Intranatal Care

Hs1088: Nursing of Childbearing

Family and Children

Group Members:Hong JiaoNanthiniSyazmanFang SiXuan Jia

Objectives• Define the common terms used in pregnancy

cases.• Define normal labor.• Explain the signs of true labor and relate it to the

case study.• Explain the difference between the true and false

labor.• Describe the nursing interventions to manage

labor pain in the first stage of labor.

Case scenario• Natalie is a 28 year old primigravida at 39 weeks

of gestation.• Reported experiencing her first labor pain 8 hours

ago. • Felt the labor pain is more painful and occurring

more frequently at every 10 minutes interval. • Has slight blood-stained vaginal discharge with

mucus, an hour ago.

Physical Examination• Regular uterine contractions every 10 minutes

lasting 30 seconds.• ‘Show’ with intact membranes.• Cervix dilated to 4 cm• Foetal heart rate: 140/minute• Maternal vital signs:

o Temperature: 36.8°Co Pulse rate: 86/minuteo Respiratory rate: 20/mino Blood pressure: 130/80mmHg

• Breast soft with slight colostrum discharge• Bladder not palpable

Definition• Gestation: The period of development in the

uterus from conception until birth.

• Gravida: A woman’s status regarding pregnancy usually followed by the number of times the woman has been pregnant.

Definition• Primigravida: A woman in her first pregnancy

• Para: A woman who has produced one or more viable offspring, regardless of whether the child or children were living at birth.

Definition• Primipara: A woman who has had one pregnancy

that resulted in a fetus that attained a gestational age of 20 weeks, regardless of whether the infant was living

Normal Labor• Normal labour at term is characterised by

‘regular, rhythmic, progressive uterine contractions that produce effacement and dilation of the cervix’

• Where the estimated gestational age is accurate, it is expected that labour will begin within two weeks of the estimated date of delivery

Signs of true labour • After each contraction ,heart rate of fetus ranges from 110-160

beats/min

• Signs of “show”(operculum)-a blood –stained mucos plug at cervix.

As a sign of cervix dilating

• more painful and frequent contraction ,lasting about 10 to 30 sec.

Contractions takes place every 10-20 minutes

Signs of true labor • Burst of water bag Might have drops of water discharging.

• Cervix dilating from 1cm to about 6-10 cm.

g

Signs of true labor Lightening- The baby settling or lowering into the

pelvis just before labor.

feel the need to urinate more frequently - uterus rests on the bladder more after lightening.

Contraction Characteristics

False Labor True Labor

How often do the contractions occur?

Contractions are often irregular and do not get closer together.

Contractions come at regular intervals and last about 30-70 seconds. As time progresses, they get closer together.

Do they change with movement?

Contractions may stop when you walk or rest, or may even stop if you change positions.

Contractions continue despite movement or changing positions.

How strong are they?

Contractions are usually weak and do not get much stronger. Or they may be strong at first and then get weaker.

Contractions steadily increase in strength.

Where do you feel the pain?

Contractions are usually only felt in the front of the abdomen or pelvic region.

Contractions usually start in the lower back and move to the front of the abdomen.

In case study labor pain is more painful; more frequently at

every 10min interval Lasting about 30sec.

Slight blood stained vaginal discharge with mucos. Cervix dilated to 4cm .

Foetal heart rate 140 beats/minute

Regular uterine contractions occurring every 10 minutes lasting 30 seconds

Labor pain• Definition: rhythmic uterine contractions that

under normal conditions increase in intensity, frequency, and duration, culminating in vaginal delivery of the infant.

• Many physiologic , emotional, psychosocial, and environmental factors influence the nature and degree of pain experienced by the laboring woman.

Labor pain• Visceral pain : the pain from cervical

changes ,distention of the lower uterine segment ,stretching of cervical tissue as it dilates ,and pressure on adjacent structures and nerves during the first stage of labor.

• It is located over the lower portion of the abdomen

Labor• first stage: beginning with the onset of uterine contractions

through the period of dilation of the uterus.

• second stage: the period of expulsive effort, beginning with

complete dilation of the cervix and ending with expulsion of the infant.

• third stage or placental stage: the period beginning at the expulsion of the infant

and ending with the completed expulsion of the placenta and membranes.

First stage of labor • Can be divided in to three 3 phases : A latent stage: cervix dilates from 0 to 3 or 4

centimeters, contractions get stronger as time progresses

An active stage: cervix dilates from 4 to 8 centimeters (called the Active Phase), contractions get stronger and are about 3 minutes apart, lasting about 45 seconds.

First stage of labor A transition stage : cervix dilates from 8 to 10

centimeters (called the Transition Phase), contractions are 2 to 3 minutes apart and last about 1 minute. You may feel pressure on your rectum and your backache may feel worse. Bleeding from your vagina will be heavier.

Pain relief method• Environment

• Non- pharmacological strategies

• Cognitive strategies

• Pharmacological strategies

environment a. Should be safe and private ,allowing a woman to

feel free to be herself as she tries out different comfort measures .

b. Appropriate light and temperature and no noise.

c. The environment should have enough space for movement

environmenta. Should have equipment such as birth balls,

comfortable chairs

b. Enhance the familiarity of the environment by bring items from home (pillows, objects for a focal point music, and DVDs.

Nonpharmacologic strategies:

I. Cutaneous stimulation strategies

II. Sensory stimulation strategies

III. Cognitive strategies

Cutaneous stimulation strategies

Counterpressure

Effleurage (light massage)

Walking

Rocking

Changing positions

Cutaneous stimulation strategies

Transcutaneous electrical nerve stimulation

Acupressure

Water therapy

Intradermal water block

Application of heat and cold

Sensory stimulation strategies Aromatherapy (fang xiang liao fa ) Breathing techniques Music Imagery Use of focal points (jiao dian )

Cognitive strategies

Hypnosis: hypnosis is a form of deep relaxation, similar to day-dreaming ,while under hypnosis, women are in a state of focused concentration.

Pharmacologic strategies

Sedatives (relieve anxiety and induce sleep.)

For first stage :o Systemic analgesiao Opioid agonist analgesicso Opioid agonist-antagonist analgesicso Epidural analgesiao Nitrous oxide o Combined spinal-epidural analgesia

Summary • We define the following terms: gestation, gravida,

para, primigravida, primipara.

• We defined normal labor.

• We discussed the signs of true labor and related it in case study .

• We described the nursing interventions to manage her labor pains in the first stage.

Reference Albers, L., Schiff, M., & Gorwoda, J. G.(1996). The length of active

labor in normal pregnancies. Obstetrics and Gynecology, 87(3),355-359.Association of wen’s Health, Obstetric,&neonatal nurses (AWHONN).

(1998). Clinical competencies and education guide . Washington, DC: Author.

Creehan, P. A. (1996), Expectant fathers’ roles during labor . In K. R.Rice & P. A. Creehan (Eds),perinatal nursing (pp. 227-245). Philadelphia: Lippincott.

Enkin, M. W ., Keirse, M. J., Renfrew, M. J., &Neilson, J.P. (1995).Effective care in pregnancy and childbirth: A synopsis.Birth, 22(2), 101-110.

Hodnett, E.(1996). Nursing support of the laboring woman. Journal ofObstetric, Gynecologic, and Noenatal Nursing, 23(9), 767-771.

Reid L; British Journal of Midwifery, 2005 Jul; 13 (7): 426-31 (journalarticle) ISSN: 0969-4900

Stadlmayr W; Grob A; Journal of Reproductive & InfantPsychology, 2007 Aug; 25 (3): 190-202 (journal article - research, tables/charts) ISSN: 0264-6838

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