nursing care of a family during labor and birth

• Use cotton-tipped applicator impregnated with Nitrazine dye for determining pH (differentiates amniotic fluid, which is slightly alkaline, from urine and purulent material [pus], which are acidic). • Provide pericare as needed. A woman who moans with contractions may not be in as much physical pain as a woman who is silent but winces during contractions. • The status of amniotic membranes such as a gush or seepage of fluid (spontaneous rupture of membranes [SROM]). *In the nullipara effacement is often complete before dilation begins; in the multipara it occurs simultaneously with dilation. • Incorporate evidence-based nursing interventions into a comprehensive plan of care relevant to each stage of labor. • Wash hands. Perform vaginal examination as needed to identify progress. Discuss the feelings that a woman has about her pregnancy and fears regarding childbirth. Even the experienced woman may have difficulty determining the onset of labor. Document Results • Provide pericare as needed. EXPECTED MATERNAL PROGRESS DURING FIRST STAGE OF LABOR. If she appears tired, ask her how much rest she has had in the past 24 hours. Non–English speaking women often feel a complete loss of control over their situation if no health care provider is present who speaks their language. If she appears tired, ask her how much rest she has had in the past 24 hours. • How does she react to being touched by the nurse or support person? About 20-40 min (Courtesy Patricia Hess, San Francisco, CA; Chinle Comprehensive Health Care Center, Chinle, AZ. Unresolved fears increase a woman’s stress and can slow the process of labor as a result of the inhibiting effects of catecholamines associated with the stress response on uterine contractions. It is important to explain the rationale for required care measures carefully (see Cultural Competence box). Regular Available childbirth options vary greatly from place to place (see Community Focus box). How to Distinguish True Labor from False Labor, • Occur regularly, becoming stronger, lasting longer, and occurring closer together, • Are usually felt in lower back, radiating to lower portion of abdomen, • Continue despite use of comfort measures, • Shows progressive change (softening, effacement, and dilation signaled by appearance of bloody show), • Moves to an increasingly anterior position, • Presenting part usually becomes engaged in pelvis, which results in increased ease of breathing; at the same time, presenting part presses downward and compresses bladder, resulting in urinary frequency, • Occur irregularly or become regular only temporarily, • Often stop with walking or position change, • Can be felt in back or abdomen above navel, • Can often be stopped through use of comfort measures, • May be soft but with no significant change in effacement or dilation or evidence of bloody show, • Presenting part is usually not engaged in pelvis. Their reactions reflect their life experiences regarding childbirth—physical, social, cultural, and religious. During this period, the mother is at risk for hemorrhage and complications associated with uterine atony, anesthesia induction, and metabolic disorders. This information includes the duration of previous labors, the type of anesthesia used, the kind of birth (e.g., spontaneous vaginal, forceps-assisted, vacuum-assisted, or cesarean birth), and the condition of the newborn. 3-5 min apart Obstetric anesthesiologists are on-site and available in Labor and Delivery 24 hours a day. Nurses are advised to care for all laboring women in this manner because it is not unusual for a woman to choose not to reveal a history of sexual abuse. In some cultures women who lose control and cry out in pain may be scolded, whereas in others support persons become more helpful (D’Avanzo, 2008). Although most women in the United States labor and give birth in a hospital under the care of a physician, others choose different settings and care providers. • Persistence of contractions despite changes in maternal position and activity (e.g., walking or lying down) Perform every 30 to 60 minutes, depending on risk status: fetal heart rate (FHR) and pattern, uterine activity, vaginal show. Contrast the views of the L&D nurse and the childbirth educator. • Presence of other persons such as students, male attendants, and interpreters. Some allergic responses cause swelling of the mucous membranes of the respiratory tract, which could interfere with breathing and the administration of inhalation anesthesia. Women who ambulate and assume upright positions or change positions frequently during labor tend to experience a shorter first stage. • How does she react to a contraction? 16-3). Only gold members can continue reading. the special request. • Wash hands, apply sterile gloves, obtain specimen of fluid (usually during sterile speculum examination). Obstetric Triage and EMTALA • Does the woman ask questions? Fetus Some allergic responses cause swelling of the mucous membranes of the respiratory tract, which could interfere with breathing and the administration of inhalation anesthesia. • Explain procedure to woman or couple. Copies of prenatal records are generally filed in the perinatal unit at some time during the woman’s pregnancy (usually in the third trimester) or accessed by computer so they are readily available on admission. These behaviors can range from total silence to moaning or screaming, but they do not necessarily indicate the degree of pain. The Non–English Speaking Woman in Labor. Some hospitals and health care providers do not allow videotaping of the birth because of concerns related to legal liability. • Perform vaginal examination as needed to identify progress.  Strength Environmental modifications such as lighting, music, privacy, focal point, items from home such as pillows. • Environmental modifications such as lighting, music, privacy, focal point, items from home such as pillows. Denotes the body part that will first contact the cervix or be born first, and is determined by the combination of fetal lie and the degree of fetal flexion (attitude). Labor and delivery nurses usually Registered Nurses. If she wishes, include her partner in the assessment and admission process. Nursing Care of the Family During the Postpartum Period, Genetics, Conception, and Fetal Development, Nursing Care of the Family During Pregnancy, Brownish discharge, mucus plug, or pale pink mucus, Excited; thoughts center on self, labor, and baby; may be talkative or silent, calm or tense; some apprehension; pain controlled fairly well; alert, follows directions readily; open to instructions, Becomes more serious, doubtful of pain control, more apprehensive; desires companionship and encouragement; attention more inwardly directed; fatigue evidenced; malar (cheeks) flush; has some difficulty following directions, Pain described as severe; backache common; frustration, fear of loss of control, and irritability may be voiced; expresses doubt about ability to continue; vague in communications; amnesia between contractions; writhing with contractions; nausea and vomiting, especially if hyperventilating; hyperesthesia; circumoral pallor, perspiration of forehead and upper lip; shaking tremor of thighs; feeling of need to defecate, pressure on anus. • Explain procedure to woman or couple. Becomes more serious, doubtful of pain control, more apprehensive; desires companionship and encouragement; attention more inwardly directed; fatigue evidenced; malar (cheeks) flush; has some difficulty following directions • Recognize the physical and psychosocial findings indicative of maternal progress during labor. • Are any nonverbal pain messages noted? This need is further emphasized by National Health Goals (Box 18.1). When you opt for a medicated labor, the team focuses on working within your birth … During the third trimester of pregnancy women should be instructed regarding the stages of labor and the signs indicating its onset. A woman may report a small amount of brownish-to-bloody discharge that may be attributed to cervical trauma resulting from vaginal examination or coitus (intercourse) within the last 48 hours. For example, in Western societies the father is viewed as the ideal birth companion. In a relatively short period they experience one of the most profound changes in their lives. The first stage of labor consists of three phases: the latent phase (through 3 cm of dilation), the active phase (4 to 7 cm of dilation), and the transition phase (8 to 10 cm of dilation).   Log In or Register to continue If she is having discomfort, the nurse should ask questions between contractions when she can concentrate more fully on her answers. • Evaluate research findings on the importance of support from family, partner, doula, and nurse in facilitating maternal progress during labor and birth. (Courtesy Julie Perry Nelson, Loveland, CO.) In many instances the support that these people provide to the laboring woman is in direct proportion to the support they receive from the nurses and other health care providers. • Occur irregularly or become regular only temporarily pH 6.0 The information obtained from a complete and accurate assessment during the initial examination serves as the basis for determining whether the woman should be admitted and what her ongoing care should be. settling of the fetal head into the pelvis during labor. Laotian (Hmong) husbands also traditionally participate actively in the labor process. • Become more intense with walking • Are usually felt in lower back, radiating to lower portion of abdomen However, keep in mind that general appearance and behavior may vary, depending on the stage and phase of labor (Table 16-1 and Box 16-3). 19. pH 5.5 engagement. The nurse reviews the prenatal record to identify the woman’s individual needs and risks. The nurse can minimize the woman’s anxiety by explaining terms commonly used during labor. She or he can determine what role the support person intends to fulfill and whether that person is prepared for the role by making observations and asking herself or himself such questions as, “Has the couple attended childbirth classes?” “What role does this person expect to play?” “Does he or she do all the talking?” “Is she or he nervous, anxious, aggressive, or hostile?” “Does he or she look hungry, tired, worried, or confused?” “Does he or she watch television, sleep, or stay out of the room instead of paying attention to the woman?” “Where does he or she sit?” “Does he or she touch the woman; what is the character of the touch?” Be sensitive to the needs of support persons and provide teaching and support as appropriate. 16-2, A and B). The nurse determines this status by asking the woman if she has a cold or related symptoms (e.g., “stuffy nose,” sore throat, cough). • Presenting part is usually not engaged in pelvis   Their reactions reflect their life experiences regarding childbirth—physical, social, cultural, and religious. • Are repeated explanations necessary because her anxiety level interferes with her ability to comprehend? The nurse's own personal view on labor support can influence the support that laboring women receive. • Location and character of discomfort from contractions (e.g., back pain, abdominal or suprapubic discomfort) • Occur regularly, becoming stronger, lasting longer, and occurring closer together • Does she talk freely with the nurse or respond only to questions? Log In or. • Labor activities such as preferred positions for labor and for birth, ambulation, birth balls, showers and whirlpool baths, oral food and fluid intake. Psychosocial Factors According to the Health Insurance Portability and Accountability Act (HIPAA), the woman must give permission for other persons to be involved in the exchange of information regarding her care. A health care provider should ensure comfort measures, information, instructions, emotional supports, advocacy, and support for the family as … Is there a difference in their views? 100. Teaching should not always be formal; it may come in the form of comments during classes or procedures. Women from many cultures prefer female caregivers and want to have at least one female companion present during labor and birth. • Time and onset of contractions and progress in terms of frequency, duration, and intensity • Care and handling of the newborn immediately after birth such as cutting of the cord, eye care, and breastfeeding. Even the experienced woman may have difficulty determining the onset of labor. Speaking slowly and avoiding complex words and medical terms can help a woman and her partner understand. Although most women in the United States labor and give birth in a hospital under the care of a physician, others choose different settings and care providers. Common diagnostic and fetal assessment tests performed prenatally include amniocentesis, nonstress test (NST), biophysical profile (BPP), and ultrasound examination. The nurse then shows the woman and her partner the layout and operation of the unit and room, how to use the call light and telephone system, how to adjust lighting in the room, and the different bed positions. Women who participate in expectant parent classes often bring a birth bag or Lamaze bag with them. See Table 8-1 for a list of common prenatal laboratory tests. Multiparous women often base their expectations of the present labor on their previous childbirth experiences. Common diagnostic and fetal assessment tests performed prenatally include amniocentesis, nonstress test (NST), biophysical profile (BPP), and ultrasound examination. Labor can trigger memories of sexual abuse, especially during intrusive procedures such as vaginal examinations. Interview a childbirth educator and ascertain his or her views of midwives and home births. Spread drop of fluid from vagina on clean glass slide with sterile cotton-tipped applicator. About 6-8 hr The nurse can help the abuse survivor associate the sensations she is experiencing with the process of childbirth and not with her past abuse. Most hospitals have specific forms, whether paper or electronic, that are used to obtain important assessment information when a woman in labor is being evaluated or admitted (Fig. Related The nurse determines this status by asking the woman if she has a cold or related symptoms (e.g., “stuffy nose,” sore throat, cough). Unresolved fears increase a woman’s stress and can slow the process of labor as a result of the inhibiting effects of catecholamines associated with the stress response on uterine contractions. • Observe for absence of ferning (alerts staff to possibility that amount of specimen was inadequate or that specimen was urine, vaginal discharge, or blood). If it is determined after several hours of observation that she is not in true labor, she is discharged. Determine the woman’s use of alcohol, drugs, and tobacco before or during pregnancy.   • Perform every 30 to 60 minutes: maternal blood pressure, pulse, respirations. • Can she ask for what she needs? Their reactions reflect their life experiences regarding childbirth—physical, social, cultural, and religious. KEY: Nursing Process Step: Implementation. Labor care begins when amniotic fluid is discharged from the vagina. Cervix (by vaginal examination) The father, coach, or significant other also experiences stress during labor. • Membranes probably intact: Identifies vaginal and most body fluids that are acidic: • Membranes probably ruptured: Identifies amniotic fluid that is alkaline: • Realize that false test results are possible because of presence of bloody show, insufficient amniotic fluid, or semen. During the examination uterine contractions are assessed, and a vaginal examination is performed. MSC: NCLEX: Physiological Integrity: Reduction of Risk. In addition, the expected date of birth (EDB) should be confirmed. Pink-to-bloody mucus • Is often in posterior position A pregnant woman presenting in an obstetric triage is considered to be in “true” labor until a qualified health care provider certifies that she is not. The nurse reassures the woman that she is in competent, caring hands and that she and people to whom she gives permission can ask questions related to her care and status and that of her fetus at any time during labor. Other important data found in the prenatal record include patterns of maternal weight gain; physiologic measurements such as maternal vital signs (blood pressure, temperature, pulse, respirations); fundal height; baseline fetal heart rate (FHR); and laboratory and diagnostic test results. For those individuals and families who choose to give birth in a hospital environment, our nurse-midwifery practice is an added source of support in creating a positive birth experience. (Courtesy Julie Perry Nelson, Loveland, CO.). They should be informed of the possibility that they will not be admitted if they are 3 cm or less dilated (see Patient Teaching box). They should be informed of the possibility that they will not be admitted if they are 3 cm or less dilated (see Patient Teaching box). Society communicates its expectations regarding acceptable and unacceptable maternal behaviors during labor and birth. Sep 16, 2016 | Posted by admin in NURSING | Comments Off on Nursing Care of the Family During Labor and Birth Evaluate the impact of perineal trauma on the woman’s reproductive and sexual health. Can she repeat what she has been told or otherwise demonstrate her understanding? At times the partner or support person(s) may need to be secondary sources of essential information. An idealized perception of labor and birth may be a source of guilt and cause a sense of failure if the woman finds the process less than joyous, especially when the pregnancy is unplanned or is the product of a dysfunctional or terminated relationship. • To what degree does the woman describe what she is experiencing, including her pain experience? She may be admitted to the Labor and Birth Unit for a period of observation lasting up to 23 hours. As caregiver and advocate the nurse integrates the woman’s desires into the nursing care plan as much as possible. They also are usually very concerned about modesty. Other factors to consider are the woman’s general health status, current medical conditions or allergies, respiratory status, and previous surgical procedures. However, the woman who lives at a considerable distance from the hospital, who lacks adequate support and transportation, or who has a history of rapid labors in the past may be admitted in latent labor. Perinatal nurses provide education and resources about pregnancy and childbirth, and help oversee the mother and child during pregnancy, childbirth, and postpartum to ensure the health of both. • Assess temperature every 4 hours until membranes rupture and then every 2 hours. Are other types of licensed midwives available? The nurse places an identification band on the woman’s wrist. Encourage the woman to request specific caregiving behaviors and practices that are important to her. The nurse first performs a screening assessment by using the techniques of interview and physical assessment and reviews the laboratory and diagnostic test findings to determine the health status of the woman and her fetus and the progress of her labor. Examine slide under microscope; observe for appearance of ferning (a frondlike crystalline pattern) (do not confuse with cervical mucus test, when high levels of estrogen cause ferning). Some allergic responses cause swelling of the mucous membranes of the respiratory tract, which could interfere with breathing and the administration of inhalation anesthesia. The concept of missed nursing care is increasingly being applied to maternity, neonatal and pediatric nursing settings after many years of focus on medical-surgical units in acute care hospitals. A nap during labor may result in a change in the desired sex of the infant. False Labor There is very little bloody show in the beginning, but the amount increases with effacement and dilation of the cervix. If she appears tired, ask her how much rest she has had in the past 24 hours. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) Protection of privacy and safety and infection control are major concerns for the expecting parents and the agency. • Does she change positions or lie rigidly still? • Moves to an increasingly anterior position Expected maternal progress and minimal assessment guidelines during the first stage of labor are presented in Table 16-1 and Box 16-4. If the woman’s support person is her mother, she may perceive the need to “behave” more strongly than if her support person is the father of the baby. Does she change positions or lie rigidly still? A pregnancy weight gain greater than recommended may place the woman at a higher risk for cephalopelvic disproportion and cesarean birth. 40-70 sec B, Current admission screen. Yellow The nature of the telephone conversation, including any, Occur regularly, becoming stronger, lasting longer, and occurring closer together, Are usually felt in lower back, radiating to lower portion of abdomen, Shows progressive change (softening, effacement, and dilation signaled by appearance of bloody show), Moves to an increasingly anterior position, Presenting part usually becomes engaged in pelvis, which results in increased ease of breathing; at the same time, presenting part presses downward and compresses bladder, resulting in urinary frequency, Occur irregularly or become regular only temporarily, Often stop with walking or position change, Can be felt in back or abdomen above navel, Can often be stopped through use of comfort measures, May be soft but with no significant change in effacement or dilation or evidence of bloody show, Presenting part is usually not engaged in pelvis, When the woman is admitted, she is usually moved from an observation area to the labor room; the labor, delivery, and recovery (LDR) room; or the labor, delivery, recovery, and postpartum (LDRP) room. • Perform every 30 to 60 minutes, depending on risk status: fetal heart rate (FHR) and pattern, uterine activity, vaginal show. Monitors, intravenous (IV) lines, and epidurals can make the woman feel a loss of control or as if she is being confined to bed and “restrained.” Being observed by students and having intense sensations in the uterus and genital area, especially at the time when she must push the baby out, can also trigger memories. FIG 16-2 Admission screens in an electronic medical record. At times the partner or support person(s) may need to be secondary sources of essential information. These expectations may be used by some women as the basis for evaluating their own actions during childbirth. • Recognize the importance of support (family, partner, doula, nurse) in fostering maternal confidence and facilitating the progress of labor and birth. a. The nurse then shows the woman and her partner the layout and operation of the unit and room, how to use the call light and telephone system, how to adjust lighting in the room, and the different bed positions. Verbal Interactions • Does she look tired? She perceives herself as failing or succeeding based on her ability to follow these “standards” of behavior. A warm shower is often relaxing during early labor. Prenatal Data • Somalia: Because Somalis in general do not like to show any sign of weakness, women are extremely stoic during childbirth, • Japan: Natural childbirth methods practiced; may labor silently; may eat during labor; father may be present, • China: Stoic response to pain; father not usually present; side-lying position preferred for labor and birth because this position is thought to reduce infant trauma, • India: Natural childbirth methods preferred; father not usually present; female relatives usually present, • Iran: Father not present; female support and female caregivers preferred, • Mexico: May be stoic about discomfort until second stage, and then may request pain relief; father and female relatives may be present, • Laos: May use squatting position for birth; father may or may not be present; female attendants preferred. • Incorporate evidence-based nursing interventions into a comprehensive plan of care relevant to each stage of labor. • Does she avoid eye contact? Some women believe that cutting her body, as with an episiotomy, allows her spirit to leave her body and that rupturing the membranes prolongs, not shortens, labor. Labor can trigger memories of sexual abuse, especially during intrusive procedures such as vaginal examinations. Accurate height and weight measurements are important. In some cultures it is traditional to take the placenta home; in others the woman has only certain nourishments during labor. Most nulliparous women seek admission to the hospital in the latent phase because they have not experienced labor before and are unsure of the “right” time to come in.

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