At Johns Hopkins University School of Nursing, "student nurse doulas provide physical, emotional and educational support and attend births at the hospital of the mother's choosing in the Baltimore metropolitan area. Background The childbirth experience is an intensely dynamic, physical and emotional event with lifelong impli-cations. This descriptive study replicates and extends the previous work on nursing support 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. If no one in the hospital is able to interpret, call a service so that interpretation can take place over the telephone. Chapter 6: Nursing Care During Labor and Birth Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc. [3] These women often have thriving careers and have purposefully chosen to wait to become pregnant. Assess for the signs of true labor. Behavior and appearance‡ • Membranes probably ruptured: identifies amniotic fluid that is alkaline: Some women believe that cutting the body, as with an episiotomy, allows the spirit to leave the body and that rupturing the membranes prolongs, not shortens, labor. Sources of data include the prenatal record, the initial interview, physical examination to determine baseline physiologic parameters, laboratory and diagnostic test results, expressed psychosocial and cultural factors, and the clinical evaluation of labor status. 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 within the last 48 hours. Protection of privacy and safety and infection control are major concerns for the expecting parents and the agency. (Courtesy Dee Lowdermilk, Chapel Hill, NC.). †Duration of each phase is influenced by such factors as parity, maternal emotions, position, level of activity, and fetal size, presentation, and position. The nurse assures the woman that she is in competent, caring hands and that she and her partner can ask questions related to her care and her status and those of her fetus at any time during labor. NursingCare Of the Family during Labor and Birth NursingCare Of the Family during Labor and Birth Anumber of females usually use particular methods to deal with laborpain during childbirth however, the labor management is a primeresponsibility of a nurse. Doulas not only offer CLS but also provide postpartum and prenatal support. The nurse can assist and support these individuals by identifying their needs and expectations and by helping make sure these are met. The nurse should be respectful, available encouraging, professional, and supportive during labor and delivery. 30-45 sec • Observe for absence of ferning (alerts staff to possibility that amount of specimen was inadequate or that specimen was urine, vaginal discharge, or blood). • Presenting part is usually not engaged in the pelvis 12-2). 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), on Nursing Care of the Family during Labor and Birth, Critical Thinking Exercise: Positioning during Labor, Occur regularly, becoming stronger, lasting longer, and occurring closer together, Usually felt in the lower back, radiating to lower portion of the abdomen, Shows progressive change (softening, effacement, and dilation signaled by the appearance of bloody show), Moves to an increasingly anterior position, 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, Occur irregularly or become regular only temporarily, Often stop with walking or position change, Can be felt in the back or abdomen above the navel, Can often be stopped through the 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 the pelvis. Women who participate in expectant parents classes often bring a birth bag or Lamaze bag with them. In some cultures, women who lose control and cry out in pain are scolded, whereas in other cultures, support persons will become more helpful. [7] Support for the mother, fetus, and her family needs to be addressed by not only advising the mother with nutritional facts and providing printed handouts but also incorporating a registered dietitian into her care. Providing the information to mothers, partners, and family members provides the foundation for embracing the pregnancy as a family and allows the mother to feel that she is not alone during this life-changing time. Even the experienced mother may have difficulty determining the onset of labor. uterine contractions 12-3). pH 7.0 Some women believe that screaming or crying out in pain is shameful if a man is present. The last ste… • Fetus She will perceive herself as failing or succeeding based on her ability to follow these “standards” of behavior. High-Touch Nursing Care During Laboris designed to provide nurses in the labor and delivery setting with the theoretical knowledge to integrate physical comfort measures, emotional support, and patient teaching from admission through second stage. †Duration of each phase is influenced by such factors as parity, maternal emotions, position, level of activity, and fetal size, presentation, and position. You've successfully added to your alerts. For example, the labor of a nullipara tends to last longer, on average, than the labor of a multipara. Determine the woman’s use of alcohol, drugs, and tobacco before or during pregnancy. The father, coach, or significant other also experiences stress during labor. • Shows progressive change (softening, effacement, and dilation signaled by the appearance of bloody show) The childbirth.org website (www.childbirth.org) provides couples with an interactive birth plan along with examples of birth plans. The nurse should discuss with the woman and her partner their plans for preserving childbirth memories by using photography and videotaping and provide information about the agency’s policies regarding these practices and under what circumstances they are allowed. Stage of labor from full dilation of the cervix to the birth of the baby • Does she talk freely with the nurse or respond only to questions? Wash hands, apply sterile gloves, obtain specimen of fluid (usually during sterile speculum examination). Prenatal data The nurse can minimize the woman’s anxiety by explaining terms commonly used during labor. One of the hardest parts of being a medical professional is informing the family about the death of their loved one. 45-90 sec Phase in the first stage of labor, when the cervix dilates from 4 to 7 cm, Artificial rupture of the fetal membranes, using a plastic Amnihook or a surgical clamp, Blood-tinged mucoid vaginal discharge that originates in the cervix and indicates passage of the mucous plug (operculum) as the cervix ripens before labor and dilates during labor; increases as labor progresses, Phase in the descent of the fetus when the top of the head can be seen at the vaginal orifice as the widest part of the head (biparietal diameter) distends the vulva just before birth, Experienced female assistant hired to give the woman support during labor and birth, Surgical incision of the perineum at the end of the second stage of labor to facilitate birth and to prevent laceration of the perineum, Appearance of a fernlike pattern found on microscopic examination of certain fluids such as amniotic fluid, Stage of labor from the onset of regular uterine contractions to full effacement and dilation of the cervix, Phase in the first stage of labor when the cervix dilates from 0 to 3 cm, Four maneuvers for diagnosing the fetal position by external palpation of the mother’s abdomen, Position in which the woman lies on her back with her knees flexed and with abducted thighs drawn up toward her chest; stirrups attached to an examination table can be used to facilitate assuming and maintaining this position, Evaluation of body fluids using a test swab to determine the fluid’s pH; urine exhibiting an acidic result and amniotic fluid exhibiting an alkaline result, Encircling of fetal neck by one or more loops of umbilical cord, Technique used to control the birth of the head; upward pressure from the coccygeal region to extend the head during the actual birth, Integrity of the amniotic membranes is broken either spontaneously (SROM) or artificially (AROM) by amniotomy, Stage of labor from full dilation of the cervix to the birth of the baby, Stage of labor from the birth of the baby to the separation and expulsion of the placenta, Phase in the first stage of labor when the cervix dilates from 8 to 10 cm, Primary powers of labor that act involuntarily to dilate and efface the cervix, expel the fetus, facilitate separation of the placenta, and prevent hemorrhage, Tension in the uterine muscle between contractions; relaxation of the uterus, Any forced expiratory effort against a closed airway, such as holding one’s breath and tightening the abdominal muscles (e.g., pushing during the second stage of labor), Additional related content can be found on the companion website at, evolve.elsevier.com/Lowdermilk/Maternity/, • Case Study: Second/Third Stages of Labor, • Critical Thinking Exercise: Positioning during Labor. If a discharge has occurred that may be amniotic fluid, ask her the date and time she first noticed the fluid and its characteristics (e.g., amount, color, unusual odor). Nurses working in labor and birth units must be familiar with their responsibilities according to the EMTALA regulations, which include providing services to pregnant women when they experience an urgent pregnancy problem (e.g., labor, decreased fetal movement, rupture of membranes, recent trauma) and fully documenting all relevant information (e.g., assessment findings, interventions implemented, patient responses to care measures provided). Often, the labor and delivery nurse is unable to provide CLS due to caring for one or more laboring patients on the intrapartum unit. Amount The nurse obtains any information not found in the prenatal record during the admission assessment. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with … Technique used to control the birth of the head; upward pressure from the coccygeal region to extend the head during the actual birth 1. Scant to moderate Procedure • Dip the cotton-tipped applicator deep into the vagina to pick up fluid. fourth stage of labor In many instances, women have heard horror stories or have seen friends or relatives going through labors that appear anything but easy. If the woman is having discomfort, then the nurse should ask questions between contractions when the woman can concentrate more fully on her answers. Are repeated explanations necessary because her anxiety level interferes with her ability to comprehend? The nurse can determine what role the support person intends to fulfill and whether he or she is prepared for that role by making observations and asking her 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 he or she 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. pH 6.5 The childbirth.org website (www.childbirth.org) provides couples with an interactive birth plan along with examples of birth plans. Common diagnostic and fetal assessment tests performed prenatally include amniocentesis, nonstress test (NST), biophysical profile (BPP), and ultrasound examination. 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. Labor and delivery nurses need a registered nursing license to practice. The woman’s interest, response, and prior experience guide the depth and breadth of these explanations. When the woman arrives at the perinatal unit, assessment is the top priority (Fig. Some hospitals and health care providers do not allow videotaping of the birth because of concerns related to legal liability. Multiparous women will often base their expectations of the present labor on their previous childbirth experiences. Trends in the society in which she lives also influence her choice. • NCLEX Review Questions • Critical Thinking Exercise: Positioning during Labor Some women may use these expectations as the basis for evaluating their own actions during childbirth. The woman’s record should reflect that the childbirth was recorded. • How does she react to a contraction? At times the partner or support person may need to be a secondary source of essential information. • The chances of a baby having a serious medical problem were slightly higher for women planning birth at home than for women planning birth in the other 3 places. 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. Log In or Register to continue Many health care facilities have volunteer doula programs where a mother can obtain the services of a doula during the prenatal period, labor, and delivery. The woman’s record should reflect that the childbirth was recorded. Japan: Natural childbirth methods practiced; may labor silently; may eat during labor; father may be present. Susan L. Lindner, RNC-OB, MSN; Jacqueline M. McGrath, PhD, RN, FNAP, FAAN. The Labor Support Questionnaire is used to measure attitudes about the importance of and intended behaviors associated with labor support. 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. 12-2). It consists of the following 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). Test for Ferning or Fern Pattern Many women still call the hospital or birthing center first for validation that coming in for evaluation or admission is acceptable. Nurses should be committed to providing culturally sensitive care and to developing an appreciation and respect for cultural diversity (Callister, 2005). 12-3). • Care and handling of the newborn immediately after birth, such as cutting of the cord, delaying eye care, and breastfeeding 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. Nurses should be committed to providing culturally sensitive care and to developing an appreciation and respect for cultural diversity (. Monitors, intravenous (IV) lines, and epidurals can make the woman feel a loss of control or feel as if she is being confined to bed and “restrained.” Being watched 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. • Wash hands, apply sterile gloves, obtain specimen of fluid (usually during sterile speculum examination). The nurse obtains any information not found in the prenatal record during the admission assessment. Thoroughly review her prenatal record. Strong to very strong doula Fluid restriction. Chapter 19: Nursing Care of the Family During Labor and Birth Lowdermilk: Maternity & Womens Health Care, 11th Edition MULTIPLE CHOICE 1. • Spanish Guidelines: Labor Assessment 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. Also, inquire about allergies to tape. Perceptual Ability 18 Once an assessment is completed, an interdisciplinary task force can be created. Nursing care management focuses on assessment and support of the woman and her significant others throughout labor and birth, with the goal of ensuring the best possible outcome for all involved. 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  Rhythm A support person is sometimes able to serve as an interpreter. If the woman lives near the hospital and has adequate support and transportation, she may be asked to stay home or return home to allow labor to progress (i.e., until the uterine contractions are more frequent and intense). How to Distinguish True Labor from False Labor, • Occur regularly, becoming stronger, lasting longer, and occurring closer together, • Usually felt in the lower back, radiating to lower portion of the abdomen, • Continue despite use of comfort measures, • Shows progressive change (softening, effacement, and dilation signaled by the appearance of bloody show), • Moves to an increasingly anterior position, • 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, • Occur irregularly or become regular only temporarily, • Often stop with walking or position change, • Can be felt in the back or abdomen above the navel, • Can often be stopped through the 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 the pelvis. 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. The Labor and Delivery Nurse assists the physician or midwife with all aspects of pregnancy and birth, assists surgeons during caesarian sections, and cares for women who experience complications with their pregnancies or birthing processes. Discuss the feelings a woman has about her pregnancy and fears regarding childbirth. • Are repeated explanations necessary because her anxiety level interferes with her ability to comprehend? Avoid words and phrases that can cause the woman to recall the words of her abuser (e.g., “open your legs,” “relax and it won’t hurt so much”). • Does she avoid eye contact? Limit the number of procedures that invade her body (e.g., vaginal examinations, urinary catheter, internal monitor, forceps or vacuum extractor) as much as possible. • Occur regularly, becoming stronger, lasting longer, and occurring closer together nuchal cord Tags: Maternity Nursing The ideal setting for the low risk woman at this time is the familiar environment of her home. [5] In essence, all women need and should have support during pregnancy to decrease stress. *In the nullipara, effacement is often complete before dilation begins; in the multipara, effacement occurs simultaneously with dilation. • Realize that false test results are possible because of presence of bloody show, insufficient amniotic fluid, or semen. St. Louis: Mosby. Prenatal care is a catalyst for many pregnant families to discover, learn, and capture beginning health care resources. Iran: Fathers not present; female support and female caregivers preferred. Source: D’Avanzo, C. E. (2008). She will perceive herself as failing or succeeding based on her ability to follow these “standards” of behavior. Blood transfusion. Confirm the expected date of birth (EDB). The nurse should anticipate the client's need for: Supplemental oxygen. Key Terms and Definitions Many hospitals, however, now discourage this practice because of concerns related to legal liability. rupture of membranes (ROM) Easily, women who are unmarried, homeless, adolescent, or of a minority group are quickly identified as having an increased risk for stress in their lives with the need for counseling and support. Evaluate expected outcomes for achievement and effectiveness of nursing care. 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. lithotomy position Many of these women have never been in a hospital or attended regular health care visits. for childbirth, the support person or family members desired during childbirth and their availability, and ethnic or cultural expectations and needs. • How does she react to being touched by the nurse or support person? Their work spans throughout pregnancy and delivery — the antepartum, intrapartum, post-partum, and neonatal stages. For example, a 14-year-old girl and a 40-year-old woman have different but specific needs, and their ages place them at risk for different problems. At times the partner or support person may need to be a secondary source of essential information. They can panic and withdraw or become physically abusive when someone tries to do something they perceive might harm them or their babies. Copious The father, coach, or significant other also experiences stress during labor. 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. (Procedure may be performed during speculum examination.) Registered nurses, physicians, and CNM have the opportunity to provide prenatal education related to prenatal classes at health care facilities. Speaking slowly and avoiding complex words and medical terms can help a woman and her partner to understand. [8–10] Incorporating CLS with the father, family, and doula can allow the mother to labor and deliver in a family-centered environment where they are actively involved and supporting the mother. Expectations of the family about birth should be determined and it is also the best time to ascertain cultural values. Address correspondence to Susan L. Lindner, RNC-OB, MSN, School of Nursing, Virginia Commonwealth University, 1100 East Leigh St, Richmond, VA 23059. The nurse can direct significant others not participating in this process to the appropriate waiting area. • Occur irregularly or become regular only temporarily A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. • Clothing to be worn Many women still call the hospital or birthing center first for validation that coming in for evaluation or admission is acceptable. Note the arrow pointing east, the rug on the wall, and the cord hanging from the ceiling. • The status of amniotic membranes, such as a gush or seepage of fluid ([spontaneous] rupture of membranes [S] [ROM]). Typically, the mother enters the CP model at 20 to 28 weeks' gestation, and each CP visit is conducted with the same families/mothers and physician or CNM. Even the experienced mother may have difficulty determining the onset of labor. • Wash hands, apply sterile gloves, obtain specimen of fluid (usually during sterile speculum examination). • Spread a drop of fluid from the vagina on a clean glass slide with a sterile, cotton-tipped applicator. Women who ambulate and assume upright positions or change positions frequently during labor tend to experience a shorter first stage. Labor can trigger memories of sexual abuse, especially during intrusive procedures such as vaginal examinations. Nurses should implement strategies that support maternal–newborn bonding while providing specialized care in NICUs,. First Stage of Labor  Blue-gray For example, the labor of a nullipara tends to last longer, on average, than the labor of a multipara. In some other cultures the father may be available, but his presence in the labor room with the mother may not be considered appropriate, or he may be present but resist active involvement in her care. For example, in Western societies the father is viewed as the ideal birth companion. These behaviors can range from total silence to moaning or screaming, but they do not necessarily indicate the degree of pain. You may also needLabor and Birth at RiskLabor and Birth ProcessesNursing Care of the Family during PregnancyNursing Care of the Family during the Fourth Trimester21st Century Maternity Nursing: Culturally Competent, Family and Community FocusedAssessment and Health PromotionFetal Assessment during LaborAssessment of High Risk Pregnancy The non–English-speaking woman in labor. My bag of waters just broke. Many times, this population is overlooked; yet, it is sometimes even more important to have support systems in place to allow for positive birth outcomes for this group of women. One of the hardest parts of being a medical professional is informing the family about the death of their loved one. Groups Strategize COVID-19 Vaccine Access for People of Color, Moral Injury: Pandemic's Fallout for Healthcare Workers, Program to Reduce the Need for Anesthesia in Pediatric MRI, Nurse Pinned in Fatal Texas Pileup Climbs Out, Goes to Work, School Nurses: Keeping School Children, Families, and Communities Healthy, Developing a Course to Promote Self-Care for Nurses to Address Burnout, Nurse Burnout Has Soared During Pandemic, Survey Shows. Duration† A health care provider should ensure comfort measures, information, instructions, emotional supports, advocacy, and support for the family as nursing interventions during labor …
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