NURS 233 Lecture Notes - Lecture 6: Cervical Effacement, Cervical Dilation, Cardiotocography
N233 perinatal week 6
Nursing Care During Labour and Birth
◦ Labour begins with regular uterine contraction, continues with hard work during
cervical dilation and birth, and ends as the woman and her family begin the
attachment process with the infant.
First Stage of Labour- begins with regular contractions and end in effacement up
to 5-8 cm dilated
◦ Assessment and nursing diagnosis
◦ Admission data
◦ Antenatal data (prenatal record)
◦ Psychosocial factors
◦ Stress in labour- stress will slow the birthing process
◦ Trans and gender-nonconforming persons
◦ Cultural factors
Physical Assessment
◦ General systems assessment
◦ Vital signs
◦ Leopold's manoeuvres
◦ Assessment of fetal heart rate (FHR) and pattern
◦ Assessment of uterine activity – how often, how intense, how many
◦ Frequency
◦ Intensity
◦ Duration
◦ Resting tone
◦ Palpation of uterus: mild, moderate, strong – feels like a nose or forehead
◦ Cervical effacement, dilation, fetal descent
◦ Vaginal examination- we want to limit the amount of these be do because they are
invasive, it increases risk for infection. The only time we do this is if we need to.
Only do this ever 4 hours unless there is concern. Normally in practice its every 2
hours and this should change. If they want an epidural they need to know how far
along you are so you do this before and epidural.
Laboratory and Diagnostic Tests
◦ Analysis of urine specimen
◦ Blood tests- CBC, group and screen- do this to see if they are pH negative and we
need to know their hemoglobin before they deliver and then test again after delivery
to make sure they are still doing great! So make sure you take the blood
◦ Assessment of amniotic membranes and fluid
◦ Signs of potential labour complications
Nursing Care During Labour
◦ General hygiene- look to make sure the amniotic fluid, if there is flakes or
meconium then they baby could be in distress.
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◦ Nutrient and fluid intake – you can eat and drink during labour you don’t been to
be NPO.
◦ Elimination – remind them to pee because sometimes they lost feeling that they
need to pee and the bladder can get in the way.
◦ Ambulation and positioning- tell her to relax between contractions, massage helps
and changing positions help and being in the bed is the worst place.
Leopold maneuvers
It allows you to determine what position the baby is in.
Location of the fetal heart
With the Doppler preferably- don’t hook up to a fetal monitor because if they do
then they normally have more interventions than needed. Having a monitor
confines them to the bed and that slows labour.
Second Stage of Labour- starts will full dilation and begins with babies birth
◦ Infant is born
◦ Begins with full cervical dilation (10 cm)
◦ Complete effacement
◦ Ends with baby's birth
◦ Two phases:
◦ Latent: relatively calm with passive descent
of baby through birth canal
◦ Active (descent): active pushing and urges to bear down
*beginning birth with vertex presenting – she wont ask the terms under the picture.
Ritgen manoeuvre – hold the perineum to control and prevent too rapid birth or
head.
KNOW THIS: Perineal Trauma Related to Childbirth
-Perineal lacerations
◦ First degree – superficial and don’t need to suture
◦ Second degree- muscle of the perennial body
◦ Third degree- through the anal sphincter muscle
◦ Fourth degree- involves anterior rectal wall
we need to know how to fix them and they need to start physio to start fixing it.
◦ How to prevent perineal laceration and trauma? – do keegal exercises, warm
compresses on perineum and gentile stretching helps.
◦ Episiotomy- mediolateral and median (midline) – 17% of women get this and it
isn’t needed and shouldn’t be done. Midline are most common. The mediolateral
have higher blood loss. With episiotomy can help avoid a 4th degree tare and that is
why they do them. But there isn’t research to back up episiotomies.
◦ When is it recommended? – sometimes but rarely recommended only when baby
cant get out to cause no distress.
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find more resources at oneclass.com
Third Stage of Labour- p. 453
Third stage of labour. A: Placenta begins the separation process in central portion,
accompanied by retroplacental bleeding. Uterus changes from discoid to globular
shape. B: Placenta completes separation and enters lower uterine segment. Uterus is
globular in shape. C: Placenta enters vagina, cord is seen to lengthen, and there may
be increased bleeding. D: Expulsion (birth) of placenta and completion of third
stage.
◦ Maternal physical status
- Signs of potential problems
◦ Excessive blood loss- if its more than 900-1000ml of blood then you consider it
excessive bleeding and can be a sign of hemorrhage.
◦ Alteration in vital signs and consciousness
◦ Care of placenta after delivery
◦ Umbilical cord blood banking- to save it if they ever need it for baby or future kids.
Placental Separation and Expulsion- we always save the placenta to make sure the
baby wasn’t post term and where the cord attaches (should be in the middle),
should be 2 arteries and 1 vein and should also collect cord blood to see how the (it
is time sensitive) baby was copping with delivery. If they have torn it will sting
when the placenta comes out
Signs that the placenta is coming:
◦ Firmly contracting fundus
◦ Change in shape of uterus
◦ Sudden gush of dark blood
◦ Apparent lengthening of umbilical cord
◦ Vaginal fullness
if the placenta doesn’t come out right then a piece can be left in and cause post
partum hemorrhage.
* some people bring home the placenta to eat and bury it and plant a tree over it.
make sure we sign a form to take it home. Make sure to ask what the mom wants
with the placenta after the birth. Taking it home isn’t specifically related to a specific
culture but cerain groups of people do it based on cultural norms. It isn’t harmful if
you eat your own placenta but FDA doesn’t recommend placenta capsules.
Fourth Stage of Labour
◦ Assessment
◦ Care of the mother, newborn, and family
◦ Postanaesthesia recovery
◦ Family–newborn relationships
acrosyanosis- is when the babies limbs are blue and can be that was for 24 hours
after birth.
How long to wait to clamp the cord: at least 5 minutes- prevents newborn jondis
and builds up iron stores
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Nursing care during labour and birth: labour begins with regular uterine contraction, continues with hard work during cervical dilation and birth, and ends as the woman and her family begin the attachment process with the infant. The only time we do this is if we need to. Only do this ever 4 hours unless there is concern. Normally in practice its every 2 hours and this should change. If they want an epidural they need to know how far along you are so you do this before and epidural. So make sure you take the blood: assessment of amniotic membranes and fluid, signs of potential labour complications. It allows you to determine what position the baby is in. With the doppler preferably- don"t hook up to a fetal monitor because if they do then they normally have more interventions than needed. Having a monitor confines them to the bed and that slows labour.
