Chapter 7
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Chapter 7 Nursing Care During Labor Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1 Birthing Centers and Nursing Care Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 2 Objectives Define key terms listed. Describe three variations in cultural practices. Compare alternative birth settings. Outline three nursing assessments and interventions during each stage of labor. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 3 Objectives (cont.) Discuss the significance of psychological support during labor. Review ways to protect the woman from infection. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 4 Goal of Nursing Care Ensure best possible outcome for the mother and the newborn Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 5 Birth Settings Traditional hospital Independent birthing centers Home birth services Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 6 In-Hospital Birthing Rooms Woman stays in the same room for labor, delivery, and recovery (LDR room) Some settings have woman stay in same room throughout entire stay; called LDRP—labor, delivery, recovery, postpartum Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 7 Freestanding Centers Out-of-hospital birthing facilities Combine homelike environment with a shortstay, ambulatory health facility with access to in-hospital obstetric and newborn care Advantage over a home birth: this type of setting has quick access to a hospital Typically provide comprehensive prenatal, birth, and postpartum care Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 8 Home Birth Community-based nurse-midwife usually manages home births Advantages Woman is in familiar, comfortable surroundings Less expensive Risks Lack of emergency equipment May be too far from hospital or medical care if complications arise Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 9 Cultural Considerations Modesty Pain Position Female care provider Support person Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 10 Pain Expressions vary based on cultural background Some women are stoic and silent to avoid bringing shame on the family Others are expressive and loud Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 11 Position Varies with culture Some prefer upright position Others prefer kneeling or squatting during birth Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 12 Cultural Sensitivity Will assist nurses in being nonjudgmental and less likely to impose their own values and beliefs on the women they care for Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 13 Care Management Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 14 When to Go to the Hospital or Birth Center Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 15 Contractions Have a pattern of increasing frequency, duration, and intensity First child: comes when contractions have been regular (every 5 minutes) for 1 hour Second or later child: comes when contractions are regular and 10 minutes apart for 1 hour Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 16 Other Reasons to Go to the Hospital Ruptured membranes Bleeding other than bloody show (e.g., active bleeding that is not mixed with mucus) Decreased fetal movement Any other concern Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 17 Preadmission Forms May have been completed before admission Prenatal record includes Nursing and medical parameters Laboratory results Nutritional guidance already provided • Psychosocial and cultural factors, including birth plan, may also be included Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 18 Care Plan Reflects Where the labor and delivery process will take place Degree to which the partner will participate Teaching aspects Incorporates what the woman can expect Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 19 Data Collection and Admission Procedures Three priority assessment questions should be completed when the woman is admitted to the labor and delivery unit What is the condition of the mother and fetus? Is the birth imminent? Does the labor appear to be uneventful? Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 20 On Presentation to L&D Unit Women who have had prenatal care and have preregistered will likely require verification of information, including recent clinical laboratory results Women who have not had prenatal care will require the nurse to obtain as much information as possible, depending on situation, and have clinical laboratory tests such as CBC, hematocrit, drug screen, STI, and others as indicated Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 21 Nursing Care of the Woman in False Labor Prodromal labor Helps prepare woman’s body and fetus for true labor Usually observed for 1 to 2 hours Fetal monitoring is performed Woman usually can walk about when not being monitored If it is true labor, walking often helps to intensify contractions and aids in cervical effacement and dilation Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 22 Factors to Consider with False Labor Number and duration of previous labors Distance from the health care facility Availability of transportation Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 23 Data Collection on Admission What three priorities should the nurse’s data collection upon admission focus on? Condition of mother and fetus Whether birth is imminent Labor appears to be uneventful Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 24 Priority Assessment Questions There are three priority assessment questions that should be answered when the woman is admitted to the labor and delivery unit. They are: 1. What is the condition of the mother and fetus? 2. Is the birth imminent? 3. Does the labor appear to be uneventful? Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 25 Fetal Assessment and Monitoring Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 26 Objectives Compare external and internal fetal monitoring during labor. Compare the advantages and disadvantages of electronic fetal monitoring during labor. Describe the cleansing of the woman’s perineum in preparation for birth. Compare reassuring and nonreassuring fetal heart rates. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 27 Objectives (cont.) Relate the nurse’s role in fetal monitoring. Describe the purpose of amnioinfusion. Discuss the role of the doula in the delivery room. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 28 Focused Data Collection First and Second Stages of Labor Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 29 Warning Signs: Potential Complications Maternal fever greater than 38° C (100.4° F) Contractions lasting more than 90 seconds Contractions less than 2 minutes apart Meconium-stained amniotic fluid Foul-smelling vaginal discharge Excessive bleeding and hypotension Fetal bradycardia or tachycardia Loss of baseline variability on fetal monitor Fetal heart rate (FHR) <110 or >160 bpm Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 30 Monitoring Fetal Heart Rate Assess by auscultation if woman not on electronic fetal monitoring Best heard over fetal back FHR should be taken immediately after ROM FHR should also be taken after Vaginal examination Administration of medications Notation of abnormal fetal activity Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 31 What are the advantages of continuously monitoring FHR? Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 32 Continuously Monitoring FHR Continuously monitoring FHR allows the nurse to Evaluate FHR variability Identify abnormalities in FHR patterns Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 33 Signs of Fetal Distress EFM signs to observe for and report, if they do not resolve after verifying placement of monitoring devices or repositioning woman, are A loss of baseline variability Variable or late decelerations that persist after maternal position change Persistent fetal tachycardia Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 34 Other Signs of Fetal Distress Meconium in amniotic fluid when fetus is in a vertex position Requires immediate reporting to health care provider Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 35 Intermittent Fetal Heart Monitoring During Labor Low-risk technology Intermittent auscultation with hand-held Doppler or fetoscope Assess at 15-minute intervals during first stage Assess at 5-minute intervals during second stage Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 36 Reassessment of FHR ROM Vaginal examination Ambulation (before and after) Change in infusion rate of oxytocin Administration of drugs (before and after) Urinary catheterization Expulsion of enema Recognition of abnormal uterine activity Decrease in fetal activity Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 37 Continuous EFM During Labor Can detect changes in FHR May indicate inadequate oxygenation of fetus Allows for immediate interventions Provides visual display of FHR Uterine activity measured and displayed Can be electronically transmitted to monitors at nursing station so woman and fetus can be assessed even if nurse is not at bedside Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 38 Documentation of EFM Some facilities still use paper to maintain medical records, whereas others now employ computerized charting called electronic medical record Regardless of method, the EFM tracings are part of the medical record and must be correctly labeled with the woman’s name, date of birth, date of admission, date of tracings Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 39 Nurse’s Role in EFM Continually assesses whether the FHR pattern is Reassuring: reflects adequate fetal oxygenation Nonreassuring: reflects fetal distress • Appropriate interventions must be taken Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 40 Monitor Strips It is important to document on the strip (or in the computer) each time anything is done, such as a vaginal examination, voiding, etc. This is important in the assessment of the tracing strips and provides permanent documentation of care provided Also important to record time EFM discontinued and restarted Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 41 Emergency Interventions Nonreassuring heart rate Administer oxygen to woman • 8 to 10 L/min by face mask Turn woman to side-lying position Stop oxytocin infusion • Keep IV line open Notify health care provider Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 42 Types of Electronic Fetal Monitoring Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 43 External Fetal Monitoring Ultrasound transducer and tocodynamometer to woman’s abdomen Secured with elastic strips, belts, or stockinette Sound waves are picked up by monitor Uterine contractions Can be monitored for frequency and duration Cannot be monitored for uterine intensity Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 44 Internal Fetal Monitoring Accuracy is main advantage Requires ruptured amniotic membranes Cervix must be dilated to at least 2 cm Spiral electrode is attached to fetal presenting part Pressure transducer introduced into uterine cavity Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 45 Reassuring and Nonreassuring Fetal Heart Rate Patterns Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 46 The Normal Pattern Heart rate 110 to 160 beats/min Beat-to-beat variability between 6 and 25 beats/min No decelerations but may see accelerations Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 47 Accelerations Brief, temporary increases in FHR At least 15 beats/min above baseline Usually occur with fetal movements May also occur with Vaginal examinations Uterine contractions Fundal pressure Breech presentations Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 48 Decelerations Transitory decreases in FHR from baseline Three types Early Late Variable Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 49 Early Deceleration Typically starts with contraction Ends when contraction is over Common cause Stays within normal range of FHR Produces a V-shaped pattern Compression of fetal head No intervention necessary Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 50 Late Deceleration Usually begins at peak of contraction Ends after contraction has ended Often associated with uteroplacental insufficiency Depth and time it takes to return to baseline is important Persistence, or recurrence, usually indicates hypoxia (lack of oxygen to fetus) A drop of 30 beats/min or change in baseline variability is significant indicator of fetal distress Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 51 Cause of Late Deceleration Maternal hypotension Excessive uterine activity Deficient placental perfusion Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 52 Repetitive Late Decelerations Require immediate intervention Repositioning Administering oxygen Discontinuing oxytocin Increasing IV fluid Evaluating vital signs Prompt reporting to health care provider Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 53 Variable Decelerations Transient drop in FHR before, during, or after uterine contraction Related to brief compression of umbilical cord Decelerations are abrupt and often associated with accelerations before or after deceleration Rare association with hypoxia Requires change in position of woman Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 54 Fetal Pulse Oximetry Value remains controversial Transcervical catheter is positioned against fetal cheek to measure oxygen saturation Amniotic membranes must have ruptured, cervix dilated to at least 2 cm, fetus in vertex presentation at the cervix Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 55 Fetal Pulse Oximetry Readings Normal term fetus during labor: 40% to 70% Levels less than 30% may indicate fetal metabolic acidosis Would indicate hypoxia and require rapid delivery of fetus Can be used to continue with labor and try to avoid cesarean birth, especially if nonreassuring FHR is present in term fetus Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 56 Monitoring Uterine Contractions 20- to 30-minute baseline electronic monitoring of uterine contractions and FHR is usually performed Palpating contractions Nurse places fingertips on woman’s abdomen over uterine fundus Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 57 Determining Fetal Position by Abdominal Palpation Leopold’s maneuvers May reveal if multifetal pregnancy exists (especially in woman without prenatal care) By doing this, can help locate best position for auscultating FHR Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 58 Monitoring Status of Amniotic Fluid If amniotic membrane is ruptured, assess for Time of rupture Color, amount, and odor • Fluid that is clear and pale with little odor is normal • Greenish suggests meconium • Wine-colored indicates presence of blood with possible separation of placenta • Foul or unpleasant odor indicates infection Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 59 Nitrazine Paper Test Test strip is sensitive to pH Turns deep blue if amniotic fluid is present Turns yellow if urine is present Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 60 Ferning Characteristic pattern of crystallization in amniotic fluid when it dries Place fluid on glass slide, allow to dry, observe under microscope Urine and other vaginal discharge will not show this type of pattern Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 61 Amnioinfusion Infusion of warmed normal saline or lactated Ringer’s solution into uterine cavity after amniotic membranes have ruptured Performed to Decrease compression of umbilical cord Increase fluid when oligohydramnios is present Dilute meconium in uterine cavity Decrease risk of fetus aspirating meconium Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 62 Contraindications to Amnioinfusion Prolapsed cord Vaginal bleeding Severe fetal distress Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 63 Physical Care and Psychological Support During Labor and Birth Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 64 The Nurse’s Role Documents progress of labor Reports abnormal findings Provides measures of support, prevention of infection, and promotion of comfort Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 65 Vaginal Examinations Performed with sterile gloves and a watersoluble lubricant Done to determine status of cervical dilation and effacement Contraindicated if vaginal bleeding is present Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 66 Documentation Vital signs every hour in latent phase and every 30 minutes in active phase of labor FHR patterns are monitored Contractions are monitored, and nurse documents in medical record the Frequency, intensity, and duration Intake and output Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 67 Supporting the Partner Some truly coach and take the lead in helping woman cope with labor Others will assist if shown Some only want to provide encouragement and support, but nothing more Partners should be permitted to provide the type of support they’re comfortable with Should be encouraged to take a break Nurse remains available Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 68 Doula A doula is a person other than a family member or friend who is trained to provide labor support May be hired by mother to provide labor support, guidance, and encouragement to mother Acts as an advocate for the family Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 69 Psychological Support Goal is to Make the labor and delivery process a more pleasant and satisfying experience Allow more family participation Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 70 Teaching Ongoing tasks of intrapartum nurse Positions or breathing techniques different from those learned in class may need to be taught to and tried by the laboring woman Encourage her to try a change in technique or position for 2 or 3 contractions before abandoning it for another Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 71 Teaching (cont.) Avoid pushing before cervix is fully dilated Teach to blow out in short puffs when urge to push is strong If pushing done before dilation is complete, can cause Maternal exhaustion Fetal hypoxia Ultimately slows progress of laboring process Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 72 Pushing Take deep breath and exhale it at beginning of each contraction Take another deep breath and push with abdominal muscles while exhaling Push for 4 to 6 seconds Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 73 Water Births Experimental procedure that requires signed, informed consent Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 74 Discussion Question What are the routine auscultations and documentation of fetal heart rate during the following phases and stages of labor? Latent phase Active phase of first stage of labor Second stage of labor Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 75 Nursing Care During Labor and After Delivery Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 76 Objectives Explain the common nursing responsibilities during birth. Identify nursing priorities when assisting in an emergency (precip) delivery. List four items important to record about the infant’s birth. Discuss the immediate care of the newborn. Explain the reason the neonate requires administration of vitamin K at birth. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 77 Objectives (cont.) Describe the nursing assessments important in the woman’s recovery period after birth. Illustrate two ways to encourage maternalnewborn bonding after birth. Discuss fetal pulse oximetry. Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 78 Provision of Care During the Four Stages of Labor Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 79 Signs of Impending Birth Sitting on one buttock Making grunting sounds Involuntarily bearing down with contractions States “the baby is coming” Bulging of the perineum Do not leave woman alone; prepare for precipitate birth and summon help Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 80 Birth of the Baby Cleansing breath before each contraction Keeps oxygen and carbon dioxide levels in balance Use open-glottis method for pushing After head delivered, woman is asked to stop pushing Baby’s nose and mouth are suctioned; health care provider checks baby’s neck to ensure nothing is wrapped around it Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 81 Nursing Care During Delivery Once positioned for delivery, cleanse vulva and perineum Prepare delivery table Continue to monitor FHR every 5 to 15 minutes All health care team members don appropriate personal protective equipment Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 82 Preparing for Delivery Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 83 Vaginal Delivery Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 84 Expulsion of Placenta Third stage of labor begins after birth of baby and ends with expulsion of placenta The uterus shrinks in size; the placenta does not Placenta insertion site buckles, and it separates as uterus contracts Usually takes place about 5 to 30 minutes after delivery Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 85 Signs of Imminent Delivery of Placenta Lengthening of umbilical cord Gush of blood from vagina May come after placenta delivered if fetal side of placenta is expelled first (Schultze mechanism) May come just before delivery of placenta if maternal side is expelled first (Duncan mechanism) Elevation of uterine fundus Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 86 Types of Placenta Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 87 Immediate Recovery Period Sometimes referred to as fourth stage of labor Physical recovery of mother Vital signs are monitored Location and firmness of uterine fundus Massage fundus and assess for amount and color of lochia Usually lasts between 1 and 4 hours Ice bag may need to be placed on perineum Assess for bladder distention Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 88 Third Stage of Labor Risks Hemorrhage Therefore nursing assessment should include Amount of bleeding Blood pressure Pulse rate Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 89 Phase 1: Immediate Care of the Newborn Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 90 Nursing Care of the Newborn in the Delivery Room Divided into three phases Phase 1: birth to 1 hour of age Phase 2: 1 hour to 4 hours after birth Phase 3: from 4 hours after birth until discharge from hospital Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 91 Phase 1 Care of the Newborn Maintain thermoregulation Maintain cardiorespiratory function Identify mother, partner, and newborn Perform a brief assessment for anomalies Observe for and document passage of meconium and urine Facilitate parent-newborn bonding Initiate first breastfeeding Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 92 Thermoregulation Hypothermia forces newborn to use glucose to warm body Hypoglycemia associated with development of neurologic problems Cold stress increases basal metabolic rate Results in an increased need for oxygen consumption; leads to hypoxia Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 93 Cardiorespiratory Obligate nose breathers Bulb suctioning of mouth prevents aspiration of mucus and amniotic fluid Once in radiant warmer, apply heart monitoring leads If cyanotic, supplemental blow-by oxygen is given Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 94 Cyanotic Newborn If heart rate less than 100 beats/min Tactile stimulation is provided Suctioning Oxygen If cyanosis does not resolve quickly Bag and mask resuscitation may be needed Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 95 Acrocyanosis A blue color to the hands and feet due to sluggish peripheral circulation for the first few hours after birth Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 96 Apgar Scoring System Numeric value (0, 1, 2) is given to Heart rate Respiratory effort Muscle tone Reflex irritability Color Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 97 Identification In delivery room Mother, newborn, and partner are all given ID bands that have the same number on them This band is checked whenever the baby is given to or taken from the mother, and at discharge Some facilities even have an alarm device attached to the bands to prevent infant abduction Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 98 Other Nursing Interventions Document first urine and passage of meconium Administer medications such as vitamin K (assist with blood clotting) and prophylactic eye ointment (to prevent ophthalmia neonatorum) Observe for abnormalities Promote infant-parent bonding Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 99 Umbilical Cord Blood Banking Umbilical cord Contains large amounts of stem cells that can help treat assorted diseases or conditions Requires informed consent of mother and special collection supplies Blood must arrive at storage center within 48 hours of collection Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 100 Emergency Delivery by the Nurse Called precipitate delivery Major nursing interventions include Remain calm and supportive Provide cleanliness as much as possible Control the birth of the baby Do not attempt to hold back the fetus’ head to prevent the delivery Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 101 Audience Response System Question 1 During the fourth stage of labor, the postpartum woman has a soft, boggy uterus. The nurse knows this is likely due to: A. B. C. D. Full bladder displacing uterine fundus Lochia flow needs 1 or more pads per hour Poorly contracted uterus Widening pulse rate and falling BP Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 102 Review Key Points Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 103
