CARING FOR A WOMAN IN LABOR AND DELIVERY Definition: Providing a safe and therapeutic environment for mother experiencing

labor and delivery. Purpose: 1. Assess fetal and maternal well being

2. To help the woman feel confident in her ability to control pain and the progress of
labor 3. To assist the pregnant woman to a safe delivery of the infant Indication: Pregnant woman experiencing true labor pains Client Education: 1. Provide information regarding labor pattern, progress of labor and planned intervention 2. Teach the woman about the proper breathing techniques during labor and delivery.

3. Keep the woman informed of the progress of fetal descent.

Special Considerations: 1. The delivery process varies from one patient to another and the nurse must be quick to provide an atmosphere of receptivity to clients needs

2. Some institutions permit the father to accompany the mother in the delivery room
3. Some physician may order enema to ensure that no stool would be expelled during delivery 4. Ambulation is allowed if the presenting part is engaged, the membranes are not rupture and the woman is not medicated

Equipments:

OB bundle (sterile gowns, 2 leggings and 3 towels) Kelly pad, Primi set (2 Kellies, 1 needle holder, 1 tissue forceps) Bandage scissors Suture scissors local anesthesia

10 cc syringe G23 needle Sponges (vaginal packs and OS)

Sterile gloves Adult diaper suction bulb Basins

PROCEDURE ADMISSION 1. Obtain vital signs, including temperature, and weight

RATIONALE To obtain baseline data and determine For any problems. Blood pressure is taken between contractions because BP rises 5-15 mm hg during a contraction. An increase in BP may Indicate the development eclampsia. A decrease in BP may indicate hemorrhage.

2. Obtain relevant data related to the pregnant woman such as LMP, AOG, and EDC. 3. Place client on a supine position with knees flexed, and measure the fundic height and perform Leopolds maneuver.(refer to the checklist)

This data helps establish the viability of Fetus

To relax the abdomen. Performing Leopolds maneuver will determine the feral position

4. Prepare the client for vaginal

examination (refer to the checklist) 5. Monitor for frequency, interval and duration of the uterine contractions, and record in the monitoring sheet 6. Encourage the client to urinate and defecate.

to assess cervical readiness

To assess progress of labor and monitor fetal well being

A full bladder may impede descent of the presenting part; over distention may cause injury as well as postpartum voiding difficulty.

7. Encourage her to walk and rest alternately, unless contraindicated.

This will reduce muscle tension, relieves pressure and promotes fetal descent

8.

PROCEDURE Administer IV fluids as ordered by

RATIONALE Maintains hydration and provides venous access for medication.

the Attending Physician. CARING FOR A WOMAN IN THE 2ND STAGE OF LABOR 1. Wash hands. Wear mask and bonnet 2. Gather the equipments needed

Deters spread of infection Organization facilitates ease in the performance of the task

3. Transfer the woman from the labor room to the delivery room when the cervix is fully dilated. 4. Assist patient into the delivery table and place her in lithotomy position with both legs hanging in the tables stirrups

To provide an environment necessary for delivery

For a good visualization of the perineum

5. Shave the perineum and do perineal

skin preparation. Use sterile gloves or working forceps to clean the perineal area. Use cherry balls soaked with antiseptic solution or 7% betadine solution 6. Perform hand washing and put on sterile gloves. 7. Put on drapes and towels Place a towel sheet under the buttocks Slide leggings over each leg, protecting the gloved hands in the folded cuffs Place a towel sheet across the abdomen from the level of the pubis.

To reduce the number of microorganisms in the skin

To prevents spread of infection

Proper draping will provide a sterile field and prevents contamination

PROCEDURE 8. Arrange the instruments in the mayo table according to their uses.

RATIONALE To facilitate a systematic progression of the procedure Exhaling during contraction prevents valvalvas maneuver which could impede blood return to the heart because of increase intrathoracic pressure. This could also interfere with blood supply to the uterus. The woman is asked to push until the occiput of the fetal head is firmly at the pubic arch. Panting in between contractions can minimize the urge to push.

9. Instruct the client to breathe out and

push and pant in between contractions.

10. As the fetal head is pushed towards

the perineum, support the perineum with sterile gauze. This time the doctor will perform episiotomy with a blunt tip scissors 11. Pass on the appropriate instruments and materials to the doctor as necessary

Supporting the perineum will prevent laceration and performing episiotomy will prevent tearing of the perineum and release pressure of the fetal head with birth.

To assist the doctor in efficient performance the procedure

12. Provide support to the birth canal by

pressing an OS against the perineum with the palm of the hand

Pressing against the incised perineum will seal the cut edges and minimize bleeding

13. When the head is delivered, support it

with both hands hyperextended and the doctor will pass her finger along the occiput of the newborns neck. Prepare the suction bulb, wipe first and suction the babys mouth first then the nose.

Passing fingers along the occiput of the newborns neck determines whether a loop of umbilical cord is encircling the neck. If a loop is felt, it is gently loosed and drawn over to the fetal head. If it is tight, it must be clamped and cut before shoulders are delivered. Suctioning removes secretions and prevents aspiration

14. As the head restitute and rotates, give The downward pull allows the delivery of the
a steady, gentle downward pull and slowly give upward lift. anterior shoulder and the upward lift will deliver the posterior shoulder to slide over the perineum

PROCEDURE

15. Assist the doctor as necessary in the

delivery of baby and note the time of delivery gender of the infant.

RATIONALE The baby is slippery and may slip off. The time of delivery serves as the time of birth. It is the responsibility of the nurse to check and record accurate data especially the gender and time of birth.

16. Hand 2 kellies, one clamp at a time.

(The doctor will clamp approximately 8-10 inches from the base of the cord.) Then pass the bandage scissors for cutting of the umbilical cord. Check the cord for presence of 3 vessels ( 2 arteries and one vein)

2 clamps will prevent the flow of blood from the baby and from the placenta during cutting. Clamping the cord is a part of the stimulus that initiates the first breath.

17. Place the baby on the womans

abdomen. Dry the baby quickly and Bring the infant to the NICU for further management

Placing the baby on the abdomen can promote bonding and visualization of the newborn. Drying can prevent heat loss. For immediate care of the neonate and prevent complications

CARING FOR A WOMAN IN THE 3rd STAGE OF LABOR 1. Once you see signs of placental separation, deliver the placenta using a gentle touch on the cord Signs of placental separation are lengthening of the cord, a sudden gush of blood and changing of the size of the lower abdomen

2. When the placenta is coming out, twist the trailing membrane until it is completely delivered

This maneuver promotes the delivery of the placenta

3. Assess placenta for size, shape and

completeness then place it the basin ( may drop in the bucket if theres no tray available) 4. Wipe vulva with sterile gauze for the doctor to check the lacerations 5. Aspirate the local anesthetic using sterile technique and prepare sutures place in the needle holder, then assist in episiorrhapy

To ascertain that placenta is intact and normal in appearance and weight. Normally, a placenta is one-sixth of the weight of the infant. To check and for bleeders and note for laceration to be repaired. To prevent contamination of the sterile field. Anesthesia provides can lessen pain sensation during the repair

PROCEDURE 6. As soon as repair is done, perform perineal flushing

RATIONALE This will remove blood stains, and promote comfort Removing Kelly pad after flushing will prevent a messy workplace To promote uterine contraction Lowering the legs simultaneously can prevent back injury. The mother may experience chill and shaking sensation. Clean gown and a warm blanket can provide her comfort.

7. Remove drapes and Kelly pad and put

on adult diaper. 8. Place ice pack over the perineum.

9. Remove drapes covering the patient

and lowers both legs from the stirrup simultaneously... Offer a clean gown and a warm blanket. Transfer the patient to the stretcher 10. Remove your gloves and discard it properly. Do after care.

Bloody instruments must be properly cleaned to eliminate microorganism. After care will ensure a clean environment for labor and childbirth.

11. Document the care performed to the

patient, the medications, intravenous fluids given, and patients response and endorse

Serves as a record and basis for further assessment.