Dr Notes

True and False Labor Location Regularity Intensity Frequency Pain Show Amniotic Fluid Cervical Dilation Ambulation

TRUE back to abdomen regular increases more frequent can’t be relieved bloody/pinkish rupture w/ amniotic fluid present effacement & dilation contraction continues no matter what position

FALSE groin to abdomen irregular mild to tolerable changing frequency can be relieved none none none contractions fade on ambulation

Stages of Labor

First Stage (Bearing Stage) • Begins w/ true labor contractions and ends w/ the cervix in full dilation (10cm) • Objectives: to provide comfort to the mother • Latent / Resting / Preparatory Phase o Nullipara: 6 hours o Multipara: 4.5 hours o Dilation: 0-3cm o Contraction Duration: 20-40 seconds o Contraction Frequency: 5-7min o Woman can still walk around doing last minute things • Active / Descent Phase o Nullipara: 3 hours o Multipara: 2 hours o Dilation: 4-7cm o Contraction Duration: 40-60 seconds o Contraction Frequency: 3-5min o Contractions start to be stronger and woman realizes that labor is truly progressing • Transition / Advance Active Phase o Nullipara: 2 hours o Multipara: 1 hour o Nullipara: effaced before dilated o Multipara: dilated before effaced o Dilation: 8-10cm o Contraction Duration: 60-90 seconds o Contraction Frequency: 2-3min o Woman is fully concentrated on pushing and will push away any person trying to provide support to her

Second Stage (Fetal/Pushing Stage) • Begins when the cervix is fully dilated and effaced up to the birth of the infant • Objectives: to deliver the fetus safely and maintain the mother’s safety o Crowning – vaginal introitus opens and fetal scalp appears at the opening o Episiotomy incision is made o Ritgen’s Maneuver –pressing forward on the fetal chin while pressing downward on the occiput o Crede’s Maneuver – applying gentle pressure on the contracted uterine fundus (never apply pressure on an uncontracted uterus) • Nursing Management o Suction baby’s mouth then nose o Clamp cord o Assess AVA o Trendelenburg position for baby o Uterine contractions palpated continuously Third Stage (Placental Stage) • Begins with the birth of the infant up to the delivery of the placenta (5-20 min) • Objectives: delivery of the placenta and prevention of infection and complications o Placental Separation – signified by lengthening of umbilical cord, sudden gush of blood (300-500mL) uterus rise and becomes globular o Placental Expulsion – delivered either by natural bearing-down effort of the mother or by Crede’s Maneuver o Methergine and/or oxytocin may be given to stimulate contractions further • Nursing Management o Note time of delivery of placenta o Assess uterus, fundal height, and consistency o Fundus should be in line with umbilicus o Inspect perineum for lacerations Fourth Stage (Recovery Stage) • 1-4 hours after placental delivery • Objectives: prevent complications • Most dangerous stage for mother • NSVD Blood Loss: 300-500mL • CS Blood Loss: 500-1000mL • Monitor maternal V/S continuously

Immediate Newborn Care 1. Promotion of Mother-Infant Bonding Once the baby’s cord is cut, place the baby on the mother’s abdomen where a sterile cloth has been placed ready for the baby. Then wrap the baby exposing the face for transfer to the bassinet. 2. Promotion of Patent Airway Place the baby in the bassinet with the head lower than the feet. Using the bulb syringe or suction bulb, remove the mucus from the mouth then t the nose. In suctioning, press the bulb before inserting into the intended cavity and allow bulb to go back to its original form. You may stimulate the baby to cry by rubbing the back. 3. General Assessment using APGAR Scoring Appraise the infant’s condition based on the following five signs: heart rate, respiratory effort, muscle tone, reflex irritability, and skin color. Evaluate each criterion for one minute of life. Repeat the process after five minutes and then after ten minutes. Score each sign using the correct form guided by the APGAR chart. Add the scores of each sign to get the total APGAR score. 4. Provision of Cleansing Bath Get sterile gauze soaked in container with antiseptic solution. Cleanse the baby starting from the face, back portion of the head down to the lower extremities. Pay particular attention on the skin folds. Change gauze once it is soaked with blood, tissues, and vernix caseosa. Once the baby is clean, wipe the skin with dry sterile gauze following same sequence – head to toe. 5. Application of Eye Prophylaxis Instill 1-2 drops of 1% Silver Nitrate / Garamycin / Gentamicin / Neosporin into the conjunctival sac of each by separating the eyelids making sure that the tip of the container will not contact with the baby’s eye. 6. Provision of Cord Care Change gloves to a new pair after preparing the needed materials to be used. Then clean the cord three times using cotton pledgets soaked with betadine starting from the base of the cord up to 4-5 inches. Repeat the procedure using pledgets with alcohol. Clamp the cord one inch from the base using a cord clamp and cut the cord half inch from the clamp using a surgical scissors. Press the stump with sterile gauze until there is no bleeding. Then clean the cord stump three times using cotton pledgets soaked with betadine starting from the stump to the base. Repeat the procedure using the pledgets with alcohol. Include the clamp in the application of the antiseptic. 7. Provision for Temperature Taking Lubricate a clean rectal thermometer with baby oil. Insert it in the baby’s rectum in a rotating manner just enough that the bulb is inside by lifting the legs to expose the anal sphincter for 2-3 minutes. Take note of the result. Other parts of the body should be wrapped with dry cloth. 8. Provision for Measurement & Weight Taking Using a tape measure, take the height of the baby from the tip of the head to the tip of the heel. For the head circumference, make sure that the tape measure is placed just above the eyebrows. For the chest circumference, place the tape measure at the nipple line. Take the mid-arm circumference by placing the tape measure in the middle part of the upper arm. Measurement should be in centimeters. Then weight the baby by placing him on the weighing scale without any clothes on. Convert the results from pounds/ounces to grams/kilograms. 9. Provision of Parenteral Administration of Vitamin K Prepare drug for IM administration. Expose one led and disinfect upper 1/3 of the lateral aspect of the femoral muscles following the correct technique. Inject 0.1cc of the drug if the baby is mature, and 0.05cc of the drug if premature (based on hospital policy). Follow correct principles in injecting the drug.

10. Provision for Identification Fill up the identification bracelet properly and place it around the baby’s wrist. Make sure that it is not too tight or loose. Do foot printing. Wrap the baby properly.