NORMAL LABOR AND DELIVERY

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NORMAL LABOR AND DELIVERY

• SFC WARD

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Terminology

• Gravida - number of pregnancies
• Para - number of pregnancies carried to viability
  and delivered
• Primigravida - pregnant for first time
• Multigravida - pregnant more than once
• Viability - able to survive outside the womb (24
  weeks gestation)
• Nulliparous - never carried a pregnancy to
  viability
• Multiparous - has had two or more deliveries that
  were carried to viability

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Duration of Pregnancy

• Average 280 days or 40 weeks (9 lunar months)
• Estimated Date of Confinement (EDC)
• Nageles rule
• Date of first day of LMP
• Subtract 3 months
• Add 7 days
• Accurate to plus or minus 2.5 weeks

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First Stage of Labor

• Begins with onset of coordinated contractions
  leading to dilation of cervical os and ends with
  complete dilation (10 cm) of the cervical os.
• False Labor (Braxton Hicks contractions)
• Cervix fails to dilate greater than 2 cm
• Duration of first stage -
• Primigravida 12 hours
• Multiparous 7 hours or less

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First Stage of LaborContractions

• Interval
• 10 to 20 minutes between contractions early
  labor
• 3 to 5 minutes between contractions late labor
• Duration
• 20 second long contraction early labor
• 40 to 80 second long contraction late labor
• Quality
• Uterus can be dented (poor quality) early labor
• Uterus is hard (good quality) late labor

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First Stage of Labor

• Management
• Take VS between contractions
• Fetal Heart Rate should be between 120 - 160 BPM
• Mother should be coached to relax and conserve
  energy between contractions

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Assessing Progress of Labor

• Vaginal Exam
• Cervix
• Soft or Hard
• Effaced or Thick
• Dilatation
• Presentation
• Part (cephalic, breech, shoulder)
• Flexion, Extension
• Station

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Second Stage of Labor

• Begins with complete dilation of the cervix and
  ends with delivery of fetus
• Duration of Second Stage -
• Primigravida 50 minutes
• Multiparous 20 minutes or less
• Contractions
• Interval 2 to 3 minutes
• Duration 50 to 100 seconds

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Second Stage of Labor

• Management
• Mother may feel urge to push, coach to push only
  during a contraction once the cervix has been
  determined to be fully dilated
• Episiotomy
• Perform to avoid unecessary tearing when head is
  crowning
• Controlled delivery avoids need for episiotomy in
  most cases

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Second Stage of Labor

• Episiotomy
• Anesthetize with pudendal block
• Put two fingers into the vagina along the
  posterior wall
• Place one blade of scissors between fingers
  inside vagina, other blade outside vagina toward
  anus
• Cut to approximately 1 inch away from anus during
  a contraction

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Second Stage of Labor

• Delivery of head - CONTROL head to prevent
  explosive delivery and subsequent tearing
• Check for presence of cord around neck
• Aspirate oral and nasal cavities with bulb
  syringe
• Deliver anterior shoulder with downward pressure
• Complete delivery and HANG ON TO BABY!

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Second Stage of Labor

• Clear airway, Assess respirations, Resuscitate if
  necessary
• Clamp cord when pulsations cease
• Leave 3 - 6 inches of cord on baby
• Obtain blood for fetal labs from the placental
  stub of cord

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Third Stage of Labor

• Begins after delivery of baby and ends with
  delivery of the placenta
• Average duration 8 minutes
• Signs of separation
• Uterus rises to become globular
• Increase (gush) of blood from vagina
• Lengthening of cord
• Do not PULL cord. Apply gentle traction
• Check Placenta for completeness

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Third Stage of Labor

• Recover missing pieces of placenta as necessary
• Massage uterus to aid in hemostasis
• IV Oxytocin can be given if available to aid
  uterine contractions and aid in hemostasis

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Neonatal Care

• Reassess Airway and Respirations
• Keep warm and dry
• Eye drops (1 silver nitrate or Neosporin)
• Allow for maternal bonding
• Stimulation of nipples during attempts at
  breastfeeding will aid in release of oxytocin by
  posterior pituitary gland resulting in uterine
  contraction and hemorrhage control

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APGAR

• Taken at 1 minute and 5 minutes after delivery
• Score of zero to two is given for each category
• The higher the score, the more vigorous and
  healthy the child is considered to be

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APGAR

• APPEARANCE
• 2 Completely Pink
• 1 Hands and Feet are blue
• 0 Paleness and blue color over entire body
• PULSE (most important sign)
• 2 Greater than 100 BPM
• 1 Detectable rate below 100 BPM
• 0 No heart rate detected

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APGAR

• GRIMACE (flexing and muscle tone of limbs and
  resistance to straightening)
• 2 Normal muscle tone
• 1 Limp to normal muscle tone
• 0 No resistance to straightening
• ACTIVITY (response to flicking of foot)
• 2 Infant cries in response to flick
• 1 Weak cry or head movement in response
• 0 No response

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APGAR

• RESPIRATORY (Second most important)
• 2 Regular respirations and vigorous cry
• 1 Weak cry
• 0 No respiratory response
• Scoring
• 7 to 10 provide supportive care
• 4 to 6 indicates moderate depression
• lt 4 requires aggressive resuscitation

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Emergency Birth Video
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SUMMARY

• First Stage of Labor
• Second Stage of Labor
• Third Stage of Labor
• APGAR

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