Week 7: Intrapartal Care - Increases fetal movement like kicking

of fetus
Assessment of the Laboring
➢ Slight loss of weight
Mother: - As progesterone level falls, body
Signs of Labor: fluids are more easily excreted from
the body
➢ Before labor, woman often
- This increase in urine production can
experiences subtle signs that signal
lead to a weight loss between 1-3
labor is imminent.
pounds
➢ It is important to review these with
women during the last trimester to
➢ Braxton Hicks Contractions
easily recognize beginning signs
- Women usually notices extremely
Preliminary Signs of Labor: strong braxton hick's contractions
- Prodromal or false labor pains (not
➢ Lightening
true labor contractions but just to
- Descent of the fetal presenting part
prepare a woman for labor)
into the pelvis
- Contraction of uterus that typically
- 10 to 14 days before labor begins
are not felt until the second or third
(primipara)
trimester of pregnancy
- Fetal descent changes a woman's
abdominal contour, bcos it positions
➢ Ripening of the Cervix
the uterus lower and more anterior in
- At term, the cervix becomes still
the abdomen
softer (described as “butter-soft”)
- Gives a woman relief from
and tips forward
diaphragmatic pressure and
- Is an internal announcement that
shortness of breath and lightens her
labor is very close at hand
load (the baby)

➢ Increase in Level of Activity

Signs of True Labor
- Related to an increase in epinephrine
release initiated by a decrease in ➢ Uterine Contraction
progesterone produced by the - Surest sign that labor has begun is
placenta productive contractions
- This added epinephrine prepares a - Bcos contractions are involuntary and
woman’s body for the work of labor come without warning, their intensity
ahead can be frightening in early labor
- Helping a woman appreciate that she Two Risks:
can predict when her next one will
1. Intrauterine Infection
occur and can control the degree of
2. Prolapse of the umbilical cord
discomfort she feels by using
- Which could cut off the oxygen supply
breathing exercises, offers her a
to the fetus
sense of well-being
➢ If labor has not spontaneously
- Inform and educate them about what
occurred by 24 hours after membrane
will happen like 40-60 seconds of rest
rupture and pregnancy is at term,
and another contraction will happen
labor will be induced to prevent these
risks.
➢ Show
- Mucus plug (operculum) fills the Components of Labor:
cervical canal during pregnancy as
➢ Passage
the cervix softens and ripens
- Woman’s pelvis is of adequate size
- The exposed cervical capillaries seep
and contour
blood as a result of pressure exerted
- Route a fetus must travel from uterus
by the fetus
through the cervix and vagina to
- Blood mixed with mucus takes on a
external perineum
pink tinge or “show” and “bloody
show” Two Pelvic Measurements:
- Woman may need to be aware of this
- Important to determine the adequacy
event to prevent conceptions of
of the pelvic size and if fetus can pass
bleeding abnormally - If pelvic outlet is too narrow, cesarean
birth is done
➢ Rupture of Membranes 1. Diagonal Conjugate (anteroposterior
- Labor begins experienced either as a
diameter of the inlet)
sudden gush or as scanty, slow - inlet
seeping of clear fluid from the vagina 2. Transverse Diameter of the outlet
- Early rupture of the membranes can
- Outlet
be advantageous as it can cause the
fetal head to settle snugly into the ➢ Passenger (the fetus)
pelvis which shortens labor - Is of appropriate size and in an
- Assess if the fluid is urine or amniotic advantageous position and
fluid, urine = acidic / amniotic fluid = presentation
Alkaline - Body part of the fetus that has the
widest diameter is the head
 - Wether a fetal skull can pass depends Engagement
on both its structure (bones,
- Refer to the settling of the presenting
fontanelles, and suture lines) and its
part of a fetus far enough into the
alignment with the pelvis
pelvis or midpoint of the pelvis
- The degree of engagement is
➢ Powers of labor (uterine factors)
established by a vaginal and cervical
- Should be adequate
examination
- Strongly influenced by the woman’s
- Floating – a presenting part is not
position during labor (better the push,
engaged
shorter the labor)
- Dipping – one that is descending but
➢ Psychological Outlook
not yet reached the ischial spines
- Of a woman is preserved, so that
afterward labor can be viewed as a
positive experience
Station

- The relationship of the presenting part

Molding
of the fetus to the level of the ischial
- Is a change in the shape of the fetal spines
skull produced by the force of uterine
contractions 0 station (synonymous w/
- Pressing the vertex of the head engagement)
against the not yet dilated cervix - Presenting fetal part is at the level of
- Parents can be reassured that the ischial spines
molding only lasts for a day or two -1 to -4 cm – presenting part is above
and not a permanent condition the spines
+1 to +4 cm – presenting part is below
Little Molding – brow is the presenting
the ischial spines
part because frontal bones are fused
+3 or +4 cm or Crowning – the
No skull molding – fetus is breech presenting part is at the perineum and
because buttocks, not the head, present can be seen if vulva is separated
first
Fetal Attitude
No molding – babies born by cesarean
- Describes the degree of flexion a
birth when there is no pre-procedure
fetus assumes during labor or the
labor
relation of the fetal parts to each
Presenting Part – first fetal body part that other
will touch the cervix Types:
1. Vertex (good or full flexion)
 2. Brow (moderate or military)
3. Face (poor)
Fetal Presentation
4. Mentum (very poor)
- Denotes the body part that will first
A good attitude is in complete flexion:
contact the cervix or be born first
1. Spinal column is bowed forward - Combination of fetal lie and fetal
2. The head is flexed forward that the attitude
chin touches the sternum
3. The arms are flexed and folded on the ➢ Cephalic
chest - Most frequent type of presentation,
4. The thighs are flexed onto the occurring as often as 95% of the time
abdomen - With this presentation, the fetal head
5. Calves are pressed against the is the body part that will first contact
posterior aspect of thighs the cervix

Descent
➢ Breech
- Downward movement of the - Either the buttocks or the feet are the
biparietal diameter of the fetal head first part that will contact the cervix
within the pelvic inlet - Approximately 3% of births are
Full Descent – fetal head protrudes affected by fetal attitude
beyond the dilated cervix and touches - Good attitude brings fetal knees up
the posterior vaginal floor against abdomen
- Poor attitude knees are extended
- It occurs because of the pressure on - Can be difficult births with the
the fetus by uterine fundus presenting point influencing degree of
- The mother will experience the typical difficulty
“pushing” sensation Types:
1. Complete (good flexion)
Fetal Lie
2. Footling (poor)
- Relationship between the long 3. Frank (moderate)
(cephalocaudal) axis of the fetal body
and the long axis of a woman’s body ➢ Shoulder Presentation
- Fetus lies horizontally in the pelvis so
Longitudinal Lie – 96% of fetuses with that the longest fetal axis is
their long axis parallel to the axis of perpendicular to that of mother
the mother
Transverse Lie – vertical fetal lie Presenting part is usually one of
Oblique Lie – slanted fetal lie these:
 1. Shoulders (acromion process) The middle letter denotes the fetal landmark:
2. Iliac crest
- O for occiput
3. Hand
- M for mentum
4. Elbow
- Sa for sacrum
- A for acromion process
Fewer than 1% fetuses lie transversely
The first letter defines whether the landmark
Causes: is pointing to the mother’s pelvis:

1. Pelvic Contractions - R = right

2. Presence of Placenta Previa - L = left
(placenta is located low in the uterus
The last letter defines whether the landmark
obscuring vertical space)
points:
3. Relaxed abdominal walls from grand
multiparity - A = anteriorly
- P = posteriorly
- T = transverse
Fetal Position
Position is important because it can
- Relationship of the presenting part to influence both the process and efficiency of
a specific quadrant and side of labor
woman’s pelvis
Typically, a fetus is born fastest from an ROA
or LOA
Maternal Pelvis Quadrants:
1. Right Anterior Labor is extended if position is ROP or LOP
2. Left Anterior and may be more painful because the
3. Right Posterior rotation of fetal head puts pressure on sacral
4. Left Posterior nerves

Four Parts of a fetus chosen as landmarks to

describe relationship of presenting part to
Mechanisms (Cardinal Movements) of
pelvic quadrants:
Labor
1. Vertex presentation – the occiput is
- Goal: keep the smallest diameter of
the chosen point
the fetal head always presenting the
2. Face presentation – it is the chin
smallest diameter of the pelvis
3. Breech presentation – it is the
- to keep the fetal head fit onto the
sacrum
maternal pelvis for successful birth
4. Shoulder presentation – it is the
scapula or acromion process Movements:
➢ Descent - Head extends and foremost parts of
- Downward movement of biparietal head, face, and chin are born
diamater of fetal head within pelvic
inlet ➢ External Rotation
- Full Descent - aided by abdominal - Immediately after the head of the
muscle contraction as the woman infant is born, head rotates back to
pushes diagonal or transverse position of the
early part of the labor
➢ Flexion - The anterior shoulder is born first
- Making the smallest anteroposterior
diameter present to the birth canal ➢ Expulsion
- Aided by abdominal muscle - End of the pelvic division of labor
contraction during pushing - Once shoulders are born, rest of the
baby is born easily and smoothly
As descent occurs: because of its smaller size
1. Fetal head reaches the pelvic
floor
2. Head bends forward onto the The Powers of Labor
chest
- is the force supplied by the fundus of
the uterus, implemented by uterine
➢ Internal Rotation
contractions, is a natural process that
- During descent, head enters the
causes cervical dilation and then
pelvis with fetal head diameter in a
expulsion of the fetus
diagonal or transverse position
- After full dilation, the primary power
- Head flexes as it touches the pelvic
is supplemented by use of the
floor, and occiput rotates to bring
abdominal muscles
head into best relationship to the
- It is important for women to NOT bear
pelvic outlet
down with their abdominal muscles
- This movement brings shoulder
until the cervix is fully dilated doing so
coming next and putting the widest
impedes primary force and cause
diameter of the shoulders in line with
fetal head cervical damage
wide transverse diameter of the inlet
False Contractions
➢ Extension - Begin and remain irregular’
- As the occiput is born, the back of the - Felt first abdominally and confined to
neck stops beneath the pubic arch
the abdomen and groin
and acts as a pivot for the rest of the
head
 - Often disappear with ambulation or - During labor, contracting uterus
sleep shortens the cervix that the cervix
- Do not increase in duration, virtually disappears
frequency, or intensity
Effacement and Dilation of the cervix:
- Do not achieve cervical dilatation
1. The beginning of labor
True Contractions
2. Effacement is beginning, dilatation is
- Begin irregularly but become regular not apparent yet
and predictable 3. Effacement is almost complete
- Felt first in the lower back and sweep 4. After complete effacement, dilatation
around to the abdomen proceeds rapidly
- Continue no matter what the
woman’s level of activity
Dilatation
- Increase in duration, frequency, and
intensity - Enlargement or widening of the
- Achieve cervical dilatation cervical canal from an opening of few
millimeters to 10 cm
- Dilatation occurs first because
Contraction Phases
uterine contractions gradually
1. Increment – when intensity of increase the diameter of the cervical
contraction increases canal
2. Decrement – when intensity of - As dilatation begins, there is an
contraction decreases increase in vaginal secretions (show)
3. Acme – when contractions is at it is because minute capillaries in the
strongest cervix rupture
- 10 cm = size of melon
As labor progresses, the relaxation intervals
decrease from 10 minutes to 2-3 minutes. The Psychological Outlook

The duration of contractions also changes - Refers to the psychological state or

from 20 to 30 seconds to 60 to 70 seconds feelings a woman brings into labor
- For many women, this is a feeling of
apprehension or fright
Effacement - For almost everyone, it includes a
sense of excitement or awe
- Is the shortening and thinning of the
cervical canal. Women who manage best in labor have a
- All during pregnancy, the canal is 1-2 strong sense of self-esteem and a meaningful
cm long support person with them
These factors allow women to feel in control - Onset of regularly perceived uterine
of sensations and circumstances contractions and ends when rapid
cervical dilatation begins
Women without adequate support can have
- Contractions during the phase are
labor experience that might develop PTSD
mild and short lasting 20 to 40
Encourage women to ask questions during seconds
prenatal visits and attend preparation for - Cervical effacement occurs, and
childbirth classes cervix dilates from 0 to 3 cm

Encourage them after birth to talk about and

Phase lasts approximately:
share their experiences because a
6 hours in a nullipara
“debriefing time” may help them appreciate
4.5 hours in a multipara
the experience
A woman who enters labor with a “nonripe”
cervix will have a longer than usual latent
Week 8: Stages of Labor phase

Although women should not be denied

and Delivery analgesia at this point, if given too early it
Stages of Labor: might prolong this stage

1. First stage of dilatation Measuring the length of the latent phase is

- Begins with the initiation of true labor important because a reason for a prolonged
contractions and ends when cervix is latent phase is cephalopelvic disproportion
fully dilated (disproportion between fetal head and pelvis)
2. Second Stage that could require cesarian birth
- Extending from the time of full A woman can and should continue to walk
dilatation until infant is born about and make preparations for birth
3. Third or Placental Stage
- Lasting from the time the infant is Encourage her to continue or begin
born until after the delivery of the alternative methods of pain relief such as
placenta aromatherapy or distraction
4. Fourth Stage
- The first 1 to 4 hours after birth of the
placenta to emphasize maternal Active Phase
observation - Cervical dilatation occurs more
First Stage rapidly, increasing from 4 to 7 cm
- Contractions grow stronger, lasting 40
- Latent Phase or preparatory phase to 60 seconds every 3 to 5 minutes
 - Show and spontaneous rupture of A woman may experience intense
membranes may occur during this discomfort accompanied by nausea and
time vomiting

Because of the intensity and duration of

Phase approximately lasts:
contractions, they may experience loss of
3 hours in nullipara
control, anxiety, panic, or irritability
2 hours in multipara
The peak of the transition phase:
The active stage of labor in a Friedman Graph
can be subdivided into the following periods: Slight slowing in the rate of cervical dilatation
when 9 cm is reached
- Acceleration (4 to 5 cm)
- Maximum Slope (5 to 9 cm) On the end of this stage at 10 cm of
dilatation, a new sensation (irresistible urge
During the maximum slope, cervical
to push) occurs
dilatation is at its most rapid pace, 3.5 cm
per hr in nulliparas and 5 to 9 cm per hr in
multipara
Second Stage
Encourage women to be an active participant
- Period from full dilatation and
in labor by assuming what position is most
cervical effacement to birth of the
comfortable for them
infant that takes about 1 hour
- Contractions change from the
characteristic crescendo-
Transition Phase
decresendo pattern to an
- Contractions reach their peak of uncontrollable urge to push down
intensity - Patient feels momentary nausea or
- Rupture of membranes and show vomiting
occurs as the last of the mucus plug - She pushes with force that her
from the cervix is released vessels in her neck become
- By the end of this phase, both full distended
dilatation and complete cervical - Fetal head touches the internal side
effacement have occurred of the perineum, the perineum
begins to bulge and appear tense
Interval: every 2 to 3 mins
- Anus may become everted, and stool
Duration: 60 to 90 seconds may be expelled
- Fetal head pushes against the
Cervical Dilatation: 8 to 10 cm
perineum
 - Vaginal Introitus – slit like oval Schultze Presentation
circular opening where fetal scalp
- Placenta separates first at its center
appears
and lasts at its edges
- Circle enlarges into a dime, to a
- Fold onto itself like an umbrella with
quarter, to a half a dollar or Crowning
fetal surface evident
- Appearing shiny and glistening from
Third Stage (Placental Stage) the fetal membranes

- Begins with the birth of the infant and Duncan Presentation

ends with the delivery of the placenta
- looks raw, red, and irregular with the
Two separate phases: ridges or cotyledons show
- “dirty” or irregular maternal surface
1. Placental Separation
2. Placental Expulsion Bleeding occurs as part of the normal
consequence of placental separation to seal
After birth of the infant, uterus can be
maternal sinuses
palpated as a firm, round mass inferior to
the umbilicus Normal blood loss: 300 to 500 mL

After a few minutes of rest, uterine B. Placental Expulsion

contractions begin again, and the organ - After separation, placenta is delivered
assumes a discoid shape by the natural bearing down effort of
mother or by gentle pressure on the
A. Placental Separation
contracted uterine fundus by a
- Folding and separation of the
physician or nurse midwife (Crede’s
placenta occur as the uterus
Maneuver)
contracts down
- Pressure must NEVER be applied to a
- Active bleeding on the maternal
uterus in a non contracted state by
surface of the placenta begins with
doing so it may cause uterus to evert
separation that helps to separate the
and hemorrhage
placenta pushing it away
Hemorrhage is a grave complication of birth
Signs that indicate placenta has loosened
because maternal blood sinuses are open.
and is ready to deliver:
If the placenta does not deliver
- Lengthening of the umbilical cord
spontaneously, it can be removed manually
- Sudden gush of vaginal blood
w/ doctors order or proper practice
- Change in the shape of the uterus
- Firm contractions of the uterus
- Appearance of the placenta at vaginal
opening
Physiologic Effects of Labor on a Woman: D. Respiratory System
- Total oxygen consumption increases
A. Cardiovascular System
by about 100% during second stage
- Each contraction greatly decreases
of labor
blood flow to the uterus because the
- It can result in hyperventilation
contracting uterine wall puts pressure
- Use appropriate breathing patterns to
on uterine arteries
avoid such a problem
- Increases the amount of blood that
remains in a woman’s general
E. Temperature Regulation
circulation thus increase diastolic
- Increased muscular activity
and systolic blood pressure
associated by labor result in a slight
- The work of pushing during labor may
elevation (1 F) in temperature
increase cardiac output by 40% to
- Diaphoresis occurs to cool and limit
50%
excessive warming

B. Blood Pressure
F. Fluid Balance
- Systolic bp rises an average of 15
- Becos of the increase in rate and
mmHg w/ each contraction
depth of respirations and diaphoresis,
- When a woman lies in a supine
insensible water loss increases
position and pushes during second
during labor
stage of labor, pressure on the uterus
- Fluid balance is further affected if a
on the vena cava causes her blood
woman eats nothing but sips of fluid
pressure to drop leading to
or ice chips
hypotension
- Upright or side-lying position during
G. Musculoskeletal System
second stage of labor makes pushing
- During pregnancy, relaxin, an
more effective and avoid such a
ovarian-released hormone has acted
problem
to soften cartilage between bones
- In the week before labor, the
C. Hemopoietic System
symphysis pubis and the sacral joints
- Development of leukocytosis or a
become relaxed and movable
sharp increase in the number o
allowing them to stretch for as much
circulating WBC as a result o stress
as 2 cm
and heavy tension
- At the end of labor, the woman has
H. Urinary System
WBC count of 25,000 to 30,000
- With a decrease in fluid intake during
compared to a normal count of 5,000
labor and increased insensible water
to 10,000
loss, kidneys begin to concentrate
 urine to preserve both fluid and - Be sure to explain that contractions
electrolytes last a certain length but always have a
- Specific gravity may rise to a level of pain-free rest period in between
1.020 to 1.030
- It is not unusual for traces of protein 3. Cultural Influences
to be evident caused by increased - In the past, woman was accustomed
muscle activity to follow hospital procedures
therefore followed instructions during
I. Gastrointestinal System labor
- GIS becomes inactive during labor - Today, women are educated to help
- Digestive and emptying time of plan their care
stomach is prolonged - This makes her responses, choices,
- Some women may experience loose preferences, and all related customs
bowel movement are individualized

J. Neurologic and Sensory Responses

- The responses that occur during labor Physiologic Effects of labor to a Fetus:
is related to pain (increased PR and
1. Neurologic System
RR)
- Uterine contractions exert pressure
- At the moment of birth, the pain is
on the fetal head, so increased
centered on the perineum
intracranial pressure occurs
- FHR decreases by as much as 5 bpm
during a contraction
Psychological Responses of a woman
- This decrease appears on an FH
during labor:
Monitor as a normal or early pattern
1. Fatigue
- Women are generally tired from the 2. Cardiovascular System
burden of carrying so much weight - During contractions, arteries of uterus
- In most cases, most woman do not sharply constrict and filling of
sleep well during the last month of cotyledons completely halts
pregnancy - Amount of nutrients, oxygen
exchanged is reduced causing a slight
2. Fear inconsequential fetal hypoxia
- Women appreciate a review of the
labor process early in the labor as a
reminder that childbirth is not strange
 3. Integumentary System - May be another indication of
- Pressure involved in the birth process hemorrhage
is often reflected in minimal
petechiae or ecchymotic areas ➢ Inadequate or Prolonged
- May also be edema of the presenting Contractions
part (caput succedaneum) - If they become less frequent, less
intense, shorter duration, it may
4. Musculoskeletal System indicate uterine exhaustion (inertia)
- Force of contractions tends to push a - If problem cannot be corrected,
fetus into a full flexion cesarean birth is necessary
- Uterine contractions lasting longer
5. Respiratory System than 70 seconds should be reported
- Process of labor appears to aid in
maturation of surfactant production ➢ Pathologic Retraction Ring
by alveoli in fetal lungs - Indentation across a woman’s
- Contractions and passage through abdomen
the birth canal help clear it of lung - Sign of extreme uterine stress and
fluid possible impending uterine rupture
- It is important to observe the contour
of a woman’s abdomen
Maternal Danger Signs - Bandl’s Ring

➢ High or Low Blood Pressure

➢ Abnormal Lower Abdominal Contour
- Normally, a woman’s bp rises slightly
- Indicates a full bladder = a round
in second stage of labor bcos of
bulge on her lower anterior abdomen
pushing effort
- To avoid a full bladder, void about
- Pregnancy induced hypertension =
every 2 hours during labor
140/90 mmHg
- An increase of systolic pressure 30
Dangers:
mmHg or diastolic pressure 15 mmHg
1. Bladder may be injured by the
should be reported
pressure of the fetal head
2. Pressure of the full bladder may
➢ Abnormal Pulse
not allow fetal head to descend
- Most pregnant woman have a PR of
70 to 80 bpm
➢ Increasing Apprehension
- A maternal pulse rate greater than
- Should be investigated for physical
100 bpm during labor must be
reasons because it can be a sign of
reported
 oxygen deprivation or internal 4. No interventions such as IV fluids
hemorrhage should be used routinely
5. Women should be allowed to assume
a nonsupine position for birth
Fetal Danger Signs
6. Mother and baby should be together
➢ High or low Fetal HR after birth w/ unlimited opportunities
- >160 bpm (fetal tachycardia, <110 for breastfeeding
bpm (fetal bradycardia) is a sign of
A woman needs to feel that she has some
fetal distress
control over her situation

➢ Meconium Staining Most women accomplish this by stating their

- Fetus has had a loss of rectal preferences and changing their position
sphincter control allowing meconium where they are comfortable
to pass into amniotic fluid
Some women handle stress from labor by
- Fetus is or has experiencing hypoxia
being quiet and passive others feel
which stimulate vagal reflex and
comfortable by shouting or crying
increase bowel motility
Respect Contraction Time
➢ Hyperactivity
- Do not interrupt a woman who is in
- Fetal hyperactivity may be a sign of
the middle of breathing exercises
hypoxia bcos of frantic motion is a
during labor
common reaction for the need of
oxygen Promote Change of Positions

- In early labor, woman may be out of

➢ Oxygen Saturation bed walking or sitting, kneeling
- O2 Sat in a fetus is normally 40% to
squatting or in whatever position she
70% prefers
Six major concepts to make labor and birth If membranes have ruptured:
as natural as possible:
- She should lie on her side until a fetal
1. Labor should begin on its own, not
monitor shows a good baseline
artificially induced
variability and no variable
2. Women should be able to move about deceleration
freely throughout labor, not confined - Or until she has been checked by a
to bed physician because unless the head of
3. Women should receive continuous the fetus is well engaged the
support during labor umbilical cord may prolapse into
the vagina if she walks
 - Narcotics is given and educate a - The feeling to push is so strong, some
woman to remain in bed for 15 mins women react to this change by being
afterward to avoid fall if she should argumentative and angry or crying
feel dizzy from the meds and screaming
- While woman is in bed, encourage her - Others react by tensing their
to lie on her side, preferably the left abdominal muscles which make the
side (it will not suppress the vena sensation more painful and
cava, allowing free blood return) frightening

Preparing the place of Birth:

➢ Offer Support
- There is no substitute for personal Multipara -convert a birthing room into a
touch and contact as a way to provide birth room by opening the sterile packs of
support supplies on waiting tables when the cervix
- Patting a woman’s arm while telling has dilated to 9 to 10 cm
her she is progressing in labor
Primipara – this can be delayed until the
head has crowned to the size of a half dollar
➢ Respect and Promote the support
person A table set with equipment such as sponges,
- Admit a woman’s support person to drapes, scissors, basins, clamps, bulb
the birthing area and allow him or her syringe, vaginal packing, and sterile gowns,
to remain with them throughout the gloves, and towels can be left uncovered for 8
birth hours

Be certain that the drapes and materials

➢ Support a woman’s pain
used for birth are sterile
management needs
- Many women plan on using a
nonpharmacologic pain relief Positioning for Birth:
measure such as aromatherapy
during labor - Lithotomy Position
- Ask what she has planned and what - Sims Position
you need to do - Squatting Position
- Semi sitting position
Care of a woman during the Second Stage of - Dorsal Recumbent Position
Labor
Because pushing becomes less effective in a
- Even women who have taken classes lithotomy position, the top portion of the
about childbirth are still surprised by table should be raised to a 30-60 degree
the intensity of the contractions
angle
Lying for longer than 1 hour in a lithotomy - Rinse with designated solution before
position leads to intense pelvic congestion, birth according to the physician
because blood flow to the lower extremities
Always clean from the vagina outward so that
is impeded
microorganisms are moved away from the
Pelvic Congestion may lead to an increase in vagina using a clean compress for each
thrombophlebitis in postpartum period stroke

Be sure and include a wide area

Promoting Effective Second Stage Pushing If physician or nurse midwife plans to use
sterile drapes, help place them around the
- Woman should wait to feel the urge to
perineum
push
- She should push with contractions
and rest between them
Introducing the Infant
- Pushing is usually best done from a
semi-fowler, squatting, or all fours - After cord is cut, it is time for the
position rather than lying flat to allow parents to spend some time w/ their
gravity to aid the effort newborn
- Wrap the infant in a sterile blanket
A woman can use short pushes or long,
- Be sure to HOLD newborns firmly
sustained ones, whichever are more
because they are covered with
comfortable
slippery amniotic fluid and vernix
Holding the breath during a contraction could - Establish a parent-child relationship
cause a valsalva maneuver or temporarily
impede blood return to the heart because of
Care of woman during third or fourth stage
increased intrathoracic pressure
of Labor:
To prevent her from holding her breath during
1. Placenta Delivery
pushing, urge her to breathe out during
2. Oxytocin Administration
pushing effort
3. Perineal Repair

Perineal Cleaning Immediate Postpartum Assessment and

Nursing Care
- To remove vaginal or rectal secretions
and prepare a clean environment for - Obtain vital signs every 15 minutes
the baby, clean the perineum with a for the first hour
warmed antiseptic such as lodophor
(cold solutions cause cramping)
 - Pulse and respirations may be rapid experience chills and shaking
immediately after birth (80 to 90 sensation 10 to 15 mins after birth
bpm and 20 to 24 cpm)
- BP may slightly be elevated because
of the excitement of the moment and Aftercare
recent administration of oxytocin
- Beginning of the postpartum period or
fourth stage of labor
Palpate a woman’s fundus for size, - Because the uterus may be so
consistency, and position and observe the exhausted from labor, there is a high
amount and characteristics of lochia risk for hemorrhage
- In addition, women are often
Lochia Rubra
exhausted that she may not be able to
- Red assess her own condition and report
- 1st to 4th days after childbirth any changes
- Flow like heavy menstrual bleeding
and may contain small clots

Lochia Serosa Week 9: Newborn Care

- Pinkish / Yellow / Brownish Profile of a Newborn
- 5th to 9th days after childbirth
➢ Vital Statistics
- Flow is moderate to small and less
- Measured in a newborn are weight,
bloody, more watery
length, and head / chest
Lochia Alba cirfumference
- Whitish-yellow - Safety issues specific to newborn
- 10th to 14th days after childbirth care such as not leaving a newborn
- Flow is small/spotting with little to no unattended on a bed or scale
blood
Weight
Nursing Care Purpose:
- Perform perineal care, and apply a - too small for their gestational age
perineal pad (newborns who have suffered
- If birth was in birthing room, return intrauterine growth constriction)
bed to its original position - from preterm infants (infants who are
- Offer a clean gown and a warmed healthy but small becos they were
blanket because a woman may born early
The birth weight of newborns varies - >37cm (14.8 in) or <33 cm (13.2) –
depending on: assess for neurologic involvement,
although occasionally a well newborn
- racial, nutritional, intrauterine, and
falls within these limits
genetic factors that were present
(microcephaly or hydrocephalus)
during conception and pregnancy
- Head circumference is measured
- weight should be plotted on a
with a tape measure at the center of
standard neonatal graph
the forehead and around the most
Female: 3.2 kg prominent portion of the posterior
head
Male: 3.4 kg

>4.7 kg (10 lbs) – unusual weight

Head Circumference
7.7 kg (17 lbs) – highest documented weight
- 2 cm (0.75 to 1 in) less than the head
Macrosomic – weighs >4.7 kg, Maternal circumference
Illness: Diabetes Mellitus - Measured at the level of the nipples
- If there is large amount of edema and
Second born children usually weigh more
breast tissue is present, it will not be
than first born
accurate until it subsides
Birth weight continues to increase with each
succeeding child in a family
➢ Vital Signs

Length Temprature

- 53 cm (20.9 in) – average birth length - Temp of newborns is about 99 F

of a mature female neonate (37.2C) at birth because they have
- 54 cm (21.3 in) – average birth length been confined in an internal body
for mature male organ
- 46 cm (18 in) – lower limit of normal - Temp falls almost immediately to
length below normal because of heat loss
- 57.5 (24 in) – rare report of baby and immature temperature regulating
length mechanisms

Insulation – an efficient means of conserving

Head Circumference heat in adults is not effective in newborns
because they have little subcutaneous fat
- 32.5 to 36 cm (12.7 to 14.1 in) – in
mature
Shivering – means of increasing metabolism - Newborn HR is always determined by
and thereby providing heat in adults, is rarely listening for an apical heartbeat for a
seen in newborns full minute is strictly done
- 110-160 bpm = heart rate of fetus in
Brown Fat
utero averages
- A special tissue found in mature - 180 bpm = immediately after birth as
newborns, helps conserve or produce newborns struggles to initiate
body heat by increasing metabolism respirations
- Aid in controlling newborn - 120-160 bpm = within 1 hr after birth,
temperature similar to a hibernating NB settles down to sleep
animal - 180 bpm = during crying
- Found in intrascapular region, thorax, - 90110 bpm = during sleeping
and perineal area

Skin to skin care Respirations

- Placing newborn against mother’s - 90 cpm = first few mins of life

skin then covering the newborn w/ - 30 to 60 cpm = newborn at rest
blanket help transfer heat from the - Periodic Respirations (NORMAL) =
mother to the newborn short periods of apnea (w/o cyanosis)
- Newborns exposed to cool air tend to which last less than 10 seconds
kick and cry to increase their - RR can be observed easily by
metabolic rate and produce more watching the movement of a
heat newborn's abdomen
- Drying them and placing them under
a radiant heat source, “drop light”, are
Blood Pressure
excellent mechanical measure to
help conserve heat - 80/40 mmHg = blood pressure of
newborn at birth
Pulse
- 100/50 mmHg = by the 10th day
- Remain slightly irregular because of - For an accurate reading, cuff width
immaturity of cardiac regulatory used must be no more than two
center in the medulla thirds the length of upper arm or
- Transient murmurs may result from thigh
the incomplete closure of fetal - BP increases while crying
circulation shunts (close the fetal - A Doppler Method may be used to
shunts) take blood pressure
 ➢ Physiologic Function Respiratory System

Cardiovascular System - All NB have some fluid in their lungs

from intrauterine life that will ease the
- Lungs must oxygenate the blood that
surface tension on alveolar walls and
was formerly oxygenated by placenta
allows alveoli to inflate easily
- As lungs inflate for the first time,
- About a third of this fluid is forced out
pressure decreases in the pulmonary
of the lungs by pressure of vaginal
artery
birth
- This decrease in pressure plays a role
- Additional fluid is quickly absorbed by
in promoting closure of the ductus
lung blood vessels and lymphatics
arteriosus, a fetal shunt
after first breath
Once proper lung oxygenation has been - NB who has difficulty in establishing
established, need for high RBC count respirations at birth should be
diminishes examined in postpartal period for
cardiac murmur
Bilirubin is a byproduct of the breakdown of
- Within 10 mins of birth, most NB have
RBC
established a good residual volume
Indirect Bilirubin level at birth is at 1-4
mg/100 mL
GastroIntestinal System
Hematocrit
- Meconium = first stool of newborn
- Adult (36-45%) passed within 24 hours after birth.
- Newborn (45-60% Sticky, tarlike, blackish-green,
odorless material formed from
RBC
mucus, vernix, lanugo, hormones, and
- Adult (3.50-5.50) carbohydrates
- Newborn (6.0 million/cubic meter) - Although GIT is usually sterile at birth,
WBC bacteria may be cultured from the
intestinal tract in most babies within 5
- Adult (9,000-30,000) hours after birth and from all babies
- Newborn (15,000-30,000) at 24 hours of life
- It does not mean there is an infection
but may be because of exertion Bacteria enter the tract through the
during birth newborns mouth from:
- Airborne sources
- Vaginal secretions at birth
- Hospital bedding
 - Contact at breast Immune System

Accumulation of bacteria in the GIT is - Newborns have difficulty forming

necessary for digestion and synthesis of VIt. K antibodies against antigens until
about 2 months of age, they are
Transitional Stool
prone to infection
- Second or third day of life (green and - Newborns do have some
loose) immunologic protection bcos they
are born with passive antibodies
Breastfed Babies
(immunoglobulin G) from their
- Fourth day of life, three or four light mother
yellow stools per day (sweet-smelling - NBs are routinely administered hepa
because of breast milk is high in lactic b vaccine during first 12 hours after
acid birth
Formula
Neuromuscular System
- Two or three bright yellow stools a day
with a slightly more noticeable odor - Mature newborns demonstrate
neuromuscular function by moving
their extremities, attempting to
Urinary System control head movement, exhibiting
- The average NB voids within 24 hours strong cry, and demonstrating
after birth newborn reflexes
- Newborns who do not void within this - Limpness or total absence of a
time may have urethral stenosis or muscular response to manipulation
absent kidneys or ureters is never normal and suggest narcosis,
- 15 ml – single voiding in a newborn shock, or cerebral injury
(pink or dusky bcos of uric acid Blink Reflex
crystals)
- Purpose: protect the eye from any
- 1.008 – 1.010 – specific gravity
object coming near it by rapid eyelid
(normal)
closure
- 30 – 60 ml – daily urinary output for
- It may be elicited by shining a strong
the first 1 or 2 days
light such as a flashlight or otoscope
- 300 ml – week 1 total daily volume
- Sudden movement toward the eye
sometimes elicit blink reflex
Rooting Reflex Palmar Grasp Reflex

- If cheek is brushed or stroked near - Newborns grasp an object placed in

the corner of the mouth, newborn their palm by closing their fingers on
will turn the head in that direction it
- Serves to help a newborn find food - Reflex disappears at about 6 weeks or
like when a mother allows her breast 3 months of age
to brush at newborns cheek the baby
Step (walk) in place Reflex
will turn that way
- Newborns who are held in a vertical
Sucking Reflex
position with their feet touching a
- When newborns lips are touched, the hard surface will take a few quick,
baby makes a suckling motion alternating steps
- When newborns lips touch the - This reflex disappears by 3 months of
mother’s breast or a bottle, the baby age
sucks
Plantar Grasp Reflex
- Begins to diminish at about 6 months
of age - When an object touches the sole of a
newborn's feet at the base of the toes,
Swallowing Reflex
the toe grasp in the same manner
- Food that reaches the posterior with their fingers
portion of the tongue is automatically - This reflex disappears at about 8-9
swallowed months of age in preparation for
- Gag, cough, and sneeze reflexes are walking
present to maintain a clear airway
Tonic Neck Reflex
Extrusion Reflex
- When newborns lie on their back,
- Newborn extrudes any substance their heads usually turn to one side or
that is placed on anterior portion of the other
tongue - Also called boxer or fencing reflex
- Prevents swallowing of inedible - Reflex disappears between second or
substances third month of life
- Disappears at about 4 months of age
Moro Reflex (Startle)
until then infant may seem to be
spitting out or refusing solid foods - Initiated by startling a newborn with
placed in mouth loud noise or jarring the bassinet
- In response to this sudden head
movement, they abduct and extend
 legs and arms and fingers assume a Landau Reflex
“C” position
- Prone position with hand underneath,
- Strong for the first 8 weeks of life and
supporting the trunk, should
fades by end of fourth or fifth month
demonstrate some muscle tone
Babinski Reflex - Not able to lift their head pr arch their
back but neither should they sag in an
- When sole of the foot is stroked in an
inverted “U” position
inverted “J” curve from the heel
upward, a newborn fans the toe
(positive babinski sign)
Appearance of a Newborn
- This occurs because nervous system
development is immature 1. Skin
- It remains positive until 3 months of
age ➢ Color
- Ruddy complexion – term newborns
Magnet Reflex
have this bcos of increased
- If pressure is applied to soles of the concentration of RBC in blood vessels
feet on a newborn in a supine and decreased amount of SC fats,
position, they push back against the which makes blood vessels more
pressure visible
- Test for spinal cord integrity - This ruddiness fades slightly over the
first month
Crossed Extension Reflex
- Gray color – generally indicate
- One leg – supine, extended, sole of infection
the food irritated (rubbing sharp - Pale and Cyanotic – poor central
object) nervous system control
- Other leg – raises and extends as if
Cyanosis
trying to push away the hand irritating
the first leg - generalized mottling of skin is
common. Newborns lips, hands, and
Trunk Incurvation Reflex
feet are likely to appear blue from
- In prone position immature peripheral circulation
- Touch the paravertebral area by
Acrocyanosis
probing a finger, flexing of trunk and
swing their pelvis toward touch - blueness of hands and feet
- normal phenomenon in the first 24 to
48 hours after birth
Central Cyanosis Early feeding promotes intestinal movement
and excretion of meconium that prevent
- indicates decreased oxygenation
indirect bilirubin buildup
- may result in temporary obstruction
or an underlying disease state Level of jaundice may be judged by
estimating the extent it has progressed on the
Hyperbilirubinemia
surface of the body. Noticed first in the head
- leads to jaundice or yellowing of the and then spreads to the rest of the body
skin
Treatment
- occurs on the second or third day of
life in 50% of all newborns as a result - For physiologic jaundice, early
of breakdown of fetal RBC feeding to speed passage of feces
(physiologic jaundice) through the intestine and prevent
- Many newborns have immature liver reabsorption of bilirubin
function that indirect bilirubin - There is no set level at which indirect
remains indirect serum bilirubin requires treatment
- As long as there is buildup of indirect - If level rises to more than 10-
bilirubin, red coloring of RBC remains 12mg/100ml, treatment is usually
tinted of yellow by bilirubin considered
- Indirect bilirubin has risen to 7mg/00 - Phototherapy (exposure of the infant
ml to light to initiate maturation of liver
- Bilirubin permeates the tissue outside enzymes) is a common therapy
circulatory system which causes - Some infants need continued therapy
infant to appear jaundice after discharge and receive
phototherapy at home
Observe infants who are prone to extensive
bruising Kernicterus

- Large, breech, or immature babies - Above-normal indirect bilirubin levels

for jaundice because bruising leads to are potentially dangerous (about
hemorrhage of blood in SC tissue or 20mg/100ml) leaves the bloodstream
skin it can interfere with the chemical
- Cephalhematoma is a collection of synthesis of brain cells, resulting in
blood under periosteum of the skull permanent cell damage and cogntive
bone challenge

If intestinal obstruction is present and stool Pallor

cannot be evacuated, intestinal flora may
- Pallor in Nb is usually the result of
break down bile leading to release of indirect
anemia
bilirubin into bloodstream again
Caused by: Stork’s beak marks (Telengiectasia)

- Excessive blood loss when cord was - lighter, pink patches

cut - do not fade, but covered by hairline
- Inadequate flow f blood from the cord - occur often in females than in males
into infant at birth
Nevus Flammeus
- Fetal-maternal transfusion
- Low iron stores caused by poor - strawberry hemangiomas
maternal nutrition during pregnancy - elevated areas formed by immature
- Blood incompatibility capillaries and endothelial cells
- Internal bleeding - high estrogen levels of pregnancy
- may continue to enlarge up to 1 yr of
Harlequin Sign
age but after first year they tend to be
- Because of immature circulation, a absorbed and shrink
newborn who has been lying in his or - By the time the child is 7 years old,
her side appears red on the 50% to 70% of these lesions have
dependent side of the body disappeared
- This is a transient phenomenon,
Cavernous Hemangiomas
although startling, it is of no clinical
significance - Dilated vascular spaces
- the odd coloring fades immediately if - Do not disappear
infant’s position is changed - Can be removed surgically
- Children who have skin lesions may
have additional ones on internal
➢ Birthmarks organs
- Blows to the abdomen can cause
Portwine Stain
bleeding from an internal
- Macular purple or dark red lesions hemangioma
- Typically appear on the face and - Their hematocrit levels are assessed
found on the thigh as well to evaluate for possible internal blood
- tend to fade loss
- can be covered by cosmetic
Mongolian Spots
preparations later in life or removed
by laser therapy - Collections of pigment cells
(melanocytes) that appear as slate-
Hemangiomas
gray patches across the sacrum or
- vascular tumors of the skin buttocks and arms or legs
- Tend to occur on asian, southern
european, or african ethncity
- Disappear by school age without ➢ Milia
treatment - Pinpoint white papule (plugged or
- Assure parents that these are not unopened sebaceous gland) can be
bruises found on the cheek or across the
bridge of the nose
➢ Vernix Caseosa - Disappear by 2-4 weeks of age
- White, cream cheese-like substance
that serves as a skin lubricant in utero ➢ Erythema Toxicum
- Document color of vernix - First to fourth day up to 2 weeks of
- Yellow vernix – implies that the age – appearance of rash
amniotic fluid was yellow from - Flea-bite rash
bilirubin - Chief characteristics is lack of pattern
- Green vernix – indicates meconium - Caused by eosinophils
was present in amniotic fluid - Requires no treatment
- Until first bath, handle newborns
with gloves to protect yourself from ➢ Skin turgor
exposure - Newborn skin should feel resilient if
- Never use harsh rubbing to wash well hydrated
away vernix - Fold of skin is grasped between
- Newborn skin is tender and too thumb and fingers; it should feel
vigorous attempts at removal may elastic
open portals of entry for bacteria - When released, should fall back to
form a smooth surface
➢ Lanugo - If severe dehydration is present, skin
- Fine, downy hair that covers a will not smooth out again but remain
newborn’s shoulders, back, and in an elevated ridge
upper arms
- Babies born between 37-39 weeks 2. Head
have more lanugo than 40 weeks - One fourth of total body length
- By 2 weeks of age, it has disappeared - Forehead is large and prominent
- Chin appears receding and quivers
➢ Desquamation easily if startled or cries
- Within 24 hours after birth, skin has - Full bodied hair – nourished
become extremely dry newborns
- Evident on palms of hands and soles - Thin, lifeless hair – poorly nourished
of feet and preterm infants
- Normal and needs no treatment
Fontanelles - Cause: rupture or periosteal capillary
because of pressure of birth
- Spaces between or openings where
- Swelling usually appears 24 hours
skull bones join
after birth
- Anterior Fontanelle = diamond
- Discolored (black and blue) –
shaped, can be felt as a soft spot
presence of coagulated blood
- Posterior Fontanelle = triangular
- Often takes weeks to be absorbed
shaped
- Could be aspirated to relieve
- Dehydration – indented fontanelle
condition but will introduce the risk
- Increased ICP – bulging when infant
of infection
is held upright, w/ crying a pulse may
be seen Craniotabes
- 12-18 months – anterior fontanelle
- Localized softening of the cranial
normally closes
bones
- End of second month – posterior
- cause: pressure of the fetal skull
fontanelle closes
against mother’s pelvic bone in utero
Sutures - bone returns to its normal contour
after pressure is removed
- Separating lines of the skull
- after a few months, corrects itself
- May override at birth bcos of extreme
without treatment as infant takes
pressure exerted on head
calcium
- If sagittal suture overrides,
fontanelles are less perceptible
3. Eyes
- Overriding subsides in 24 to 48 hours
- Newborns cry tearlessly because
- Wide separation – increased
their lacrimal ducts do not fully
intracranial pressure
mature about 3 months of age
- Abnormal – fused suture lines
- 3 and 12 months of age – assume
because it will prevent the head from
permanent color
expanding with brain growth
- Eye inspection: should appear clear
Caput Succedaneum w/o redness or purulent discharge
- Lay in supine and lift head to cause
- Edema of the scalp at the presenting
baby to open the eyes
part of the head
- Needs no treatment
4. Ears
Cephalhematoma - Level of the top part of the external
ear: inner canthus to the outer
- Collection of blood between the
canthus of the eyes
periosteum of a skull bone and the
bone itself
- Ears that are set lower has certain 7. Neck
chromosomal abnormalities - Short and often chubby, with creased
- Good practice is to test babies skin folds
hearing by ringing a bell held about 6 - Head should rotate freely on it
inches from each ear - If membranes are ruptured more than
- If quiet, a newborn who can hear will 24 hours before birth, nuchal rigidity
blink the eyes and appear to attend suggests meningitis
to the sound, possibly startle - Congenital Torticollis – rigidity of the
neck caused by injury of the
5. Nose sternocleidomstoid muscle during
- Tends to appear large for the face birth
- Test for choanal atresia (blockage at
the rear of the nose) – close NB 8. Chest
mouth and compress one naris at a - 2 years of age chest measurement
time with finger exceed that of head
- Note any discomfort or distress while - Crepitus or actual separation on one
breathing this way clavicle may indicate that a fracture
- Nasal Flaring – upon inspiration is occurred during birth
another indication of respiratory - Supernumerary nipple – found below
distress and in line with normal nipples
- Witch’s Milk – breasts of babies
6. Mouth secrete a thin, watery fluid
- Should open evenly when he or she - Engorgement – develops as a result of
cries influence of mother's hormones
- If one side moves more than the - 1 week – hormones are cleared from
other, cranial injury is suggested the infant's system, engorgement and
- If tongue is short, the frenulum fluid subside
membrane is attached close to the - Retraction – drawing in of the chest
tip of the tongue, an impression the wall with inspiration, strong force to
infant is tongue tied pull air into respi tract
- Epstein’s Pearls – one or two, round, - Respiratory distress syndrome –
small, glistening circumscribed cysts abnormal sound such as grunting
on the palate as a result of extra - Stridor or immature tracheal
calcium development – high, crowing sound
- Inform parents that it requires no on inspiration
treatment and will disappear within
1 week, has no significance
 9. Umbilical Cord - Dorsal Surface (epispadias) –
- After first hour of life, cord begins to urethral opening on dorsal surface
dry and shrink and turns brown like - Ventral Surface (hypospadias) –
the dead end of a vine urethral opening on ventral surface
- Second or third day – has turned
Female genitalia
black
- 6th to 10th day – cord breaks free by - Vulva in female newborns may be
leaving a granulating area swollen because of the effect of the
- Base of the cord should appear dry maternal hormones
- Omphalitis – moist or odorous cord - Pseudomenstruation – female
suggests infection newborns have a mucus vaginal
- if infection is present, receive secretion which is sometimes blood
immediate treatment or may cause tinged
septicemia - Cause: action of maternal hormones
and disappears as soon as hormones
are cleared in infant’s system
10. Anogenital
- Inspect anus of newborn to be certain 11. Back
it is present, patent, and not covered - Flat in the lumbar and sacral areas –
by a membrane (imperforate anus) spine of a newborn
- Test for anal patency – gently insert - child is able to sit and walk – curves
tip of glove and lubricate little finger will be present
- Note time after birth of first pass of - Inspect base of a newborn’s spine –
meconium, if not for the first 24 to be sure there is no pinpoint
hours, suspect imperforate anus or opening, dimpling, sinus tract in the
meconium ileus skin which would suggest dermal
sinus or spinal bifida occulta
Male genitalia

- Scrotum in male newborns is 12. Extremities

edematous and has rugae (folds in - Arms and legs
the skin) - Fingernails are soft and smooth
- Cryptorchidism – one or both - Good tone – arm should return
testicles are not present immediately to its flexed position
- Cremteric reflex – stroke internal after being released
side of thigh, testes on that side - Achondroplast Dwarfism – unusually
moves upward (may be absent in short arms
younger than 10 days - Simian crease – single palmar crease
- Syndactyly – webbing
 - Polydactyly – extra toes or fingers Return of Menstrual Flow
- Ortolani’s sign – subluxation is
- 6 to 10 weeks after birth if not
present, a “clunk” of the femur head
breastfeeding
striking the acetabulum can be heard
- 3 or 4 months or entire lactation
- Barlow’s sign – if hip can be felt to
period return of mens flow for
actually slip in the socket
breastfeeding woman
- Absence of a menstrual flow does
not guarantee that a woman will not
Week 10: Postpartum conceive

Care!!!!!!!!!!!!! Nursing Responsibilities

Progressive changes 1. Perineal Care

- Inspect perineum for presence of
- Building new tissue requires good drainage or bleeding from any
nutrition, caution women against episiotomy stitches or other
strict dieting complications
Lactation 2. Provide pain relief for after pains
- Pain from uterine contractions is
- Formation of breast milk in intense but this type of discomfort is
postpartal women wether she intends normal and rarely lasts longer than 3
to breastfeed or not days
- First two days – little changes in her 3. Relieve muscular aches
breasts - Backrub is effective for relieving an
- Third day – breasts become full and aching back or shoulder
feel tense as milk forms in breast 4. Administer cold and hot therapy
ducts - During first 24 hours reduces perineal
- Breast milk forms in response to edema
decrease in estrogen and 5. Episiotomy Care
progesterone levels - Soothing cream or anesthetic ray to
- Primary engorgement – feeling of suture line to reduce discomfort
tension in breasts on third or fourth 6. Inspect Lochia
day after birth and fades as soon as - Clots may indicate that a portion of
infant starts sucking and empties the placenta has been retained
breast of milk
Psychological Changes Puerperium/Postpartum – 6 weeks period
after giving birth
1. Postpartal Blues (baby blues)
- Temporary feeling after birth where Engorgement – swell with blood, water, or
they burst into tears, easily let down, another fluid
irritable
Involution – return of repro organs to their
- Normal
non-pregnant state
Phases of Puerperium
Lochia – uterine flow consisting of blood,
1. Taking-in phase fragments of decidua, wbc, mucus
- Time of reflection
Sitz bath – type of therapy done by sitting in
- Woman is passive 2-3 days
warm, shallow water
2. Taking-hold phase
- Woman begins to initiate action and 1000 g – weight of uterus immediately after
take strong interest birth
- Should have watchful guidance
500 g – end of first week
3. Letting-go phase
- Woman redefines her new roles 50 g – by the time involution is complete

BUBBLE-HE Well contracted uterus is Firm

- Acronym used to denote the First hour after birth is potentially the most
components of the post partum dangerous time for a woman because she
maternal nursing assessment might lose blood very rapidly

B – breast Hymen is permanently torn

U – uterus 2000 to 3000 ml – excess fluid accumulates

in the body during pregnancy
B – bowel
1500 ml – normal daily output of a postpartal
B – bladder
woman
L – lochia
Normal Blood loss:
E – episiotomy
Vaginal Birth – 300 to 500 ml
H – homan’s signs
Cesarean birth – 500 to 1000 ml
E – emotional status
Woman with postpartal complications is at Dissmeniated Intravascular Coagulation
risk from three point of view, which is her (DIC)

1. Own health - Deficiency in clotting ability caused

2. Future childbearing potential by vascular injury
3. Ability to bond with her new infant
Subinvolution

- Incomplete return of the uterus to its

Postpartal hemorrhage prepregnated size and shape

- Blood loss from uterus greater than Mastitis

500 ml within a 24-hour period
- Infection of the breast
Usual dosage of oxytocin - Breastfeeding is continued to keep
breasts empty to prevent growth of
- 10-40 U per 1000ml of ringers lactate
bacteria
solution
- If given IV, action is immediate Psychosis exists when a person has lost
contact with reality
Iron theraphy
Postpartal Psychosis
- May be prescribed to ensure good
hemoglobin formation - Severe mental illness
- Do not leave woman alone
Hysterectomy
-
- Ligation of the uterine arteries

Methorexate

- Presrcibed to destroy retained

placental tissue
- Usually, dilatation and curettage are
performed to remove placental
fragments

Uterine Inversion

- Prolapse of the fundus ot the utrerus

through the cervix to uterus turns
inside out