Introduction to Labor, Vaginal and Cesarean Delivery

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Introduction to Labor, Vaginal
and Cesarean Delivery
Cheyenne County Hospital
Candi Douthit, BSN
OB Manager
Understanding Labor and Delivery
• Every labor is different
• Despite modern medicine, we can’t predict what
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will happen
Being prepared with knowledge, helps you and
your spouse be calmer and less stressed
You are never alone
You have every right to ask for things to be the
way you want them to be
Types of Delivery
• Vaginal Delivery: most natural, baby descends
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through the vaginal canal for birth
Cesarean Section: major abdominal surgery, cut
in the abdomen which baby is delivered through
Instrumented delivery: use of vacuum or forceps
There are indications for all types.
Types of Delivery
• Despite the type of delivery you are
planning, it is important to know about all
of them
• Best plan is to keep in mind that our most
important goal is a healthy mom and a
healthy baby.
Symptoms your body is Preparing
for Labor
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Backache: persistent dull ache
Cramps: mild to moderate discomfort
PMS symptoms: crabby, irritable
Nesting Urge
Frequent, soft bowel movements
Flu-like symptoms
Baby “drops”
Impending Signs of Delivery
• Mucous plug
– May be thick mucous, blood tinged or not
– It is normal after a vaginal exam to have
brownish/red discharge d/t the trauma of the
exam
• Water breaks
– 80% of time you will go into labor after
– Note the color, any odor, amount
– Go the hospital
Contractions
• Braxton Hicks: irregular or regular, may
come and go, short while or several hours
• “False Labor” doesn’t mean they don’t
hurt and doesn’t mean they aren’t doing
anything to prepare for delivery
Contractions
• Contractions of Active Labor
– Progressive, get stronger and stronger, closer
together
– Felt in the back, abdomen, or both. May start
in the back and radiate forward
– Usually increase with activity
– Don’t go away with rest or fluids
Other signs you are in “Active
Labor”
• Dilation of the cervix with vaginal exam
– Labor check-2 exams, one hr apart
• The contractions just don’t stop
When to go to the hospital
• Contractions are 3-5min apart and don’t
go away with rest/fluids
• Water breaks
• If you’re having contractions, and/or your
water breaks and you are scheduled for a
c-section
• http://www.youtube.com/watch?v=2EnRV
31mjZY
Induction of Labor
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Means we artificially start the labor process
Done for medical and personal reasons
Only after 39wks, unless medically indicated
Associated with increased pain, interventions
and cesarean delivery (forces your body to do
what it may not be ready to do)
What to bring to the Hospital
• Insurance card and preadmission packet
• Your glasses, even if you wear contacts normally…may want to take
them out. (Don’t forget contact case and solution)
• Toiletries-things you might want during your stay
• Comfortable lounging clothes
• Slippers and a robe
• Light reading
• Massage oils, lotions, favorite music, favorite pillow, movies,
whatever you need to relax
• Massage tools, aromatherapy
What to bring to the Hospital
• For your husband/support person:
– Change for the vending machine
– Snacks, snacks, snacks-fridge in the room
– Toiletries-no smelly breath!
– Clothes, something for you to sleep in
– Something to read, DVD player, computer
– Camera, video camera, extra batteries
What to bring to the Hospital
• After you have the baby:
– Clean lounging clothes (we have disposable
underwear and pads for you)
– Snacks!
– Nursing Bra (we have lanolin and all of the
things needed to get your breastfeeding off to
a good start)
– Phone numbers
– Going home outfit
What to bring to the Hospital
• For Baby:
– Onesies
– Going home outfit
– Blanket, if you want
– We supply everything you really need
What to expect at the hospital
• Fetal heart monitoring
• Vital signs
• IV
• Vaginal exams-determine your progress
– Done by RN or provider
– Effacement, station, dilation, pg 34-35
– Not done on a schedule, just when needed
Vaginal Delivery
• Vaginal Exam cont.:
– Effacement 0-100%
– Dilation: 0-10
– Station: location of baby’s head in relation to
spines of the pelvis, -4 to +4
• http://www.babycenter.com/stages-oflabor
What to Expect During Labor
• Progression of contractions
• Progression of pain
• To move
• Verbalize your needs
to your support team
Labor
• Labor is the transition point, going from
individual to mother, from couple to family.
Hence with the transition you have many
changes:
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Physical-labor changes, pain
Emotional-fear, stress, anxiety
Intellectual-can I be a mom, will the baby be ok
Loss of control-we don’t like to be vulnerable or out of
control, creates fear
Labor
• Average 12-16hrs for first baby
• Is difficult and painful, even with drugs
• Your body instinctively knows what to do
• Your body gives you time between
contractions to rest and prepare for the
next one
Stages of Labor
• Stage One-onset of labor to 10cm dilation
– Early Phase Avg 8hrs
– Active Phase Avg 4-5hrs
– Transition Phase 30 min to 2hrs
• Stage Two-10cm to birth of baby, 1 contraction
to 2hrs
-laboring down, pushing, delivery
• Stage 3-delivery of the newborn to delivery of
the placenta, 5-30min
Stage One of Labor
• 1. Early Phase
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Start of labor to 3cm
Feel very social, excited, anticipatory
Conserve energy
Longest phase, one you are most comfortable in
• 2. Active Phase
– 3-7cm dilation
– Contractions are stronger and more intense, regular
– Need to concentrate on the work at hand, no longer
social
– Relaxation techniques helpful here
Stage One of Labor
• 3. Transition
– 7-10cm dilation
– Hardest but shortest stage
– Contractions are very intense and feel they
come one after the other
– Pressure in the perineum as the baby comes
down
Labor: Stage Two
• May feel the urger to bare down
• Push when the physician tells you to do so
• Prior to this you have been cooperating
with your body, now you will actively work
with your body to deliver the baby
• With each contraction you will bare down
and move the baby through the birth
canal
Labor: Stage Three
• Birth of the baby
• Focus on the baby
• Several more labor-like contractions will
come then delivery of the placenta
(physician will massage your belly to
facilitate this)
• Breastfeed or just watch and touch your
baby
Live Natural Birth
• http://www.babycenter.com/2_live-birthnatural_3656508.bc
Instrumented Delivery
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Vacuum
Episiotomy-don’t do unless necessary
Forceps
Complications occur in labor and delivery. Can’t
always be predicted, just have to react when
they occur. We will tell you what is going on
throughout if this occurs.
http://www.babycenter.com/2_vacuum-andforceps-during-birth_3656512.bc
Cesarean Section Birth
• Indications: prior c-section, infant
complications, mother complications
• Know that any delivery can go to a
cesarean section at any time….again, our
goal is a healthy mom and a healthy baby
• If mom or baby has complications, this will
happen very quickly, goal is delivery within
30 min.
What to expect for a scheduled
c-section?
• Arrive early in the morning
• To sign consents, talk to the CRNA,
complete paperwork (nurses do this online)
• Labs drawn day before or morning of
• IV, catheter, tight-fitting hose
• Fetal monitor
• Support person will put on scrubs
Risks of Cesarean Delivery
• Mother
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Longer hospital stay
Increased blood loss
Infection
Injury to bowel, bladder, ureter
Blood clots
Anesthesia complications
Pain
Admission to the ICU
Hysterectomy
Risks of Cesarean Delivery
• Baby
– Not squeezed, so increased breathing
complications
– Less immediate contact with mom
– Longer till breastfeeding is initiated
– Scalpel injury
– Fetal death
Risks of Cesarean Delivery
Risks for future pregnancy and birth:
Repeat cesarean is
likely
Placental accreta
Pre-term labor and
lower birthweight
baby
Placental abruption
• Placenta previa
• Ectopic pregnancy
• Increased risk of
uterine rupture
http://www.babycenter.com/2_live-birth-c-section-surgery_3656510.bc
Role of the
Support
Person in
Labor and
Delivery
Support Person Job Description
• You are the second most important person in
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the room
You know mom best, can best “read” her, and
will know what she needs throughout delivery,
she will hear you better than the rest of us
Together, this is your birth experience, not your
wife’s and the health care staff. Take an active
role in the labor process.
Support Person Job Description
1. Emotional supporter
2. Provider of reassurance
3. Reminder of class content
4. Time officiate
5. Sharer of what makes her feel best
6. Hand holder, brow mopper
7. Family liaison
8. Photographer, baby and mom assistant
9. Breastfeeding helper
10. Bouncer
Support Person Job Description
• Your job if so very important, post
delivery, mom needs a lot
• Hormonal shifts, mom needs support
• Need to stay overnights to help with baby
and learn how to be a dad!
• See support person handout as well!
Questions???
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