Intrapartum Care
Maternal and child Nursing
NUR 362
Lecture 7
Intrapartum care
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Intrapartum period extends from the
beginning of contractions that cause cervical
dilatation to the first 1 to 4 hours after
delivery of the newborn and placenta.
Factors affecting the intrapartum
experience
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Experience
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Culture
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Prepregnant health & biophysical preparedness for
childbearing
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Motivation for childbearing
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Socioeconomic readiness
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Age of mother
Phenomena and process of labor and
delivery
Onset of labor
labor is the process by which the fetus and products of
conception are expelled as the result of regular
,progressive frequent and strong uterine
contractions.
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Theoretically ,labor is thought to result from:
a- progesterone depriviation.
b- oxytocin stimulation.
c- fetal endocrine control.
d- Uterine decidua activation
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Factors affecting labor
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1-passageway: The adequacy of the pelvis and
birth canal allowing fetal descent
2-passenger: refer to the fetus
Size of fetal head.
Fetal presentation.
Fetal position.
Fetal attitude-the relationship of fetal parts to
one another
Fetal presentation-the part of the fetus that enters
the maternal pelvis first.
Fetal position
Factors affecting labor
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3- power: Frequency, duration and strength
of the uterine contractions to cause complete
cervical effacement and dilatation.
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4-placental factors.-site of placenta.
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5-Psyche: client’s psychological state
Signs and symptoms of impeding labor
1-lightening:
The descent of the fetus and uterus into
the pelvis cavity 2 to 3 weeks before
the onset of labor.
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Signs and symptoms of impeding labor
2-Braxton Hicks contractions:
Irregular ,intermittent contractions that
have occurred throughout the
pregnancy ,become uncomfortable and
produce a drawing pain in the
abdomen.
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Signs and symptoms of impeding labor
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3-Cervical changes: include softening
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4-Rupture of the amniotic membrane
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5-Burst of energy or increased tension and
fatigue.
6- weight loss: about 1 to 3 pounds may
occurs 2 to 3 days before the onset of labor.
True and false labor
False labor
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-contractions may be
irregular.
True labor
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-regular contractions
-decrease in frequency
and intensity.
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-progressive frequency
and intensity.
-longer interval between
contractions.
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-shorter interval
between contractions.
-activity has no effect or
decrease contractions
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-activity increase
contractions.
False
Contractions
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-disappear while
sleeping.
-sedation decrease or
stop contractions.
-bloody show usually
not present.
-no appreciable changes
in the cervix.
True
contractions
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-continue while
sleeping.
-sedation does not stop
contractions.
-bloody show usually
present.
-progressive thinning
and opening of the
cervix.
Stages of labor
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1-First stage. begins with the onset of regular
contractions.
Latent phase: dilation of cervix to3 to 4 cm.
contraction become increasing
Active phase: dilation continues from 3 to 4 cm to 7
cm. Contraction become stronger and painful
Transition phase: cervix dilates from 8 to 10 cm
Stages of labor
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2- Second stage. (expulsive stage)-begins
with complete dilatation of the cervix and
ends with delivery of the newborn.
-it should be complete within one hour after
complete dilatation.
Cont, second stage
-Movements..
1. descent.
2. flexion.
3. internal rotation.
4. extension.
5. external rotation.
6. expulsion.
Cont, second stage
-”crowning” occurs when the newborns head or
presenting part appears at the vaginal
opening.
-”Episiotomy” surgical incision in the perineummay be done to facilitate delivery and avoid
laceration of the perineum.
3-Third stage (placental stage)
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-This stage begins with delivery of the
newborn and ends with delivery of placenta.
-It occurs in two phases –placental separation
and placental expulsion.
4-Fourth stage
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-It lasts from 1 to 4 hours after birth.
-the mother and the newborn recover from physical
process of labor.
-systems readjustment.
Newborn body systems begins to adjust to
extrauterine life.
-Intrapartum pain experience.
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-overview of pain.
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-factors affecting perception of intrapartum pain.
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-physiologic causes of intrapartum pain.
-uterine anoxia.
-compression of the nerve ganglia in the cervix.
-stretching of the cervix.
-traction on, stretching of the perineum.
-pressure on the urethra, bladder and rectum during
fetal descent.
-distension of the lower uterine segment.
- Intrauterine pain management
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-overview of goals.
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-none pharmacologic pain management.
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-pharmacological pain management.
-narcotic analgesics.
-barbiturates.
-tranquilizers.
-regional anesthesia.
- general anesthesia.