INTRAPARTAL NURSING
Developed by
D. Ann Currie,R.N., M.S.N.
INTRAPARTUM PERIOD
• PHYSIOLOGY OF LABOR
• CAUSES OF LABOR
• PREMONITORY SIGNS OF
LABOR
• CRITICAL FACTORS IN LABOR
• TRUE VS FALSE LABOR
• STAGES OF LABOR
• NURSING MANAGEMENT OF
THE INTRAPARTAL CLIENT
INTRAPARTUM PERIOD
• MATERNAL RESPONSE TO
LABOR
• FETAL RESPONSE TO LABOR
• PAIN MANAGEMENT DURING
THE INTRAPARTAL PERIOD
• INTRAPARTAL FETAL
ASSESSMENT
• HIGH RISK INTRAPARTAL CARE
CAUSES OF LABOR
• LABOR USUALLY STARTS 38-40
WEEKS OF GESTATION
• VARIOUS FACTORS MAY CAUSE
LABOR TO START
• ESTROGEN.DECREASING
PROGESTERONE,PROSTAGLANDINS, STRETCHING UTERUS,
CORTICOTROPIN-RELEASING
HORMONE
PREMONITORY SIGNS
OF LABOR
• LIGHTENING
• BRAXTON HICKS
CONTRACTIONS
• CERVICAL CHANGES
• BLOODY SHOW
• RUPTURE OF MEMBRANES
• BURST OF ENERGY
• WEIGHT LOSS-2.2-6.6 LBS.(1-3
KGS)
PREMONITORY SIGNS
OF LABOR
• URINARY FREQUENCY
• INCREASED BACKACHES OR
SACROILIAC PRESSURE
• DIARRHEA
• N/V
• LOSS OF MUCOUS PLUG
TRUE VS FALSE LABOR
• TRUE
• FALSE
• CERVICAL
• NO CERVICAL
EFFACEMENT
CHANGES
AND DILATION
• UC- IRREGULAR
• UC-REGULAR,
AND NO
STRONGER,
CHANGE IN
LONGER
FREQ.,
INTENSITY,
• LOCATIONDURATION
BACK TO FRONT
TRUE VS FALSE LABOR
• TRUE
• WALKING WILL
NOT LESSEN UC
MAY INTENSIFY
• FALSE
• POSITION
CHANGE OR
WALKING WILL
LESSEN UC.
CRITICAL FACTORS IN
LABOR
• KNOWN AS THE FIVE “P’s” OF
LABOR
• PASSAGEWAY
• PASSENGER
• POWERS
• POSITION
• PSYCHE
PASSAGEWAY
• REFERS TO THE MATERNAL
STRUCTURES-BONES OF THE
PELVIS, SACRUM AND COCCYX
AND THE SOFT STRUCTURES
CERVIX AND VAGINA.
• SIZE OF MATERNAL PELVISDIAMETERS OF THE PELVIC
INLET,MIDPELVIS, AND OUTLET
Manual Measurement of
Pelvis
Manual measurement of
the Interspinous
Passageway
PASSAGEWAY
• ANTEROPOSTERIOR
DIAMETERS OF THE PELVIC
INLET-DIAGONAL CONJUGATE(
11.5CM), OBSTETIC
CONJUGATE(10CM OR MORE),
CONJUGATA VERA(TRUE
CONJUGATE)(10cm),
TRANSVERSE(13.5CM) AND
OBLIQUE (12.75CM)
PASSAGEWAY
• MIDPELVISANTEROPOSTERIOR
DIAMETER(11.5-12
CM),POSTERIOR SAGITAL
DIAMETER(4.5-5CM),
TRANSVERSE DIAMETER
(INTERSPINOUS) (10CM)
PASSAGEWAY
• PELVIC OUTLETANTEROPOSTERIOR DIAMETER
(9.5-11.5 CM),TRANSVERSE
DIAMETER ( 8-10CM),
POSTERIOR SAGITTAL
DIAMETER (LEAST 7.5 CM)
PASSAGEWAY
•
•
•
•
•
TYPE OF MATERNAL PELVIS
GYNECOID
ANDROID
ANTHROPOID
PLATYPELLOID
PASSAGEWAY
• THE TYPE OF PELVIS AND ITS
DIAMETERS CAN INFLUENCE
THE DESCENT OF THE FETUS,
THE PROGRESSION OF LABOR
AND TYPE OF DELIVERY.
PASSAGEWAY
• SOFT TISSUES- THE CERVIX,
VAGINA, AND THE OPENING OF
THE VAGINA (INTROITUS)
• CERVIX MUST EFFACE AND
DILATE
• VAGINA AND THE INTROITUS
MAY DISTEND
• FAT PADS CAN CAUSE
PROBLEMS.
Bishop Score – Cervical
Riping
PASSENGER
• PASSENGER REFERS TO THE
FETUS. IT’S :
• SIZE
• ATTITUDE
• LIE
• PRESENTATION
• POSITION
• ENGAGEMENT
• STATION
PASSENGER
• SIZE-LARGE BABIES MAY NOT
BE ABLE TO BE DELIVERIED
VAGINAL.
• FETAL HEAD-DIAMETERS OF
THE FETUS HEAD
• BIPARIETAL-9.5CM
• BITEMPORAL-8CM
• OCCIPITOFRONTAL -11.75CM
• OCCIPITOMENTAL-13.5CM
PASSENGER
• SUBMENTOBREGMATIC-9.5 CM
• SUBOCCIPITOBREGMATIC9.5CM
PASSENGER
• ATTITUDE-IS THE
RELATIONSHIP OF THE FETAL
PARTS TO ONE ANOTHER.
• FLEXION
• EXTENSION
PASSENGER
• FETAL LIE-IS THE
RELATIONSHIP OF THE
LONGITUDINAL AXIS OF THE
FETUS TO THE LONGITUDINAL
AXIS OF THE MOTHER
• LONGITUDINAL LIE- VERTEX OR
BREECH
• TRANVERSE LIE- LATERALLY
ACROSS UTERUS.
• OBLIQUE LIE -DIAGONALLY
PASSENGER
• PRESENTATION-REFERS TO
THE FETAL PART ENTERING
THE PELVIS FIRST
• CEPHALIC
• FACE
• BROW
• BREECH
• SHOULDER
PASSENGER
• PRESENTATION
• COMPOUND- MORE THAN ONE
FETAL PART- IE-HEAD AND HAND.
PIPER FORCEPS
PASSENGER
• POSITION-IS THE
RELATIONSHIP OF THE FETAL
PRESENTING PART TO THE
MATERNAL PELVIS
• CAN BE A TWO-LETTER OR
THREE- LETTER NOTATION AND
IS USED TO DESCRIBE THE
FETAL POSITION
POSITION
• TWO-LETTER NOTATION
• 1ST- PRESENTING PART IE
O=OCCIPUT,M=MENTUM,
S=SACRUM
• 2ND-INDICATES THE
RELATIONSHIP OF THE
LANDMARK(FETAL) TO THE
FRONT,BACK OR SIDE OF THE
PELVIS.A=ANTERIOR,P=POSTERIOR,
• IE-OA OR OP.
POSITION
• THREE-LETTER NOTATION
• 1ST LETTER- WHICH SIDE OF
THE MATERNAL PELVIS IS THE
FETAL PART TOWARDS.
• R=RIGHT
• L=LEFT
POSITION
• 2ND LETTER INDICATES THE
LANDMARK OF THE
PRESENTING PART
• O=OCCIPUT
• M=MENTUM
• S=SACRUM
• A OR AD OR Sc=SHOULDER
POSITION
• 3RD LETTER INDICATES THE
RELATIOSHIP OF THE
LANDMARK OF THE
PRESENTING PART TO THE
FRONT.BACK, OR SIDE OF THE
MATERNAL PELVIS
• A=ANTERIOR, P=POSTERIOR,
T= TRANSVERSE (SIDE)
• ROA,ROT,ROP,LOP,LOT,LOA
• RSA,RST,RSP,LSP,LST,LSA
PASSENGER
• ENGAGEMENT-OCCURS WHEN
THE LARGEST DIAMETER OF
THE PRESENTING PART
REACHES THE PELVIC INLET
AND CAN BE DETECTED BY
VAGINAL EXAM
• FLOATING
• BALLOTABLE
• ENGAGED
PASSENGER
• STATION-IS THE RELATIONSHIP
OF THE PRESENTING PART TO
THE ISCHIAL SPINES OF THE
MATERNAL PELVIS
• MEASURED IN CM
• ABOVE ISCHIAL SPINES(-1 TO5)
• AT THE ISCHIAL SPINES( O
STATION)
• BELOW THE ISCHIAL SPINES(+1
TO +4)
POWER
• INCLUDES PRIMARY AND
SECONDARY FORCES OF LABOR
• PRIMARY FORCES- CONSIST OF
THE INVOLUNTARY
CONTRACTIONS OF THE
UTERINE MUSCLES
• CONTRACTIONS-INCREMENT,
ACME, DECREMENT PHASES
AND RESTING PHASES
POWER
• PRIMARY FORCES
• CONTRACTIONSFREQUENCY,DURATION,INTENSITY
• UC CAUSE EFFACEMENT AND
DILATION OF THE CERVIX
• PRIMIGRAVIDAS WILL EFFACE
FIRST THEN DILATE
• MULTIGRAVIDAS CAN DO BOTH
TOGETHER
EFFACEMENT
• THE THINNING AND
SHORTENING OF THE CERVIX.
• MEASURED IN PERCENTAGES
• O% TO 100%
DILATION
•
•
•
•
OPENING OF THE CERVIX
MEASURED IN CM
0CM TO 10CM
10CM =COMPLETE DILATION.
POWER
• SECONDARY POWERS-CONSIST
OF THE VOLUNTARY USE OF
THE ABDOMINAL MUSCLES
DURING THE SECOND STAGE
OF LABOR TO FACLITATE THE
DESCENT AND DELIVERY OF
THE FETUS.
• PUSHING
POSITION
• MATERNAL POSITIONS IN
LABOR CAN FACILITATE THE
DESCENT OF THE FETUS IN
THE BIRTHCANAL, COMFORT
OF THE MOTHER, AND UTERINE
BLOOD FLOW(PERFUSION)
PSYCHE
• THE PSYCHOLOGICAL
COMPONENT OF
CHILDBEARING
• EXCITEMENT
• FEAR/ANXIETY
• PERCIEVED LOSS OF CONTROL
PSYCHE
• FEAR-TENSION-PAIN CYCLE
• CHANGE VITAL SIGNSINCREASE B/P, P,&R.
• LACK OF KNOWLEDGE AND
PREPARATION FOR
CHILDBIRTH CAN NEGATIVELY
AFFECT THE PSYCHE.
STAGES OF LABOR
• FIRST STAGE OF LABOR-ONSET
OF UC TO COMPLETE
EFFACEMENT AND DILATION
• SECOND STAGE-COMPLETE
EFFACEMENT AND DILATION
TO DELIVERY OF BABY
• THIRD STAGE-DELIVERY OF
BABY TO DELIVERY OF
PLACENTA
• FOURTH STAGE-1-4HRS AFTER
BIRTH
FIRST STAGE OF LABOR
• 0-100% EFFACED AND 0-10CM
DILATION
• HAS THREE PHASES :
• LATENT-0-3CM
• ACTIVE-4-7CM
• TRANSITION-8-10CM
LATENT PHASE
• 0-3CM
• UC MAYBE IRREGULAR AT
FIRST THEN BECOME REGULAR
AND MORE FREQUENT..MILD TO
MODERATE INTENSITY
• LONGEST PHASE-NULLIPARAS
8.6 HRS,MULTIPARAS 5.3HRS
LATENT PHASE
• MATERNAL
REACTION/BEHAVIORS
• RELIEVED LABOR HAS
STARTED
• AMBIVALIOUS
• ANXIOUS
• EXCITED
• TALKATIVE
• CAN USUALLY TALK DURING
UC.
ACTIVE PHASE
• 4-7CM
• UC-REGULAR,FREQ.-2-5
MIN,DURATION-40-60 SEC,
INTENSITY MOD.-STRONG.
• AVE LENGTH-NULLIPARAS4.6HRS, MULTIPARAS-2.4HRS
ACTIVE PHASE
• MATERNAL
REACTION/BEHAVIOR
• SERIOUS
• INTENSE
• FOCUS ON UC..DOESN’T TALK
DURING UC ONLY
BETWEEN..SHORT PHRASES
• INTENSE PAIN
• MORE DEPENDENT
TRANSITION PHASE
• 8-10CM
• UC- FREQ.-1 1/2-2 MIN.,
DURATION-60-90 SEC,
INTENSITY STRONG.
• WOMEN IS WORKING HARD
WITH INTENSE
CONCENTRATION
• FOCUS ONLY ON HER NEEDS
• ONE WORD ANWSERS
• INCREASE ANXIETY
TRANSITION PHASE
• MATERNAL REACTION/
BEHAVIOR:
• FATIQUE
• FEARS LOSS OF CONTROL
• SENSES HELPLESSNESS
• DIFFICULT TO RELAX
• DEMANDING
• MAY SAY “I CAN’T DO THIS
ANYMORE”
SECOND STAGE OF
LABOR
• EXTENDS FROM COMPLETE
EFFACEMENT AND DILATION
TO BIRTH OF THE BABY
• UC - FREQ.-1 1/2-2
MIN.,DURATION 60-90 SEC,
INTENSITY-STRONG
• INVOLUNTARILY EFFORTS TO
EXPEL FETUS.
• NORMAL LENGTH-UP TO 3HRS
FOR NULLIPARAS & 1/2HR FOR
MULTIPS
SECOND STAGE
• MATERNAL
REACTION/BEHAVIOR:
• RENEWED ENERGY
• FATIGUE
• DETERMINED
• FOCUSED
• REST BETWEEN
PUSHING/SLEEPS
• UNABLE TO CONTROL PUSHING
THIRD STAGE OF
LABOR
• EXTENDS FROM BIRTH OF
BABY TO DELIVERY OF THE
PLACENTA
• AVERAGE LENGTH--UP TO
THIRTY MINUTES
• RELIEF LABOR IS OVER
• EXCITED ABOUT INFANT
• RENEWED ENERGY
• FATIGUE
FOURTH STAGE OF
LABOR
• FIRST ONE TO FOUR HOURS
AFTER DELIVERY
• RECOVERY PHASE
• UC NEEDED TO PREVENT
BLEEDING
• EXCITED
• FATIGUE
• NEEDS CONT. MONITORING
CARDINAL MOVEMENTS
• THE ADAPTATIONS THE FETUS
UNDERTAKES TO MANEUVER
THROUGH THE PELVIS DURING
LABOR AND BIRTH• ENGAGEMENT
• DESCENT
• FLEXION
• INTERNAL ROTATION
• EXTENSION
CARDINAL MOVEMENTS
•
•
•
•
RESTITUTION
EXTERNAL ROTATION
EXPULSION
Every Darn Fool In Rotterdam
Eats Rotten Egg Rolls Everyday
• THIS IS THE CARDINAL
MOVEMENTS FOR A CEPHALIC
PRESENTATIONFL
Fetal moving through
the Pelvis
MATERNAL RESPONSE
TO LABOR
• CARDIOVASCULAR:
• CARDIAC OUTPUT-SIGNIFICANT
INCREASE OF CO DURING
LABOR
• BLOOD PRESSURE INCREASES
DURING UC
• PULSE RATE INCREASES
DURING UC
• TAKE VS DURING RESTING
PERIOD NOT DURING UC.
FLUID AND
ELECTROLYTE
BALANCE
• DIAPHORESIS
• LOSS THROUGH BREATHING
• INCREASE MUSCLE ACTIVITY
RESPIRATORY SYSTEM
• OXYGEN DEMANDS AND
CONSUMPTION INCREASE
• VARIES FROM METABOLIC
ACIDOSIS-RESPIR.ALKALOSIS
RETURNS TO NORMAL IN 4TH
STAGE
• 50% INCREASED O2 USED BY
THE PLACENTA
RENAL SYSTEM
• POLYURIA
• PROTEINURIA
GASTROINTESTINAL
SYSTEM
• GASTRIC MOTILITY AND
ABSORPTION ARE DECREASED
• FOOD WILL REMAIN IN THE
STOMACH
• CLIENT WILL VOMIT IN
TRANSITION PHASE
IMMUNE SYSTEM
• WBC’S WILL BE INCREASED-TO
25,000-30,000.
NERVOUS SYSTEM
•
•
•
•
PAIN
TYPES
LOCATION
FACTORS THAT INFLUENCE
PAIN PERCEPTION
FETAL RESPONSE TO
LABOR
• HEART RATE 110-160
• CO2 INCREASES
• PH DECREASES-SLIGHTLY
ACIDITIC-7.25-7.35
PAIN MANAGEMENT
DURING THE
INTRAPARTAL PERIOD
• NONPHARMACOLOGIC
METHODS OF PAIN
MANAGEMENT
• POSITIONING
• BREATHING TECHIQUES
• RELAXATION TECHIQUES
• GATE CONTROL METHODS
• HYDROTHERAPY
ANALGESIA AND
ANESTHESIA
• CAN BE GIVEN TO DECREASE
OR ELIMINATE PAIN DURING
THE LABOR PROCESS WHEN
NONPHARMACOLOGIC
METHODS OF PAIN
MANAGEMENT ARE
INEFFECTIVE
PHARMACOLGIC
METHODS
• ANALGESIC AGENTS DECREASE
THE AMOUNT OF PAIN
PERCEIVED
• GOAL IS TO MAXIMUMIZE PAIN
RELIEF WITH MINIMAL RISK
FOR THE WOMAN OR FETUS
• IF GIVEN TOO EARLY MAY
SLOW LABOR PROCESS
• IF TOO MUCH IS GIVEN CAN
EFFECT THE NEONATE
RESPIRATIONS.
NARCOTIC ANALGESIA
• DEMEROL
• FENTANYL
• MORPHINE
NARCOTIC
AGONIST/ANTAGONIST
• NUBAIN-NALBUPHINE
HYDROCHLORIDE
• STADOL-BUTORPHANOL
TARTRATE
NARCOTIC POTENTIATE
• VISTARIL
• PHENERGAN
REGIONAL ANESTHESIA
• EPIDURAL-LUMBAR,CAUDAL
• COMBINATION
EPIDURAL/SPINAL
• SPINAL
• LOCAL
• PUDENDAL PARACERVICAL
Pudendal Anesthesia
Area Affected by a
Pudendal Nerve Block
GENERAL ANESTHESIA
• ONLY FOR EMERENCIES
• WATCH FOR BLEEDING
• EFFECT OF BABY