight irregularity or jitter to the wave.

Long term-LTV-fluctuations in FHR of 6 to 10 beats occurring 3 to

10 times / min.

Short term-STV- difference between successive heartbeats, 3 to

5 bpm

Rated as present, decreased or absent

Periodic Changes:

Acceleration-temporary normal increases in FHR due to fetal

movement or compression of the umbilical vein during contractions.

Early Decelerations-are periodic decreases in FHR resulting from

pressure on fetal head during contractions. Slowing of FHR.

Follows pattern of contraction beginning when contraction begins

and ending when contraction ends.

Waveform is inverse to contraction

Lowest point of deceleration occurs with peak of contraction.

(mirror image)

Rate rarely falls below 100 bpm and returns quickly to 120 and

160 bpm

Normally occurs late in labor

If early in labor cause for concern

Late Decelerations:

Delayed until 30 to 40 sec after onset of contraction and

continue beyond end of contraction.

Suggests uteroplacental insufficiency or decreased blood flow

through intervillous spaces during uterine contractions.

Lowest point of deceleration occurs near the end of the

contraction instead of at the peak.

Oxytocin-stop or slow rate, change positions, administer IV or O2

Prolonged deceleration last longer than 2 to 3 min but less than

10 min.

Cord compression or maternal hypotension

Variable Decelerations:

Unpredictable times in relation to contractions.

Indicates compression of cord

Change woman’s position from supine to lateral or to

trandelenburg

Administer fluids and O2

May need amnioinfusion

Amnioinfusion:

The addition of fluid into the uterus to supplement amniotic fluid.

Prevents additional cord compression

Sterile catheter is introduced through cervix into uterus.

Attached to IV tubing and warmed NS or LR is infused rapidly. 500ml

initially then rate is adjusted to infuse the least amount to maintain a

monitor pattern without variable decelerations.

Keep woman in lateral recumbent position

Maintain aseptic technique

Monitor temp q 1 hr

Change bed frequently due to continuous flow of solution.

If vaginal leakage stops means head is engaged and fluid will

remain in uterus which may lead to hydramnios or uterine rupture.

Sinusoidal FHR Pattern:

CNS control of heart pacing so impaired that pattern resembles a

undulating wave

Nonperiodic Changes:

Decelerations or accelerations changes that occur at times other

than when the uterus is contracting.

Due to fetal movement, change in maternal position, or

administration of analgesia.

Other Assessment Technique

Scalp Stimulation:

Apply pressure with fingers to fetal scalp

Tactile response increased FHR

If fetus is in distress and becoming acidotic FHR will not increase

Assesses acid base balance in fetus

Fetal Blood Sampling:

Composition determine hypoxia before ECG (pH decreased <

7.20 = hypoxic

Sample taken from scalp into capillary tube

Acoustic Stimulation:

Sharp sound next to woman’s abdomen to produce FHR

acceleration.

Care During First Stage of Labor

Starts at beginning of contractions and ends when cervix is fully

dilated.

Helping the woman feel confident in pain control, progress of

labor and physiologic stability.

Give frequent progress reports.

Respect Contraction Time and do not interrupt the woman during

breathing exercises.

Promote Change of Positions walking, kneeling, squatting

Promote Voiding and Provide Bladder Care. A full bladder

impedes fetal descent.

Void q 2 to 4 hours, catheterize if needed.

Hyperventilation (resp. alkalosis) breath in paper bag.

Offer Support give a cool cloth, TLC

Respect and Promote the Person’s Activities, allow them to

remain with the woman throughout the birth.

Support the Woman’s Pain Management Efforts

Amniotomy artificial rupturing of membranes with amniohook or

hemostat.

Risk for cord prolapse

Monitor FHR immediately

Care During Second Stage of Labor

Full cervical dilation to birth of the newborn.

Preparing the Place of Birth

Birthing Room

Positioning for Birth

Lithotomy-raise both legs up at the same time to prevent back

and lower abdominal strain.

Lateral, Sim’s, dorsal recumbent, semisitting and squatting.

Promoting Effective Pushing:

Must push with contractions and rest between them.

Allow her to push when she feels the urge, use the position and

technique she chooses.

Semi fowlers, squatting, all fours.

Do not hold breath when pushing always breath out.

Panting with contraction is used to prevent her from pushing.

Breath with her and take deep cleansing breath.

Perineal Cleaning:

Clean from vagina outward

Episiotomy:

Surgical incision of perineum made to prevent tearing of the

perineum with birth and to release pressure on the fetal head with

birth.

Mediolateral have an advantage over midline cuts, tearing occurs

away from the rectum.

Substitutes a clean cut for a ragged tear.

Minimizes pressure on fetal head

Shortens last portion of labor

Pressure of fetal presenting part against perineum deadens

nerve endings so an episiotomy may be done without anesthesia.

Pressure of the fetal presenting part also seals the cut edges and

minimizes bleeding.

Birth:

As soon as the head of the fetus is prominent (8 cm) the Dr. may

place a sterile

Towel over rectum and press forward on fetal chin while the

other hand presses downward on the occiput.

This helps fetus achieve extension, so head is born with the

smallest diameter presenting.

Also controls the rate at which the head is born.

Never apply pressure to the fundus of the uterus to effect birth,

because uterine rupture may occur.

Woman pushes until occiput of the fetal head is firmly in the

pubic arch.

The head is born between contractions. (panting)(flash of pain or

burning sensation)

Suction infant’s mouth and feel neck for cord and gently remove

it if present by drawing over the fetal head. If tight it must be clamped

and cut before shoulders are delivered.

Push again without a contraction to deliver the shoulders.

Downward pressure on head. Delivers the anterior shoulder.

External rotation occurs and upward pressure on side of head

delivers posterior shoulder.

The remainder of the body slides free and when whole body is

delivered this is the time of birth recorded.

Cutting and Clamping the Cord:

Hold infant in dependent position and suction with bulb syringe.

Lay infant on abdominal drape while cord is cut. Place 2 Kelly

hemostates placed 8 to 10 inches from infant’s umbilicus, and is cut

between them. An umbilical clamp is applied.

Obtain a sample of cord blood and count the vessels.

Clamping the cord is part of the stimulus that initiates a first

breath.

Introducing the Infant:

Use sterile blanket and hold firmly because the baby is very

slippery.

Lay infant on radiant heat warmer and dry with warmed towel.

Cover head with cap and wrap infant snugly

Take to mother and father.

May breast feed which stimulates the release of endogenous

oxytocin.

Care During Third Stage of Labor

From the time of the birth until the placenta is delivered.

Fourth stage includes the first few hours after birth.

Oxytocin:(Pitocin)

Once placenta is delivered oxytocin is administered IM or IV (8

hours)

Increases uterine contractions and minimizes uterine bleeding.

Methergine last several hours.

Check B/P for hypertension

Placenta Delivery:

Spontaneous or manual removal within 5 min.

Inspect to be certain it is intact and normal in appearance and

weight.

1/6th weight of infant.

Perineal Repair:

Long tedious process

Immediate Postpartal Assessment

VS q 15 min for 1 hour

Palpate the fundus for size, consistency, and position.

Observe the amount and characteristics of the lochia.

Perform peri care and apply a pad.

Clean gown and warm blanket

Aftercare:

Fourth stage of labor

High risk for hemorrhage

Concerns of Woman in Labor

Woman Without a Support Person:

Woman Who Will Be Placing Her Baby Up For Adoption:

Hold baby, has a number of days to decide.

Support

Vaginal Birth After Cesarean Birth:

Low transverse incision she may try.

Risk for uterine rupture.

Less painful afterwards.