Establishing a
Therapeutic Relationship
Establishing a Therapeutic Relationship

Make the family feel welcome

Determine family expectations about birth

Convey confidence

Use touch for Comfort

Respect cultural values
Health History

Once the woman has been admitted and labor
progress has been assessed, the following
additional information regarding health history is
collected:
 Personal data – blood type, allergies, etc.
 History of previous illnesses
 Problems with this pregnancy
 Preferences for labor and delivery
 Preparation for childbirth
Admission to
Labor and Delivery

Assessments performed on admission include:
 Vital signs
 Physical exam with a vaginal exam
 Contraction pattern
 Membrane status
 Fetal status
 Psychosocial assessment, cultural assessment
 Preparation for labor and delivery
Assessment of Contractions
Palpation
Electronic Monitoring
Vaginal Examination
Palpation
Leopold’s Maneuver
Start by: Stand on the Right side, face the woman
and palpate with the palms of the hands.
Step 1 - Start at upper fundus and palpate for the head or
buttocks
Step 3 - Gently
grasp lower
portion of uterus
and feel for the
head
Step 2 - Go down each
side and locate back
Step 4 - Turn and face
the woman and repeat
the steps.
Characteristics of a Contraction
Latent Phase
• Every 10-30 min. progressing to
• Every 5-7 min. X 30-40 sec.
Active Phase
• Every 2-5 min. X 40-60 sec.
• Moderate to strong
Transition
Phase
• Every 1½ -2 min. X 60-90 sec
• Strong
Auscultation
Location of FHR in relation to
the more commonly seen fetal
positions
Ask Yourself?

If the fetal heart tones (FHT’s) are heard
loudest (PMI) in the patient’s upper right
quadrant of her abdomen, the fetus would be
assessed for a breech presentation.
A. True
B. False
Vaginal Examination
Information Obtained:
 Presentation
 Position
 Condition of Membranes -ruptured or intact
 Dilation - enlargement and
widening of os ( cm.)
 Effacement- thinning of the
cervix (%)
 Station
 Engagement
Fetal Oxygenation

Main assessments related to fetal well-being are:
 Fetal Heart Rate
 Contractions
 Characteristics of amniotic fluid
 Maternal vital signs
Signs and Symptoms of the Stage 1 - Latent Phase


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Contraction: dilate 0-3 cm.
 Mild
 Duration – 30-45 seconds
 Frequency – 5-20 minutes
Scant pinkish discharge, bloody show
Mother’s response
 Surge of energy and excited
 Talkative, outgoing
 Anxiety low
**Best time to do teaching!
Nursing Care
Stage 1 – Latent Phase
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Welcome to the Hospital
Assess goals for this labor
Assess Psychological response
Orient to common procedures
 Vital signs and FHT’s
 Enema
 IV
 NPO
 Assessment of Labor Progress –
dilation, effacement, station, lie, etc.
Stage 1 – Active Phase
Signs and Symptoms


Contractions – dilate 4-7 cm.
 Moderate
 Duration – 45-60 seconds
 Frequency – 2-5 minutes
Mother’s Response
 More serious
 Determined, Dependent
 Restless
 Focuses on self
Stage 1 – Active Phase Nursing Care



Anticipate Needs:
 Sponge face with cool cloth
 Keep bed clean and dry- change chux
 Provide with mouth care – lip balm to lips
 Assess voiding
Non-Pharmacological Measures
 Modified breathing
 Effleurage
 Music
Analgesia and Anesthesia
Stage 1 – Transition Phase Signs and Symptoms


Contractions 7-10 cm
 Strong
 Irregular with multiple peaks
 Duration – 60-90 seconds
 Frequency – 2 minutes
Mother’s response
 Withdrawn, drowsy,
 Nausea, trembling of legs
 Irritable, aggressive
 Urge to push
Stage 1- Transition Nursing Care

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Provide support- may need to breathe with the
patient – get in her face
Back rub
Assist with pant-blow breathing
Watch for hypervention – have breathe in mask
and slow down the breathing
Do NOT allow to push by having patient blowblow-blow with urge.
Do not be offended by irritability
Stage Two of Labor

Signs and Symptoms:

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Sudden Appearance of sweat on upper lip
An episode of vomiting
Increase in bloody show
Shaking of extremities
Increased restlessness
Pressure on rectum; involuntary bearing
down
Bulging of perineum
Stage 2 Nursing Care
1.
The key to care during this stage
is to teach QUALITY PUSHING !
2.
Keep perineum clean and dry
3.
Provide quiet environment
4.
Support with positive feedback
5.
Repeat doctors instructions
6.
Allow to hold the baby , Congratulate!!
Stage 2 – Nursing Care
Stage 3 – Nursing Care

Congratulate on delivery of baby

Coach in relaxation for delivery of the placenta

Initiate contact with the infant
 May allow to breast feed if desires
Test Yourself!



The cardinal movement that facilitates the emergence of the
fetal head ____________.
A. Flexion
B. Extention
C. External rotation
Cardinal movement that allows the smallest diameter of the
head to pass through the pelvis is__________________.
A. Flexion
B. Internal rotation
C. Extension
Cardinal movement that occurs as the fetal shoulders engage
and descend through the pelvis is termed ______.
A. Internal rotation
B. External rotation
Causes of Pain in Labor
Stretching of the cervix
during dilation & effacement
Stage One
Uterine Anoxia
Stretching of the
uterine ligaments
Causes of Pain in
Labor
Distention of the vagina and
Perineum
Stage
Two
Compression of the nerve
ganglia in cervix & lower uterus
Pressure on urethra, bladder,
rectum during fetal descent
Traction on and stretching of
the perineum
Factors affecting Mothers Response to Pain in
Labor
 Preparation - Knowledge and confidence
gained through childbirth classes
 Cultural influences on expression of pain
 Maternal fatigue, anxiety, sleep deprivation
 Previous experiences with pain
 Support
Methods of Pain Relief

Nonpharmacologic
 Childbirth methods
 Breathing
Techniques
 Relaxation Techniques
 Touch
 Focusing attention on one object

Effleurage
Non-Pharmacological

Sensory Stimulation
Listening to music; subdued lighting
 Imagery
 Applying heat and cold
 Massage (lower back); Counterpressure
 TENS
 Position Changes

Pain Relief in Labor

Pharmacologic Methods
 Analgesia
 Stadol
 Barbiturates
 Seconal; Nembutal
 Tranquilizers
 Vistaril
Pain Relief in Labor

Criteria for administering an analgesic:
 Needs to be in active phase of labor

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If give in latent phase – it may slow labor
If give in transition phase – can lead to
neonatal respiratory depression
Anesthesia

Regional
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Paracervical
Epidural; Caudal
Spinal
Pudendal
Local
General

Used mainly in cesarean deliveries
Epidural Anesthesia
Injection of an anesthetic
agent into the epidural
space
Provides pain relief
during labor and delivery
Nursing Care related to an epidural


Preparation
 Assess platelet count – must be normal
 Empty bladder
 Assess vital signs for baseline
 IV fluids
Following
 Assess V/S – especially the B/P because the
main side effect is hypotension
 Rotate position between right and left side-lying
 Assess bladder and catheterize as needed
 Assess for other side effects and intervene
Spinal Anesthesia
A local anesthetic is
injected directly into
the spinal fluid in the
spinal canal to provide
anesthesia for
cesarean birth and
occasionally for vaginal
birth
Pudendal Anesthesia
Anesthesia administered
transvaginally and
intercepts pudendal
nerve.
Provides pain relief for
episiotomy and delivery.
Local Anesthesia
Local injection of
anesthetic agent in
the perineum for
episiotomy and
repair
General Anesthesia

Mainly used for emergency deliveries via
cesarean birth

Used for delivery of the woman with active
herpes who will require a cesarean delivery.
Do not want fetus to go through the birth canal
and risk contact.
True or False ?

The anesthesia used for both labor and delivery is
an epidural
A. True
B. False

The nurse would be careful to keep the patient flat
following delivery with a pudendal block
A. True
B. False

The initial side effect of an epidural anesthesia is
fetal bradycardia
A. True
B. False
The End