Maternal

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Maternal Child Nursing CareSecond Edition
Marcia L. London Patricia W. Ladewig Jane W.
Ball Ruth C. Bindler
Lecture NotesChapter 19The Family in
ChildbirthNeeds and Care
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Clinical Pathway for Labor

• Information obtained during admission used to
  develop clinical pathway for four stages of
  labor
• Prenatal information
• Current assessments
• Expected teaching
• Nursing care expected for each stage
• Expected activity level
• Proposed comfort measures
• Elimination and nutritional needs
• Level of family involvement

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Admission

• Nursing care at admission focuses on providing
  orientation to the unit and obtaining overall
  physical assessment of mother that focuses on
  well-being of mother and fetus
• Assess maternal vital signs and FHR
• Perform vaginal exam to determine stage of
  cervical dilatation and state of membranes
• Determine frequency and intensity of contractions

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Admission (contd)

• Nursing care at admission focuses on providing
  orientation to the unit and obtaining overall
  physical assessment of mother that focuses on
  well-being of mother and fetus
• Review systems such as respiratory and
  neurological
• Assess any recent symptoms experienced by the
  woman
• Assess woman's understanding of labor process and
  identification of woman's support system

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TABLE 191 Nursing assessments in the First
Stage
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Nursing Care in the First Stage of labor

• Establish rapport with woman and support person
• Discuss expectations of labor and delivery
• Provide for privacy
• Discuss individual expression of pain and
  discomfort

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FIGURE 191 Woman and her partner walking in
the hospital during labor.
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Nursing Care in the Second Stage of Labor

• Provide as much privacy as possible
• Encourage woman and her support person to decide
  who should be present at delivery
• Provide praise and encouragement of progress

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Nursing Care in the Third and Fourth Stage of
Labor

• Encourage woman and her support person to hold
  and look at infant as much as possible
• Teach woman about care to be performed after baby
  is delivered
• Provide woman with food and fluids as allowed

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Comfort Measures Common in Labor First and
Second Stages

• Assist client to reduce anxiety
• Provide information and enhance coping skills -
  teach about what to expect during the labor
  process
• Promote relaxation techniques
• Instruct appropriate controlled breathing pattern
• Give instructions to womans support person

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TABLE 193 Nursing Support of
Patterned-Paced Breathing
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TABLE 193 (continued) Nursing Support of
Patterned-Paced Breathing
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TABLE 193 (continued) Nursing Support of
Patterned-Paced Breathing
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FIGURE 192 The laboring woman is encouraged
to choose a comfortable position. The nurse
modifies assessments and intervention as
necessary.
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FIGURE 192 (continued) The laboring woman
is encouraged to choose a comfortable position.
The nurse modifies assessments and intervention
as necessary.
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FIGURE 192 (continued) The laboring woman
is encouraged to choose a comfortable position.
The nurse modifies assessments and intervention
as necessary.
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Comfort Measures During the First Stage of Labor

• Administer pharmacologic agents as ordered by
  physician or certified nurse-midwife
• Assist with placement of epidural for pain control

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Comfort During the Second Stage

• Help woman find effective pushing pattern
• Support womans attempts to rest between pushes

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FIGURE 193 The womans partner provides
support and encouragement during labor.
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Immediate Care of the Newborn

• Maintain respiration
• Promote warmth
• Prevent infection
• Accurate identification

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FIGURE 199 Umbilical alarm in place on a
newborn infant.
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TABLE 197 Initial Newborn Evaluation
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FIGURE 198 To clear secretions from the
newborns nose or oropharynx, a DeLee mucus trap
(shown here) or other suction device is used. One
end of the suction tubing is connected to low
suction, and the other end of the tubing is
inserted 3 to 5 inches into the newborns nose or
mouth. Suction is applied as the tubing is pulled
out. The process is repeated for as long as fluid
is aspirated.
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Adolescent Mother

• Adolescent is unique in that she has
  developmental needs as well as physical needs
  that must be addressed
• Very young adolescent has fewer coping mechanisms
  and less experience to draw on than older
  laboring mothers
• Crucial to have support person
• Adolescents have high risk for pregnancy and
  labor complications

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FIGURE 1911 An adolescent mother receives
breastfeeding assistance in the immediate
postpartum period.
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Precipitous Birth

• Precipitous birth is one that occurs rapidly
  without physician or certified nurse-midwife in
  attendance
• Mother may fear what is going to happen and feel
  that everything is out of control
• Mother needs to assume comfortable position

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Precipitous Birth (contd)

• Nurse scrubs his or her hands if time permits
• When infant's head crowns, mother should pant
• Gentle pressure is applied against fetal head to
  prevent it from popping out rapidly
• Perineum is supported and head is born between
  contractions