• List of comfort and relaxation measures • Clothing to be worn The nurse places an admissions band on the woman’s wrist. A support person is sometimes able to serve as an interpreter. • Identify signs of developing complications during labor and birth. F or most women, labor begins with the first uterine contraction, continues with hours of hard work during cervical dilation and birth, and ends as the woman begins to recover physically from birth and she and her significant others begin the attachment process with the newborn. Evaluate expected outcomes for achievement and effectiveness of nursing care. However, keep in mind that general appearance and behavior may vary, depending on the stage and phase of labor (Table 12-1 and Box 12-2). Source: D’Avanzo, C. E. (2008). Iran: Fathers not present; female support and female caregivers preferred. According to the EMTALA, true labor is considered an emergency medical condition. Web Resources Our 100-percent registered nursing staff is highly experienced in labor and delivery. The status of amniotic membranes, such as a gush or seepage of fluid ([spontaneous] rupture of membranes [S] [ROM]). The childbirth.org website (www.childbirth.org) provides couples with an interactive birth plan along with examples of birth plans. [5] In essence, all women need and should have support during pregnancy to decrease stress. Build a Sense of Trust. 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. (Courtesy Patricia Hess, San Francisco, CA; Chinle Comprehensive Health Care Center, Chinle, AZ.). Nitrazine test Varies: +1 to +2 cm Very little bloody show occurs in the beginning, but the amount increases with effacement and dilation of the cervix. Confirm the expected date of birth (EDB). How long the patient states the contractions last b. A woman’s level of anxiety in labor increases when she does not understand what is happening to her or what is being said. episiotomy Confirm the expected date of birth (EDB). Women from many cultures prefer female caregivers and want to have at least one female companion present during labor and birth. • To what degree does the woman describe what she is experiencing? Stage of labor from full dilation of the cervix to the birth of the baby Common diagnostic and fetal assessment tests performed prenatally include amniocentesis, nonstress test (NST), biophysical profile (BPP), and ultrasound examination. More and more hospitals now use an electronic medical record in which almost all charting is done on computer. Alternatively, contact a hospital employee or volunteer interpreter for assistance (see Box 1-7). The nurse should explain the rationale for required care measures carefully (see Cultural Considerations box). pH 5.0 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. Recheck the status of allergies, including allergies to latex and medications routinely used in obstetrics, such as opioids (e.g., hydromorphone [Dilaudid], butorphanol [Stadol], fentanyl [Sublimaze], nalbuphine [Nubain], anesthetic agents (e.g., bupivacaine, lidocaine, ropivacaine), and antiseptics (Betadine). A warm shower is often relaxing for the woman in early labor. • Occur regularly, becoming stronger, lasting longer, and occurring closer together Protection of privacy and safety and infection control are major concerns for the expecting parents and the agency. Perceptual Ability Within cultures, women may have an idea of the “right” way to behave in labor and may react to the pain experienced in that way. Integrity of the amniotic membranes is broken either spontaneously (SROM) or artificially (AROM) by amniotomy • Discuss how the nurse can increase the use of evidence-based practices in caring for women during labor and birth. 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. 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. Chapter 12 Pain described as severe; backache common; frustration, fear of loss of control, and irritability may be voiced; 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 Ischemic Stroke May Hint at Underlying Cancer, Topol: US Betrays Healthcare Workers in Coronavirus Disaster, The 6 Dietary Tips Patients Need to Hear From Their Clinicians. However, caution is warranted because the interpreter may not be able to convey exactly what the nurse or others are saying or what the woman is saying, which can increase the woman’s stress level even more. A, General Admission screen. third stage of labor The woman who lives at a considerable distance from the hospital or has a history of rapid labors in the past, however, may be admitted in latent labor. If the woman has had no prenatal care or her prenatal record is unavailable, then the nurse must obtain certain baseline information. Some feel discouraged after learning that the contractions that feel so strong and regular are not true contractions because they are not causing cervical dilation or are still not strong or frequent enough for admission. 2012;12(2):70-72. 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 shaky or terminated relationship. • Identify nursing interventions for each stage of labor and birth. The nurse also prepares the woman for the possibility of change in her plan as labor progresses and assures her that the staff will provide information so that she can make informed decisions. Labor care and labor support are powerful nursing functions, and it is incum-bent on health care facilities to provide an envi-ronment that encourages the unique patient-RN relationship during childbirth. Major fears and concerns relate to the process and effects of childbirth, maternal and fetal well-being, and the attitude and actions of the health care staff. Bloody mucus Their work spans throughout pregnancy and delivery — the antepartum, intrapartum, post-partum, and neonatal stages. The nurse measures the frequency of a laboring womans contractions by noting: a. 1. The way in which women and their support person or family members approach labor is related to the manner in which they have been socialized to the childbearing process. Stage of labor from the birth of the baby to the separation and expulsion of the placenta • Care and handling of the newborn immediately after birth, such as cutting of the cord, delaying eye care, and breastfeeding However, keep in mind that general appearance and behavior may vary, depending on the stage and phase of labor (Table 12-1 and Box 12-2). Phase in the first stage of labor, when the cervix dilates from 4 to 7 cm Women who ambulate and assume upright positions or change positions frequently during labor tend to experience a shorter first stage. Doctors and nurses can attest that telling relatives who are expecting the death of a seriously ill loved one is a different experience than having to break the news of a sudden and unexpected death. Four maneuvers for diagnosing the fetal position by external palpation of the mother’s abdomen Stress in labor Ideally, a bilingual nurse will care for the woman. 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. After graduating from nursing school, you must take the NCLEX-RN exam to become licensed as a nurse. • Presenting part usually becomes engaged in the pelvis, which results in increased ease of breathing; at the same time, the presenting part presses downward and compresses the bladder, resulting in urinary frequency For example, in many cultures, having a male caregiver examine a pregnant woman would be unacceptable. for childbirth, the support person or family members desired during childbirth and their availability, and ethnic or cultural expectations and needs. Are repeated explanations necessary because her anxiety level interferes with her ability to comprehend? St. Louis: Mosby. BOX 12-2   Psychosocial Assessment of the Laboring Woman A satisfactory view of childbirth may also enhance a woman’s adaptation to her role as a mother. • Describe the ongoing assessment of maternal progress during the first, second, third, and fourth stages of labor. doula Common diagnostic and fetal assessment tests performed prenatally include amniocentesis, nonstress test (NST), biophysical profile (BPP), and ultrasound examination. For example, in Western societies the father is viewed as the ideal birth companion. Encourage the woman to request specific caregiving behaviors and practices that are important to her. Determine the woman’s use of alcohol, drugs, and tobacco before or during pregnancy. Conversely, a woman’s behavior in response to pain may influence the support received from significant others. If a special request contradicts usual practices in that setting, then the woman or the nurse can ask the woman’s primary health care provider to write an order to accommodate the special request. Technique used to control the birth of the head; upward pressure from the coccygeal region to extend the head during the actual birth The woman’s record should reflect that the childbirth was recorded. • How does she react to being touched by the nurse or support person? Labor and delivery nurses need a registered nursing license to practice. A woman who moans with contractions may not be in as much physical pain as a woman who is silent but winces during contractions. A weight gain greater than that recommended may place the woman at a higher risk for cephalopelvic disproportion and cesarean birth, especially if she is petite and has gained 16 kg or more. Take note of her obstetric and pregnancy history, which includes gravidity, parity, and problems such as history of vaginal bleeding, gestational hypertension, anemia, gestational diabetes, infections (e.g., bacterial, viral, or sexually transmitted), and immunodeficiency status. Women in labor usually have a variety of concerns that they will voice if asked but rarely volunteer. • Become more intense with walking For European-American couples, attending childbirth classes together has become a traditional, expected activity. St. Louis: Mosby. 8. Select all that apply. • Allow fluid to dry. Preparation for an ultrasound includes: A health care provider should ensure comfort measures, information, instructions, emotional supports, advocacy, and support for the family as nursing interventions during labor … See, Time and onset of contractions and progress in terms of frequency, duration, and intensity, Location and character of discomfort from contractions (e.g., back pain, suprapubic discomfort), Persistence of contractions despite changes in maternal position and activity (e.g., walking or lying down), Presence and character of vaginal discharge or show. (Courtesy Kitty Cashion, Memphis, TN.) Labor and delivery nursing is a specialty in obstetrics where nurses take care of pregnant patients during labor, obstetrical emergencies, and other obstetric conditions. Teaching Guidelines The last ste… • Realize that false test results are possible because of presence of bloody show, insufficient amniotic fluid, or semen. Irregular In addition, induction of labor requires intensive (1-to-1) nursing care. At times the partner or support person may need to be a secondary source of essential information. The woman undresses and puts on her own gown or a hospital gown. TRANSITION (8-10 cm) The birth plan should include the woman’s or the couple’s preferences related to the following: 12-3). When the woman arrives at the perinatal unit, assessment is the top priority (Fig. Agencies need to have specific policies and procedures in place so that compliance with the EMTALA regulations is achieved while providing safe and efficient care (Angelini & Mahlmeister, 2005; Tucker, Miller, & Miller, 2009). • Labor and delivery nurse. ; The active phase occurs when cervical dilatation is at 4 to 7 cm and contractions last from 40 to 60 seconds with 3 to 5 minutes interval. Encourage her to choose a person (e.g., doula, friend, family member) to be with her during labor to provide continuous support and comfort and to act as her advocate. Encourage the woman to request specific caregiving behaviors and practices that are important to her. In some cultures, women who lose control and cry out in pain are scolded, whereas in other cultures, support persons will become more helpful. Some women believe that screaming or crying out in pain is shameful if a man is present. • Explain procedure to the woman or couple. Working in the maternity unit requires nurses to work with both the mothers and the infants, usually providing care leading up to, during and post-labor. India: Natural childbirth methods preferred; father is not usually present; female relatives are usually present. A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. Knowing the woman’s age is important in order to individualize the plan of care to the needs of her age group. ‡Women who have epidural analgesia for pain relief may not demonstrate some of these behaviors. • Fetus Body Language The latent phase starts during the onset of true labor contractions until cervical dilatation. The birth plan should include the woman’s or the couple’s preferences related to the following: • Presence of birth companions such as the partner, older children, parents, friends, and doula and the role each will play, • Presence of other persons such as students, male attendants, and interpreters, • Environmental modifications such as lighting, music, privacy, focal point, and items from home such as pillows, • Labor activities such as preferred positions for labor and for birth, ambulation, birth balls, showers and whirlpool baths, and oral food and fluid intake, • List of comfort and relaxation measures, • Labor and birth medical interventions such as pharmacologic pain relief measures, intravenous therapy, electronic monitoring, induction or augmentation measures, and episiotomy, • Care and handling of the newborn immediately after birth, such as cutting of the cord, delaying eye care, and breastfeeding, • Cultural and religious requirements related to the care of the mother, newborn, and placenta.