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Lesson 2: Stages of Labor and Nursing Care


   

Section III. SECOND STAGE OF LABOR (DELIVERY STAGE)

2-6. SECOND STAGE OF LABOR

As previously mentioned, the second stage of labor begins when the cervix is completely effaced and dilated and ends when the infant is born.

a. These signs of the second stage of labor are considered imminent or impending signs.

(1) Imminent signs.

(a) Increased bloody show.

(b) Desire to bear down or have bowel movement (result of the descent of the presenting part).

(c) Bulging of the perineum.

(d) Dilatation of the anal orifice.

(2) Impending signs.

(a) Nausea and retching.

(b) Irritability and uncooperativeness.

(c) Complaints of severe discomfort.

(d) Pleas for relief.

b. Once dilatation and effacement are complete, the patient is instructed to push with each contraction to bring the presenting part down into the pelvis.

2-7. TRANSFER OF THE LABOR PATIENT TO THE DELIVERY ROOM

Transfer the mother to the delivery room and prepare her for delivery when delivery seems imminent. Timing is dependent on the parity of the patient, size of the infant, effectiveness of the patient's pushes, arrival of the physician, familiarity of the staff with equipment, and need for additional preparation time. Parity refers to the condition of the woman with respect to her having borne children.

a. Primigravida patients are transferred when the cervix is completely effaced and dilated and the head or presenting part is crowning.

b. Multipara patients are transferred when the cervix is completely effaced and dilated. The patient usually pushes (i.e., bears down) in the delivery room. She may be transferred prior to complete dilatation (8 to 9 cm) if she is progressing rapidly and the presenting part is descending. These patients are normally not encouraged to push when in the labor room since delivery occurs more rapidly in the multipara patient.

2-8. NURSING CARE GIVEN WHILE IN THE DELIVERY ROOM

a. Never leave the patient alone once she has been transferred to the delivery room. In addition, never turn your back on the perineum because the baby could push through the vaginal opening while your back is turned.

b. Encourage the patient to rest between contractions and to push with contractions. Only one person should coach. Verbal encouragement and physical contact help reassure and encourage the patient.

c. Position the patient's legs in the stirrups for the lithotomy position. This is the most common position for delivery. Facilities using birthing beds have the patient in an upright position. Positioning also depends upon the type of anesthesia to be used and C-section delivery. Each case may be different.

d. Prep the patient's perineum. A Betadine® scrub and water are used with 4x4's. Clean the perineum by washing the pubic area, down each thigh, down each side of the labia, down the perineum, and down the rectal area (see fig. 2-7). Begin cleaning at number 1 and proceed through number 7. Discard used sponges after each step. Rinse area with the remaining solution.

e. Monitor the patient's blood pressure and the fetal heart tones every 5 minutes and after each contraction.


Figure 2-7. Cleaning the patient's perineum.

2-9. NORMAL BIRTHING PROCESS (FIGURE 2-8)

Even though most of the time the delivery remains in the hands of the obstetrician, there may be times when a practical nurse will have to assist the patient to give birth. In general, the activity of the normal birthing process (see figure 2-8) is given below:

a. Crowning, the appearance of the infant's head on the perineum.

b. Delivery of the head. This includes suctioning of the infants nose and mouth with a bulb syringe. A DeLee suction trap is used if meconium is present.

c. Delivery of the anterior shoulder and the posterior shoulder.

d. Delivery of the trunk and lower body.

e. Clamping and cutting of the umbilical cord.


Figure 2-8. Birthing process (continued).


Figure 2-8. Birthing process (continued).

 
Figure 2-8. Birthing process (concluded).

2-10. INFORMATION TO BE RECORDED ABOUT THE DELIVERY

Record the following information.

a. Exact date and time of delivery.

b. Sex of the infant.

c. Condition of the infant (APGAR) after birth. APGAR is the most widely used method of evaluating the condition of a newborn baby. A value of 0 to 2 is given for each observation (i.e., heart rate, respiratory effort, muscle tone, reflex irritability, and color). The values are added giving a total APGAR score (see table 2-2). A baby in excellent condition would score 9 to 10 and a dead baby would score 0. Most babies score 7 or better. The condition of the infant will be taken at one (1) minute, at five (5) minutes, and at thirty (30) minutes.

Apgar Score

Category 0 Points 1 Point 2 Points
Heart Rate Absent <100 >100
Respiratory Effort Absent Slow, Irregular Good, crying
Muscle Tone Flaccid Some flexion of extremities Active motion
Reflex Irritability No Response Grimace Vigorous cry
Color Blue, pale Body pink, extremities blue Completely pink

Table 2-2. Sample APGAR scoring chart.

d. Position of the infant at delivery.

e. Type of episiotomy, lacerations.

f. Spontaneous or forceps delivery.

g. Use of oxygen and suction on the infant.

h. Number of vessels in the cord.

i. Mother's name.

j. Any other pertinent facts about the delivery.


 

LESSON OBJECTIVES

2-1. Identify the definition and process of labor.

2-2. Identify the signs and symptoms of true labor and false labor.

2-3. Identify descriptive phrases that concern the four stages of labor.

2-4. Identify those factors that distinguish the three phases of the first stage of labor.

2-5. Identify the nursing care given the patient during the first stage of labor.

2-6. Select the signs of the second stage of labor.

2-7. Identify those parameters used to determine when the patient is taken to the delivery room.

2-8. Identify the nursing care given the patient while in the delivery room.

2-9. Identify signs of placental separation.

2-9. Select the nursing interventions used during the third stage of labor.

2-11. Select the goal of the fourth stage of labor.

2-12. Identify the nursing care given the patient during the fourth stage of labor.

2-13. Identify those factors which may extend or influence the duration of labor.

 

 
 

 

   

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