antenatal preparation.doc

8/14/2019 antenatal preparation.doc

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M.S RAMAIAH INSISTUTE OF NURSING EDUCATION AND

RESEARCH

CASE PRESENTATION ON preparation

for labour

SUBMITTED TO

MRS.DIVYA RAGHAVAN

LECTURER,

DEPT OF OBG NURSING,

M.S.R.I.N.E.R

SUBMITTED BY

MRS.LIMA MATHEWS

1STYR MSC NURSING

M.S.R.I.N.E.R


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SUBMITTED ON :19/02/2011

INTRODUCTION

As a part of my speciality clinical posting, at M.S.Ramaiah Hospital ,I Mrs.Lima Mathews ,Iyr M.Sc

Nursing student has selected Mrs.Namitha for my antenatal case study,whose P! is "# w$s .She i

a primigra%idae mother !& Po Lo Ao

BASELINE DATA

Name ' Mrs. Namitha.

Age ' (" yrs

Marital status ' Married

)ard ' Semi special ward

Nationality ' Indian

Religion ' Hindu

*ducation ' SSL+

ccupation ' Home ma$er

Address A$e$atta,Na%eli post

+N Halli

-um$ur

Admission date ' /#/(0&0

1stetrical score ' !& Po Lo Ao +onsulted 1y ' 2r. 3ma de%i

LMP ' &/&(/(00# 2ate of care started ' /#/(0&0

*.2.+ ' 4/#/(0&0 2ate of care ended ' &&/#/(0&0

!estational age ' "5 wee$s


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2iagnosis ' "5 wee$s with cephalic presentation ,primigra%idae

CHIEF COMPLAINT

Mrs.Namitha came to the hospital for safe confinement with the complaint of 1ac$ pain and

a1dominal pain

OBSTETRICAL HISTORY

PAST OBSTETRICAL HISTORY

PRIMI!RA6I2A

PRESENT OBSTETRICAL HISTORY

1sT!"#$s$!

Patient concei%ed spontaneously after & year of married life. Pregnancy was confirmed aft

urine pregnancy test after &/( month of amenorrhea. Regular antenatal chec$up was done. 7lood an

urine in%estigations were done. Her H1 was &(.4 gm8. 3rine e9aminations are normal. 3ltrasoun

scan was done normal findings. No history of %omiting or 1leeding per %agina.7p&(/40 mmof H

wt: ;$g

2%&T!"#$s$!


4/47

MEDICAL HISTORY

PAST MEDICAL HISTORY

Mrs.Namitha is not ha%ing any history of medical illness li$e hypertension, dia1etes, tu1erculosis,

epilepsy, thyroid disorders etc

PRESENT MEDICAL HISTORY

Mrs. Namitha is ha%ing history of amenorrhea .No other medical illness li$e hypertension ,dia1tes

,epilepsy is present .Not suffering from anyother communica1le and noncommunica1le disease.

SURGICAL HISTORY

PRESENT AND PAST SURGICAL HISTORY

She has not undergone any surgeries

FAMILY HISTORY

Mrs. Namitha 1elongs to a nuclear family. No history of dia1etes mellitus, hypertensio

epilepsy, 1lood disorders and any other communica1le diseases. No history of congenital anomaly an

twinning in the family.


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FAMILY GENOGRAM

0 @RS 5: @RS :4 @RS :;

(EY

>emale Male patient


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PERSONAL HISTORY

Mrs. Namitha 1elongs to a middle class family. Her hus1and is the 1read winner of th

family. -hey li%e in their own house. -heir house got all facilities li$e water supply, electricit

drainage system etc

2ietary pattern appetite is good

-a$ing mi9ed diet

*limination pattern 1owel and 1ladder ha1its are regular

Rest and sleep regular

*9ercise no specific e9ercise pattern

Personal hygiene maintains good personal hygiene

+ultural history doesnt ha%e any cultural 1elief that would affect her health

ccupational history house wife

MENSTRUAL HISTORY

Age of menarchy &;yrs

Regular (4 days cycle with ;: days of 1leeding

No dysmenorrhea

MARITAL HISTORY


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married life ( yrs

Arranged marriage

Ha%ing good relationship with hus1and

Non consanguineous marriage

Ha%e not used any contracepti%e methods

PARTNER)S HISTORY

Name Mr.Suresh

Age (4 yrs

*ducation P3+

ccupation B *lectrician

!enetic disorder no history of genetic disorders

Health pro1lem no significant health pro1lem

Ha1its no 1ad ha1its

7lood group ?%e

Attitude positi%e attitude towards pregnancy


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PHYSICAL E*AMINATION .

.GENERAL APPEARANCE

Height ' &54cm

)eight ' 50 $g

7ody 1uilt ' moderate

rientation ' oriented to time, place and person.

Sensorium ' conscious.

Le%el of acti%ity ' Restricted

VITAL SIGNS

-emperature ' #4.5C>

Pulse ' 4;1t/mt

Respiration ' (;1reath/mt

7lood pressure ' &(0/40 mm of Hg

HEAD TO FOOT ASSESSMENT

S(IN

+olour ' >air

-e9ture ' Smooth


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-emperature ' )arm And 2ry

Lesions ' A1sent

>oul dour ' A1sent

*dema ' A1sent

HAIR

+olour ' 7lac$

-e9ture ' Smooth

2istri1ution ' *Dually 2istri1uted

Infection ' A1sent

NAIL

Shape ' Normal

+olor ' Pale

Infection ' A1sent

HEAD AND FACE

SiEe ' Normal

Shape ' Normal

>acial Appearance' Normal

Sinuses ' Normal.

EYES

*ye1rows ' *Dually distri1uted

*yelashes ' Normal


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*yelids ' 7ilaterally Symmetrical

Sclera ' +lear And )hite

Pupil ' Pupils eDual and reacting to light

6ision ' Normal

+on=uncti%a ' Pale

E+!

Alignment ' Normal

+ondition f S$in ' Normal

+olor ' Normal

*9ternal Pinna ' No Lesion, And Infection

2ischarge ' No 2ischarge

Hearing ' Normal

)e1er test ' Air conduction is more than 1one conduction.FnormalG

Rinne test ' Air conduction is more than 1one conductionFnormalG

NOSE

SiEe ' Normal

Shape ' Normal

Symmetry ' Symmetric

Nasal Septum ' No 2e%iated Nasal Septum

Nostrils ' No +rust, Infection,

2ischarge ' A1sent


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MOUTH THROAT

+olour ' pin$

Lesion ' a1sent

Symmetry ' eDual

Lips ' dry, pin$ in colour

-eeth ' 1rown, no loosening, and decayed teeth

Mucus mem1ranes' normal and dry

-ongue ' not coated and dry

dour ' a1sent

3%ula ' midline position

ral mucosa and gums' normal

Hard and soft palate ' normal and pin$

NEC(

-onsils ' Normal

-hyroid gland ' Normal

Range of motion ' Normal

CHEST

Inspection ' no lesion, discoloration, 1ilateral chest e9pansion

Palpation ' no mass, no tenderness,

Percussion ' resonance sound heard, eDual air entry

Auscultation ' S& S(, sounds heard


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A9illa and cla%icular nodes' not enlarged

BREAST

I%s-$"%

SiEe ' 7oth are symmetrical

Primary aerola ' Present

Monotogomery tu1ercle ' present

Nipple ' erect

No pain ,redness ,tenderness

Palpation

Palpation done 1y circular method

)arm to touch

No lymphnode enlargement

No pain, redness, tenderness

ABDOMEN

Inspection ' Shape is %oid

+ontour is con%e9

3m1ilicus is flat

>lan$s are full

7ladder is emptied

Striae gra%ida and Linea nigra present

Palpation ' >etal mass present


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Auscultation ' >etal Heart sound present

BAC(

7ody cur%e ' normal

Lesions ' a1sent

GENITALIA

2ischarges ' A1sent

7owel Pattern ' Reduced

7ladder Pattern ' Normal

E!$#""$s

No edema or 26-

OBSTETRICAL E*AMINATION

I%s-$"%

SiEe ' Appro9imate to the period of gestation

Shape ' o%oid

+ontour ' +on%e9, s$in elastic

3m1licus ' >lat

>lan$s ' >ull

>oetal mo%ement ' %isi1le fetal mo%ement present

+ondition of 1ladder ' *mptied

S$in changes ' Linea Nigra and striae gra%idarium present

P+-+"%


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A1dominal girth#0 cm

>undal height"4 in cm

"( in wee$s

>undal palpation Soft irregular mass suggesti%e of fetal 1uttoc$s

Lateral palpation

Right side ' Small irregular $no1 li$e structure suggesti%e of fetal lim1

Left side ' +ontinuous smooth well cur%ed structure suggesti%e of spine

Pel%ic palpation

At Pel%is ' Hard glo1ular non 1allota11le mass suggesti%e of fetal head,

+on%erging hand indicate head is not engaged

ccipital pole ' palpa1le

Syncipital pole ' not palpa1le

+on%erging/ di%erging ' con%erging

2escend of the head ' :/:th

*ngaged ' not *ngaged

Pel%ic grip

SiEe ' normal

>le9ion ' >le9ed

+om1ine grip

At fundus ' 7road soft irregular mass suggesti%e of fetal 1uttoc$s

At pel%is ' Hard glo1ular non 1allota1le mass suggesti%e of fetal head


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A3s3+"%

>etal heart sound ' &;; 1/mt

Rhythm ' Regular

F"%&"%4s

!estational age ' "5 wee$s

Lie ' Longitudinal

Presentation ' +ephalic presentation

Position ' LA

Attitude ' >le9ion

2escend ' :/: th R L

*ngaged ' not *ngaged

>HS ' &;; 1/mt

Regular


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INVESTIGATION

SL % I%5$s"4+"% P+"$%)s 5+3$ N!#+ 5+3$ I#-!$ss"%

1. U!"%$ !3"%$ $s

+olour @ellow @ellow Normal

a Appearance +lear +lear, haEy Normal

1 pH 5.: ;.5 B 4 Normal

c specific gra%ity &.0& &.0&5 B &.0(( Normal

2.

a

C6$#"+ $+#"%+"% 7

3!"%$

Protein??

Negati%e P!$"%3!"+

1 !lucose Negati%e Negati%e Normal

c etone Negati%e Negati%e Normal

d 7ile salt Negati%e Negati%e Normal

e 7ile pigment Negati%e Negati%e Normal

f 3ro1ilinogen 0 .( 0." & Normal

g 7lood Negati%e Negati%etrace

Normal

h Nitrates

Negati%e Negati%e Normal

'

a

M"!s-"

$+#"%+"%

*pithelial cells & B (/hpf ccasionallyfew/hpf

Normal

1 Pus cells & B (/hpf 0 B ;/hpf Normal


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c R7+s Nil Male o B

"/hpf>emale 0

:/hpf

Normal

d Mucous strands A1sent A1sent Normal

e +rystals Nil A1sent Normal

f +asts Nil A1sent Normal

8

a

Serum glucose

Random 1lood sugar 4; mg/dl 0 B &;0mg/dl

Normal

1 3rine sugar &5 mg/dl &: B ;:

mg/dl

Normal

c +reatinine 0.4"mg/dl 0.55 B &.0#mg/dl

Normal

d 3ric acid ".5 mg/dl (.: B 5 mg/dl Normal

a

Serum electrolytes

Serum sodium &" mmol/L &": B &;:

mmol/L

Normal

1 Serum potassium (.# mmol/L ;." mmol/L Normal

c Serum chloride # mmol/L #4 B

&0mmol/L

Normal

a

Haematology

Haemoglo1in &(."gm/dl &&.: B&;.:gm/dl

Normal

1 R7+ count ;."million/cmm ".4 B ;.4millions/cumm

Normal

c Pac$ed cell %olume "48 "0 B ;58 Normal

d M+6 ##fl 40 B &00 fl Normal

e

M+H "0 pg ( B "5 pg Normalf M+H+ "5gm/dl "( B ":gm/

dl

Normal

g )7+ count 4.#thousand/cmm ; B

&&thousand/cmm

Normal

h Poly morph 48 ;0 B :8 Infection

i Lymphocyte "08 (0 B ;:8 Normal


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= *osinophil ;8 0 B 58 Normal

$ 7asophil 08 0 B &8 Normal

l Platelet "(thousand/cumm &:0 B;:0thousand/cm

m

Normal

a

C"%4 -!7"$

7leeding time ".( minutes Normal (5minutes

1 +lotting time 5 minutes Normal 4&: minutes

c Acti%ated partial

throm1o plastine

"(.0# sec Normal "o;0 sec

ULTRA SOUND

Single intrauterine li%e foetus with cephalic presentation of ": wee$s of gestation. >oetal growth is

normal


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PREPARATION OF WOMEN FOR A!OUR


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INTRODUCTION

+hild1irth is one of the most mar%ellous and memora1le segment in a womans life. It does not real

matter if the child is the first, second or the third one. *ach e9perience is uniDue and calls for

cele1ration. ne of the most 1eautiful time period during a womens life is the pregnancy perio

7ecause her life will 1e satisfied 1y gi%ing 1irth to her 1a1y. >or that she will 1e ready to suffer all th

pains with full happiness.

LABOUR

Series of e%ents that ta$e place in the genital organs in an effort to e9pel the %ia1le products of

conceptions out of the wom1 through the %agina into the outer world is called la1our . Normally it

occurs 1etween "4 wee$s ;( wee$s .if it is occurring 1efore ", it is called as preterm and if it is

occurring after ;( it is called post term. Parturient is a patient in la1our .Parturition is the process of

gi%ing 1irth.

CHANGES OCURRING IN THE BODY DURING CHILD BIRTH

C6+%4$s "% +%+#"+ s!33!$

-he 1ones and muscles of the -$5"spro%ide support for the growing uterus and 1a1y, and

pro%ide a passage through which your 1a1y emerges during 1irth.

-he 3$!3s surrounds the 1a1y, growing as the 1a1y grows.

-he $!5"is actually a part of the uterus, 1ut made up of

different tissue. 2uring pregnancy, the cer%i9 is thic$ and

closed. As you approach the time of 1irth, your contractions

draw the cer%i9 up into the 1ody of the uterus, and it 1ecomes

thinner Fcalled effacementG and opens Fcalled dilationG. )hen

the cer%i9 is fully dilated Fa1out ten centimetersG, contractions

help the 1a1y 1egin to mo%e from the uterus into the %agina.

-he 5+4"%+leads from the cer%i9 to the outside of your 1ody. -he inside of your %agina has

many folds, called rugae, which unfold as the 1a1y passes through


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WHAT HAPPENS IN BODY BEFORE LABOUR BEGINS

7ody prepares for child1irth throughout your pregnancy, 1ut in the last few wee$s, it does some fina

preparation.

H!#%$s ;!< s7$% 6$ "4+#$%s =$;$$% 6$ =%$s "% -$5"s, which gi%es your

pel%is additional room for 1irth. 2uring this time, mother might feel a shift in her sense of

1alance, =oints might feel looser, and might feel sore and achy.

O6$! 6!#%$s =$4"% s7$% $!5", which is the nec$ of the uterus. -hroughout most o

pregnancy, mothers cer%i9 is closed, holding the 1a1y inside mothers uterus. Much of the

wor$ of la1or is in opening the cer%i9 to the passage of mothers 1a1y. Howe%er, mothers

cer%i9 may 1egin to soften, thin, and open e%en 1efore la1or 1egins. -his %aries from woman

to woman, and from pregnancy to pregnancy. Some women may ha%e closed cer%i9es until

la1or starts. thers may ha%e prela1or contractions that dilate their cer%i9 to three or four

centimetersG 1efore la1or 1egins.

E%4+4$#$%.2escending of the fetus towards the lower a1domen .>or first time mothers,

this may ta$e place up to a few wee$s 1efore the 1irth. >or some second or su1seDuenttime

mothers, engagement may not occur until after la1or 1egins.

M6$! #+> $-$!"$%$ 6$ -+ss+4$ 7 s!"%4>, -$!6+-s =&"%4$& #33s.-his

Jmucous plugJ has 1een in place inside the cer%i9 during pregnancy, and as the cer%i9 1egin

to soften and open, this mucous loosens and may 1egin to pass from the %agina. Some women

may notice this increased mucous passage for a few days For e%en wee$sG 1efore la1or 1egins

others may not notice it at all.

T6$ =!$+


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Second stageBstarts from the full dilatation till the e9pulsion of the foetus.It has got two phases.

2uration is ( hours in primi and "0 min in multi.

aGpropulsi%e phasestarts from full dilatation to the descent of the presenting part to the pel%ic floor

1Ge9pulsi%e phase Bfrom the maternal 1earing down effort till the deli%ery of the foetus

Third stageBfrom the e9pulsion of the fetus till the e9pulsion of the placenta .duration is &: min in

1oth multi and primi

FACTORS INFLUENCING THE PROGRESSION OF LABOUR

+hild1irth professionals often refer to the following factors influencing la1or progression as the J>ou

PsJ of la1or'

P+ss$%4$!F 1a1yG

P+ss+4$ Fthe pel%ic 1ones, cer%i9 and %agina, and the muscles in pel%isG

P;$! F contractionsG

Ps>6$ F emotionsG

FACTORS THAT EASE LABOUR

La1our is a gradual phase that gains momentum with each contraction. A %ariety of factors could

trigger la1our and e%ery womanKs e9perience is uniDue. Since a normal, hasslefree deli%ery is what

any woman would prefer here are a few factors that would facilitate a safe and easy la1our.

B!$+6"%4 R"46

7reathing techniDues play an important role in la1our and child1irth. Most antenatal and la1our

preparation classes train e9pectant mothers in the right form of 1reathing, which encourages focus an

concentration during la1our. -hough there are many types of 1reathing e9ercises, 1ut there are no


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particular rules a1out how you ought to 1reathe. Most women find that adopting a particular 1reathin

pattern helps them control la1our pain during deli%ery. -he emphasis is on lengthening the out1reath

following it till the %ery end.

S+>"%4 A"5$

It has 1een pro%en that women who are fit ha%e safer and more positi%e 1irth outcomes. Acti%ity

encourages circulation and the production of natural hormones. It also enhances energy le%els and

strengthens muscle tone in preparation for child1irth. *9ercising regularly is more 1eneficial than

e9ercising randomly as it 1uilds strength and stamina and reduces the possi1ility of in=ury.

P"+$s

Pilates is a 1ody conditioning discipline that focuses on the 1reath to achie%e impro%ed fle9i1ility an

strength for the whole 1ody. Pilates help impro%e posture and aid 1ody control and stress managemen

It strengthens the pel%ic floor muscles in preparation for child1irth and also focuses on the

a1dominals, 1ac$ and 1uttoc$s. Pilates can 1e practised from the 1eginning of the second trimester.

And 1ecause it is a nonaero1ic, noimpact system, the 1asic e9ercises are ideal during pregnancy an

child1irth as they are gentle and slow.

Y4+

@oga is a safe, effecti%e and rela9ing form of e9ercise during pregnancy. It relie%es stress and an9ietencourages hormonal 1alance, increases stamina and calms the mind. Many women consider yoga a

most empowering way to prepare for la1our and child1irth. @oga also helps lower 1lood pressure, aid

effecti%e digestion, strengthens the pel%ic floor muscles and reduces constipation.

A$!%+$ T6$!+->

In recent times, there is an emphasis on %arious alternate therapies that could ease the pain and traum

of la1our. Refle9ology, massages, meditation, aromatherapy, acupressure, acupuncture or shiatsu,

which in%ol%e stimulation of pressure points along the 1ody are popular among e9pectant mothers.

is 1elie%ed that water therapy helps the uterus to contract more effecti%ely, while asmine in

aromatherapy is noted for preparing the uterine muscles for la1our. Refle9ology the techniDue of

massaging pressure points on the feet has 1een pro%en to help induce la1our and num1 pain.


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G$"%4 P6>s"+

-uning in to 1ody is %ital during the final stages of your pregnancy, as gi%ing 1irth is a natural

physical tas$. Studies ha%e found that se9ual intercourse during the last few wee$s of pregnancy can

help soften the cer%i9 in preparation for la1our. -he prostaglandins found in semen, helps soften the

connecti%e tissue of the cer%i9 and increase o9ytocin production in the muscle cells of the wom1 in

preparation for la1our. As synthetic prostaglandin gel is often used to soften the cer%i9 and wom1 to

induce la1our, medical professionals nowadays recommend se9 during the last few wee$s of

pregnancy.

P$!"%$+ #+ss+4$ massaging the area of tissue 1etween the anus and the %agina during the last fe

months of pregnancy, is considered to 1e helpful in minimising possi1le tearing or the need for

episotomy. 7reast and nipple stimulation ha%e 1een pro%en to induce strong uterine contractionNipple stimulation has 1een 1eneficial

PREPARATION

+@ W6+ "s =$ -+


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G"%46#$ 37"

-here will 1e need clothes to go home in, so mother has to pic$ a comforta1le outfit that wont creas

easily and will allow you to 1reastfeed. A fa%ourite maternity dress with a front opening would 1e

great.

N$;=!% Ess$%"+s

Pac$ a few new1orn sleep suits mitts, 1ootees, 1i1s, a 1lan$et, new1orn nappies and cotton wool for

those first changes.

N3!s"%4 %"46;$+!

-his is a must. >eeding tops ha%e a crosso%er front, detacha1le strap or front opening so mother can

comforta1ly and discreetly 1reastfeed your 1a1y.

C+#$!+

Howe%er e9hausted and sweaty you feel, you will 1e glowing after gi%ing 1irth. -he first time mothe

holds your child is an e%ent to capture for $eeps, so ma$e sure the 1attery is fully charged.

D!$ss"%4 4;%/+!&"4+%

3seful co%erup for early la1our.

T6$ +$s "ss3$ 7 P3="+"%s Inorder to fill the days of pregnancy

H$+&=+%&eep your hair 1ac$ during la1our.

D"s-s+=$


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M+$!%"> -+&s

-he hospital will pro%ide with some, 1ut mother has to get ready with necessary one

B"!6 -+%

Should ta$e a copy of 1irth plan B itll help to get the 1irth they want.

TENS #+6"%$

In foreign countries we are ha%ing this as a complementary therapy .+an ease early la1our pains 1y

sending an electric charge through pads on the s$in.

S"--$!s +%& s


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It is gaining more importance as the women will 1e getting free from all types of tensions and worrie

along with the 1elo%ed mem1ers

W+$! B"!6

Mother cant insist on gi%ing 1irth in water 1ecause we need a midwife e9perienced in water .In

foreign hospitals we can use this option successfully

I%&3"%

According to NI+* guidelines, if your pregnancy goes 1eyond ;& wee$s you mother isa offered

induction . If mothers 1eing pressured into induction, which in%ol%es 1eing gi%en drugs to trigger

la1our,mother has to as$ these Duestions

BB what are the 7enefits of doing this

RB )hat would 1e the Ris$s if we do this

AB )hat are the Alternati%es we could try first F)hether a mother can go home and try ta$ing a

long wal$G

IB )hat is my Instinct telling me F2o I really want this 1a1y out now or am I ner%ous a1out

induction and would I prefer to let it happen naturallyG

NB )hat if we do Nothing for the ne9t day/wee$ +an I come in daily for monitoring to $eep a chec

on the 1a1y

E$"5$ C+$s+!$+%

Research has found that many of the women who as$ for a caesarean do so 1ecause of fears a1out

la1our or 1ecause they%e had a traumatic la1our pre%iously. Howe%er, all women should 1e offered

counselling and support 1y a midwife to help o%ercome her fears, 1ut if it cant 1e o%ercome, a repor

from a psychologist or counsellor may help when the o1stetrician is ma$ing the decision.

D!"-


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WRITING A BIRTH PLAN

-he most important thing to remem1er a1out a 1irthing plan is that these are preferences. ne mus

remain open and fle9i1le if e%ents stray from chosen path. 3ltimately, you want a healthy 1a1y an

mom and if that means ma$ing some tough choices, then so 1e it. No regrets

Here is an e9ample for 7irth plan


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SETTINGS FOR BIRTH

As hospital deli%ery may not 1e your only option. Many women now deli%er at a 1irthing center, 1worldwide, the most widely used setting is a home1irth.

PATIENT PREPARATION

P6>s"+ -!$-+!+"%

Sha%ing or clipping of the %ul%a is done.

-he %ul%a and perineum are washed with soap and water

-he women should ta$e shower

+ontinous encouragement and emotional support

N3!""%+ -!$-+!+"%

Patient is maintained in N.P. and ice pieces can 1e gi%en if necessary

B;$ -!$-+!+"%

*nema has to 1e gi%en on the early morning of the deli%ery

POSITIONS USED IN ACTIVE LABOUR

S+%&"%4 ! $+%"%4 7!;+!& ;6"$ s3--!$& => >3! -+!%$! ! + -"$$ 7 73!%"3!$

-his position pro%ides support 1ut it also allows to ta$e ad%antage of gra%ity. Lean 1ody

weight into each contraction. -his position may relie%e 1ac$ache. It also allows partner to gi

you a massage.

(%$$"%4 ;"6 >3! 3--$! =&> !$s"%4 +4+"%s + 6+"! ! >3! -+!%$!s +--his position ta$es the weight off spine and is a good position for pel%ic tilts, which can

relie%e 1ac$aches. Many women also find it is a restful position.

O% + 73!s

-his also ta$es the weight off spine and allows you to tilt your pel%is to relie%e 1ac$aches. It


32/47

can help encourage the 1a1y to rotate from a posterior position. )aggling your hips may help

the 1a1y mo%e.

S""%4 +s!"&$ + 6+"! 7+"%4 6$ =+"%4 % >3! s"&$

-his is a restful and rela9ing position that ta$es the pressure off your 1ac$ For your

hemorrhoids if you ha%e anyG, and it allows your partner to gi%e you a massage. @our nurse or

midwife will encourage the use of this position if your 1lood pressure is ele%ated. It is also a

practical position if you are ha%ing an epidural.

A ="!6"%4 =+or1irthing stoolcan 1e used to support different positions, to help $eep a

woman upright, and to speed the 1irth along. A 1irthing stool can also 1e used in the later

stages.

Late in acti%e la1our and during transitioning,changing your position can enhance the 1a1y

passage downward through the 1irth canal. @ou may want to try these positions'

S3+"%4

-his position widens pel%is to the ma9imum and ta$es ad%antage of gra%ity, to mo%e the 1a1

through the 1irth canal. Pushing in this position is easier for some women, 1ut others find

tiring and uncomforta1le. It is not recommended if the 1a1y is coming Duic$ly.
http://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingbhttp://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingshttp://www.womenshealthmatters.ca/centres/pregnancy/childbirth/stages.html#transitionhttp://www.womenshealthmatters.ca/centres/pregnancy/childbirth/stages.html#transitionhttp://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingbhttp://www.womenshealthmatters.ca/centres/pregnancy/glossary/index.html#birthingshttp://www.womenshealthmatters.ca/centres/pregnancy/childbirth/stages.html#transition


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S$#"s""%4 ;"6 >3! +"=%$ 7+ +4+"%s 6$ =$&

-his is a restful position that allows you to lay 1ac$ 1etween contractions. It ma$es %aginal

e9aminations or the use of a fetal monitor easy.

L>"%4 % >3! s"&$

-his is a restful position that lets you rela9 1etween pushes. It ta$es the pressure off 1ac$ an

allows an epidural to 1e used. -his position can slow down a rapid 1irth.

COMMON INTERVENTIONS DONE DURING LABOUR

-hese are the most common inter%entions used during la1our to help you deli%er your 1a1y.

Episiotomy

An episiotomy is a cut made in the perineum Fthe s$in and muscle 1etween the %agina and anusG. It

used to enlarge the %aginal opening and ma$e the 1irth of the 1a1y easier if the perineum is n

stretching. Local anesthetic can 1e used and the cut will 1e stitched up after the 1irth. It should he

within se%en to &0 days.*pisiotomies used to 1e performed routinely howe%er, se%eral studies show

that with normal 1irths, women who did not ha%e episiotomies generally fared 1etter than women wh

had one.

-he procedure ma$es it more li$ely that a woman will ha%e a larger tear that e9tends into the rectum

that her tear will ta$e longer to heal, and that she will ha%e pain in the wee$s and months following t

1irth. -here are times when an episiotomy is needed B for e9ample, if the 1a1y is in distress B 1ut the

is no e%idence to show that routine episiotomies 1enefit women or their 1a1ies.

Most doctors no longer perform episiotomies routinely 1ut a few still do. Midwi%es can perfor

episiotomies 1ut are far less li$ely to do so than doctors.

Electronic Fetal Monitoring

-his is a machine used to record the 1a1yKs heart1eat and the freDuency of the motherKs contractio

during la1our. *lectrodes that record the 1a1yKs heart1eat can 1e put on the motherKs 1elly with a 1

Fe9ternal monitoringG or can 1e placed onto the 1a1yKs scalp, through the motherKs %agina Fintern

monitoringG.


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*lectronic fetal monitoring is not used routinely 1ut it may 1e used to chec$ the 1a1yKs health durin

the 1irth. )hen internal monitoring is done, your water must 1e 1ro$en if this has not already occurr

naturally. -he monitor will 1e attached to your 1a1yKs head with a scalp clip. Support people may ne

to ma$e an e9tra effort to focus on the mother rather than the machine.

Some women feel that electronic fetal monitoring interferes with the natural 1irthing process, whi

others, especially women who may ha%e had complications with pre%ious 1irths, find it reassuring

$now that the 1a1ys heart1eat is 1eing monitored. 2iscuss the pros and cons with your care pro%ider

Forceps and Vacuum Etraction

-hese instruments are designed to guide the 1a1y out of the %agina, when the woman canKt push her

1a1y out completely. -hese methods may 1e used if' you are e9hausted

the position or siEe of the 1a1y ma$es the 1irth difficult

there is fetal distress

you are ha%ing difficulty pushing due to medication

If forceps or a %acuum e9tractor is used, mother will 1e gi%en a local anesthetic and an episiotomy w

often 1e done.7oth procedures can cause temporary changes in 1a1yKs appearance 1ut these will

disappear with time. >orceps may lea%e mar$s on the side of the 1a1yKs face and a %acuum e9tractor

may cause temporary swelling on the top of the 1a1yKs head.

!nduction"Augmentation

-hese inter%entions may or may not use drugs to start FinduceG or speed up FaugmentG la1our. -hey a

used when a more rapid child1irth is needed to protect the health of the mother or the 1a1y, or wh

mother had significantly past your due date.

A fetal heart monitor is often used during an induced la1our to ensure that all is well. -he mo

common ways of inducing la1our are'

artificial rupture of mem1ranes FARMG

prostaglandin gel


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o9ytocin

A!"7""+ !3-3!$ 7 #$#=!+%$s

In the hopes of starting la1our, caregi%er may 1rea$ the 1ag of amniotic fluid surrounding the 1a1y.

-his may 1e done with a long thin plastic hoo$ called an amniohoo$. -his procedure can increase the

ris$ of infection of the fetal mem1ranes and amniotic fluid.

P!s+4+%&"% 4$ ! >"%

7oth prostaglandin and o9ytocin are hormones. Prostaglandin gel can 1e used when the cer%i9 is less

than three centimeters dilated. It is applied to the 1ac$ of the %agina where it softens and JripensJ the

cer%i9, to help it dilate. It is a milder way to induce la1our and may 1e done on an outpatient 1asis,

depending on the hospital. 9ytocin may cause intense contractions and usually ma$es the 1irthproceed rapidly. It is gi%en through an intra%enous line after the woman is in the 1irth room.

#esarean Section

A cesarean section is a surgical procedure used to deli%er a 1a1y. A cesarean section For +sectionG is

surgical operation where the 1a1y or 1a1ies are 1orn through an incision in the uterus. -oday one o

of e%ery four or fi%e women in +anada gi%es 1irth 1y +section. +anadas +section rate has increase

dramatically o%er the past four decades.

-he most common reasons for a cesarean are'

dystocia Fa slow or difficult la1ourG

1reech 1irth Fwhen the 1a1y has not turned into a headdown position 1ut is in a position to 1

1orn 1ottom first or feet firstG

multiple pregnancy Fparticularly if there are more than twins, although many women do deli%

multiples %aginallyG

placenta pre%ia B a pregnancy complication that can cause 1leeding 1efore or during deli%ery

PSYCHOLOGICAL PREPARATION FOR LABOUR

7irth partner, or partners can pro%ide support in the following ways'


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Physical support they can help $eep you comforta1le, 1ring your drin$s and snac$s, and help

you to mo%e around.

*motional support simply ha%ing someone there for you is really important. Reassurance an

words of encouragement will also help.

Ad%ocacy you may not feel li$e answering Duestions so ha%ing someone there to e9plain yo

%iews can 1e really helpful.

MEDICATION

>or some women, these techniDues are enough other women choose to com1ine them with

medications to reduce the amount of drug they use. If choose to a%oid or delay medication, it is wise

to in%estigate the medications you might choose -here are two main drug options for pain relief' narcotic drugs, such as morphine, gi%en early in la1our

an epidural

Narcotics

2rugs, such as meperidine F2emerolQG or morphine, can 1e gi%en during early la1our, if the 1irth

not e9pected within four hours. -hese drugs relie%e pain, although pain relief may 1e less comple

than the relief achie%ed with an epidu

Epidural

An epidural uses local anesthetic Fa medication that num1s the area and causes loss of feelingG. -h

medication is in=ected into the lower 1ac$, to num1 the ner%es to the uterus and 1irth canal. A sm

dose of a morphineli$e drug is often included to reduce the amount of freeEing reDuired.


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pre%ent wear and tear on your =oints Fwhich 1ecome loosened during pregnancy due to normal

hormonal changesG 1y acti%ating the lu1ricating fluid in your =oints

help you sleep 1etter 1y relie%ing the stress and an9iety that might ma$e you restless at night

loo$ 1etter.

*9ercise increases the 1lood flow to your s$in, gi%ing you a healthy glow.

COMPARISON OF BOO( PICTURE WITHPATIENT PICTURE

BOO( PICTURE PATIENT PICTURE

PREPARATION

PAC(ING TO HOSPITAL

!oinghome outfit

New1orn *ssentials

Nursing nightwear

+amera

2ressing gown

-he latest issue of Pu1lications

2isposa1le $nic$ers and 7reast pads

Head1and

She was prepared with the cloths neededfor the hospital stay

New1orn dresses and clothes were also

ta$en

She had ta$en certain health magaEines to

occupy her leisure


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Maternity pads

7irth plan

-*NS machine

Slippers and soc$s

IPod

Snac$s

-oiletries

BIRTH OPTIONS

Home 1irth

)ater 7irth

Induction

*lecti%e +aesarean

2rip

*pidural

+aesarean

PHYSICAL PREPARATION

Sha%ing or clipping of the %ul%a is done.

-he %ul%a and perineum are washed with

soap and water

Maternity pads were carried to the hospitals

Slippers and soc$s were carried to the

hospitals

Snac$s was ta$en

Soap and other necessary toiletries wasta$en

She got admitted for the institutional

deli%ery

+lient got prepared physically for the

la1our .

Her %ul%al hairs were sha%ed

She too$ the showwer


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-he women should ta$e shower

+ontinous encouragement and emotional

support

NUTRITIONAL PREPARATION

Patient is maintained in N.P. and ice

pieces can 1e gi%en if necessary

BOWEL PREPARATION

*nema has to 1e gi%en on the early

morning of the deli%ery

POSITIONS USED IN ACTIVE

LABOUR

Standing or leaning forward while

supported 1y your partner or a piece of

furniture

neeling with your upper 1ody resting

against a chair or your partnerKs lap

n Jall foursJ

Sitting astride a chair facing the 1ac$

Sitting on a toilet leaning forward into

your partner

P!--$& 3- "% =$&

Lying on your side

SDuatting

Semisitting with your tail1one flat

against the 1ed

Lying on your side

COMMON INTERVENTIONS DONE

DURING LABOUR

She was under N.P. 1efore deli%ery

*nema was administered in the early

morning

She had ta$en a lithotomy position for the

la1our

She had undergone a right mediolateral


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*pisiotomy

*lectronic >etal Monitoring

>orceps and 6acuum *9traction

Induction/Augmentation

A!"7""+ !3-3!$ 7 #$#=!+%$s

P!s+4+%&"% 4$ ! >"%

PSYCHOLOGICAL PREPARATION

FOR LABOUR

episiotomy

Assessment of the uterine contractions

were monitored .>etal heart rate was

monitored using electronic fetal

monitoring

ARM was done

9ytocin drip was started

She was psychologically prepared for the

la1our

APPLICATION OF THEORYPEPLAUS INTERPERSONAL THEORY

Hildegard peplau 1egan her nursing career in "& .He first pu1lished the model in :( in

interpersonal relations in nursing .He 1ased her model on psycho dynamic nursing .In his model the

phases of interpersonal relationship reflects occurrence in personal interaction .-he four phases are

orientation,identification ,e9ploitation and resolution. 2uring this phases the nurse assumes so many

roles such as teacher, resource counseller,leader,e9pert and surrogate.

>3R PHAS*S B-H*@ AR*

rientation

Identification

*9ploration

Resolution

ORIENTATION Mrs. Namitha is a antenatal women and she

became oriented the situation and hospital seting and the

services rovide in the hos ital


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NURSING DIAGNOSIS

Impaired tissue perfusion related to preclampsia secondary to arteriolar %asospasm as e%idenced

1y edema on legs

Ris$ for in=ury related to signs of pre eclampsia

>ear and an9iety related to Pre eclampsia and its effect on the fetus

2i%ersional acti%ity deficit related to imposed 1ed rest as e%idenced 1y %er1al response

IDENTIFICATION

Mrs.Namitha , a client I found during my posting ,an antenatal

mother

E"POITATIONI gave health education about the breast

feeding and the excercises and she is willing to accept me

as a health worker

RESOUTION Mrs.Namitha is willing to go for follow up

continue a healthy life and happily we ended up our thera


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HEALTH EDUCATION

DIET:

Ad%ised the mother to ta$e nutritious and easily digesta1le food li$e green leafy %egeta1l

,fruits etc.

Ad%ised her to ta$e iron rich,protein rich food

Ad%ised the mother to ta$e plenty of fluidF&0&: glsses of waterG

E*ERCISE

Ad%ised the patient to do mild e9ercise and acti%ities

*9plained a1out acti%e and passi%e e9ercise

Ad%ised mother a1out antenatal e9ercise li$e pel%ic floor and a1dominal e9ercise

-aught a1out the 1reathing e9ercise to 1e practised throygh the intranatal period

Ad%ise to a%oid the strenuous acti%ities li$e lifting hea%y o1=ects

PERSONAL HYGIENE

Ad%ised the importance of oral hygiene

Ad%ised the patient a1out oral hygiene and also a1out to ta$e regular 7ath


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*ducate a1out perineal hygiene

-aughtr a1out the 1reast care needed

MEDICATION

Ad%ised client to ta$e medication at correct time ,dose and route as prescri1ed 1y doctor

CARE OF BREAST

Ad%ised to $eep the 1reast clean, taught a1out 1reast self e9amination

7reast should 1e cleaned with lu$e warm water and dry it properly

FOLLOW UP

I ad%ised the patient to ta$e medication regularly as per physician order and as$ed the patient

come for follow up.

FETAL MOVEMENT COUNT

)omen is ad%ised to and taught to monitor fetal mo%ements and fetal heart sounds

Ad%ised to chec$ the mo%ements at least " times a dayFmorning ,noon,and e%eningG.

RECTAL MOVEMENT CARE

*ncouraged to include plenty of fruits and green leafy %egeta1les in the diet

-aught the importance of roughage rich diet

A%ised ti increase the fluid inta$e


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CONCLUSION

Mrs.Namitha (" yr old lady admitted on/#/(0&0 with the complaint of mild pedal edema an

headache. !eneral condition of the patient is good. I pro%ided all care to the patient .Now h

condition is impro%ed to some e9tent. 2uring these days she was %ery cooperati%e and followed m

instruction regarding diet and e9ercise

BIBLIOGRAPHY

Adele pilliteri O Maternal And +hild Health Nursing. : th edition. 3nited States f America

Lippincott )illiams and )il$ins ' (00. 5"0.

7o1a$ B ensen. O *ssentials f Paternity Nursing. " rd edition. Mos1ys pu1lications. 3nit

States f America' #&. :;:50.

2utta. 2.+. O -e9t 7oo$ f 1stetrics. 5thedition. +alcutta' New +entral 7oo$ Agency' (00

&;:&:"

Mos1ys 2rug +onsult for NursesT. "rdedition. *%ol%e pu1lications. (005. "#, ;5&

Myles. O-e9t1oo$ for Midwi%es. &:thedition. London' +hurchill Li%ingstone *lse%ier' (004. 5:

55&.


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