Transcript normal labor and delivery

NORMAL LABOR AND
DELIVERY
SFC WARD
Joint Special Operations Medical Training Center
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)
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Nagele’s 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 Labor
• Interval
Contractions
– 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
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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
– < 4 requires aggressive resuscitation
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Emergency Birth Video
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SUMMARY
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First Stage of Labor
Second Stage of Labor
Third Stage of Labor
APGAR
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