Length of PregnancyLength of Pregnancy

• A full term pregnancy is 36-40 weeks.A full term pregnancy is 36-40 weeks.

• Three trimesters of about 3 months Three trimesters of about 3 months each.each.

• Deliveries before 36 weeks are Deliveries before 36 weeks are premature.premature.

• Lungs not fully developed until after 36 Lungs not fully developed until after 36 weeksweeks

Onset of LaborOnset of Labor

• Labor painsLabor pains

– False labor - Braxton-Hicks contractionsFalse labor - Braxton-Hicks contractions•Occur as early as 3-4 weeks (part of natural Occur as early as 3-4 weeks (part of natural

stretching)stretching)

•Contractions irregular, intensity unchangedContractions irregular, intensity unchanged

•Located in abdomenLocated in abdomen

•No affect or relief with walkingNo affect or relief with walking

Onset of LaborOnset of Labor

• Labor painsLabor pains– True laborTrue labor

•Usually begin as aching in the small of the Usually begin as aching in the small of the backback

•Next, become cramp-like pains in the lower Next, become cramp-like pains in the lower abdomenabdomen

•Regular intervals that shorten - intensity Regular intervals that shorten - intensity gradually increasesgradually increases

• Intensify with walkingIntensify with walking

Labor and DeliveryLabor and Delivery3 Stages of Labor3 Stages of Labor

• First stage: Onset of contractions , First stage: Onset of contractions , dilation and effacementdilation and effacement

• Second stage: Expulsion of the infantSecond stage: Expulsion of the infant

• Third stage: Delivery of the placentaThird stage: Delivery of the placenta

First Stage of LaborFirst Stage of Labor

• Three PhasesThree Phases

LatentLatent

ActiveActive

TransitionalTransitional

Second Stage of LaborSecond Stage of Labor“Pushing”“Pushing”• Full dilation of the cervix to delivery of Full dilation of the cervix to delivery of

babybaby

• Deliver or transport?Deliver or transport?

• Pressure on the rectum(feels like a Pressure on the rectum(feels like a BM)BM)

• May have the urge to pushMay have the urge to push

• Perineum will begin to bulge - look for Perineum will begin to bulge - look for crowningcrowning

Third StageThird Stage

• Birth of the infant to delivery of the Birth of the infant to delivery of the placentaplacenta

• This may take up to 30 minutesThis may take up to 30 minutes

• Save placenta and bring to hospitalSave placenta and bring to hospital

Preparing for DeliveryPreparing for Delivery

• When to consider field deliveryWhen to consider field delivery

• Look for crowningLook for crowning

• Questions to askQuestions to ask

Preparing for DeliveryPreparing for Delivery

• Check for crowningCheck for crowning

• Spread legs apart gentlySpread legs apart gently

• Once pushing begins it can’t be Once pushing begins it can’t be slowed down slowed down

• Never attempt to hold mother’s Never attempt to hold mother’s legs together and don’t let her go legs together and don’t let her go the bathroom!the bathroom!

DeliveryDelivery

• You are only assisting the mother You are only assisting the mother

• Guide and support the infant as it is Guide and support the infant as it is bornborn

• Support the head with your hand as Support the head with your hand as it emergesit emerges

Delivering the InfantDelivering the Infant

• Check for the cord around the neckCheck for the cord around the neck

• Suction the mouth first, then nostrilsSuction the mouth first, then nostrils

• Let shoulders come out Let shoulders come out

• Use towels to dry and hold when it Use towels to dry and hold when it comes out- slippery little things!comes out- slippery little things!

Postdelivery CarePostdelivery Care

• Wrap in a clean, dry towel Wrap in a clean, dry towel

• Keep the face exposed and make Keep the face exposed and make sure the top of the head is sure the top of the head is covered(heat loss)covered(heat loss)

• Place baby on Mom’s abdomen if Place baby on Mom’s abdomen if the cord is long enoughthe cord is long enough

• Clamp and cut the cordClamp and cut the cord

Delivery of the PlacentaDelivery of the Placenta

• Placenta usually comes out by itself Placenta usually comes out by itself

• Never pull on the cordNever pull on the cord

• Gentle massaging of the uterus after Gentle massaging of the uterus after delivery of the placenta helps prevent delivery of the placenta helps prevent heavy bleedingheavy bleeding

• Breast feeding helps contract the Breast feeding helps contract the uterus uterus

Apgar Score Apgar Score

• AppearanceAppearance

• PulsePulse

• Grimace or irritabilityGrimace or irritability

• Activity or muscle toneActivity or muscle tone

• RespirationsRespirations

• Check at 1 and 5 minutes after birthCheck at 1 and 5 minutes after birth

HemorrhageHemorrhage

• If signs of shock, place Mom on left If signs of shock, place Mom on left side during transport side during transport

• High flow oxygen High flow oxygen

• Sterile pad over vagina replace as Sterile pad over vagina replace as necessary and save the padsnecessary and save the pads

• Save any tissue that may be passedSave any tissue that may be passed

Breech PresentationsBreech Presentations

• Frank Frank

• CompleteComplete

• FootlingFootling

Rare PresentationsRare Presentations

• LimbLimb

• FaceFace

• Prolapsed cordProlapsed cord

TwinsTwins

• Need to clamp two cords-label as 1Need to clamp two cords-label as 1stst and 2and 2ndnd

• Second usually delivers a few Second usually delivers a few minutes after the firstminutes after the first

• Record time of delivery and apgar Record time of delivery and apgar scores for both infantsscores for both infants