Adonis K. Lomibao, R.N. 11/29 Obstetrics & Neonates Unit 49
Objectives • Identify basic terminology regarding obstetrics. • Understand differences between the prenatal, labor & delivery, and postpartum stages. • Understand postpartum care for both the mother and infant.
Introduction • Fetus- The baby before it is born. • Amniotic sac-a membranous bag that surrounds the fetus. • Amniotic fluid-fluid that the fetus floats in. • Umbilical cord-provides nourishment for the baby • Placenta-attached to uterine wall, and the umbilical cord.
Introduction cont. • After baby is born and seaprated from cord, Placenta, amniotic sac, and remaining cord are expelled as the afterbirth. • Three phases of pregnancy: -Prenatal-before birth -Labor & Delivery -Postpartum- after birth
Prenatal Care • Begins in prenatal period, when woman learns she is pregnant. • Obstetrical-pregnancy • Trimester-(3 months) • A normal pregnancy lasts about 280 days. Each trimester has specific signs and symptoms. (p.862-3) • Routine procedures during prenatal visits on (p.863) i.e. weighing the mother, taking B/P & Pulse, etc. • Unusual items to report (p.863) i.e. persistent headache, elevated B/P, bleeding, etc.
Preparation for Birth • Both parents encouraged to participate in birth. • Most parents elect to use natural childbirth. • Can take birth training classes to learn about the birth process, vaginal and cesarean deliveries, support systems, etc.
Prenatal Testing • Can sometimes identify congenital abnormalities. May include: -Ultrasound:uses sound waves to identify gestation age(time of development) and defects in the structure of the fetal organs. • Amniocentesis: needle inserted into sac and cells extracted. • Fetoscopy: direct visualization of fetus through an endoscope.
Labor & Delivery • At the end of 40 weeks, +/- 2 weeks signs of labor will be noted: -Engagement of lightening: the fetus moves downward. -Mucous plug expelled from cervix (bloody show) -Dilation of cervix begins -Amniotic membranes rupture before or during labor -Uterin contractions begin • Fetal monitor may be used during labor
The Doula • They provide support & comfort, and enhance communication between mother & healthcare professionals. • They DO NOT provide hands on care or assist with clinical procedures.
Dilation & Effacement • Dilation(opening)-begins with the first regular uterine contraction, and ends when the cervix is fully dilated. • Effacement- the cervix thins so the fetus can move down into the birth canal and out of the mother's body. • Vaginal Examination- the process of measuring the degree of dilation & effacement.
Expulsion • Expulsion stage-the period from the point of full cervical dilation until the baby is delivered. • May be 1-2 hours or more. • The baby moves down the birth canal and mother bears down with each contraction. • Episiotomy- enlarging the vaginal opening by making a cut in the perineum.
Placental Stage • Lasts from delivery of the baby to the delivery of the placenta. • Placenta usually delivered an hour after baby. • The placenta separates from the wall of the uterus and uterine contractions push it downward and out through the birth canal.
Cesarean Birth • The baby is delivered through an incision in the abdomen. • Spinal or epidural anesthetic is administered. Medication goes into the CSF and blocks sensation from abdomen and down. • Epidural- the patient can't feel or move their legs. • Indications for C-section. (p.868) i.e. fetal distress
Postpartum Care • Promote a home-like environment involving family members. -Mother assisted onto a bed -Protective pad placed under patients buttocks -Wear gloves & use standard precautions: will mostly come into contact with blood, mucous membranes, urine, or breast milk. • Anesthesia- post-operative care on (p.868). Checking blood pressure important! Tell nurse if patient hasn't voided by end of your shift.
Postpartum Care • Drainage: check perineum & pad for amount & color of drainage. -Lochia:red vaginal discharge. Called lochia rubra if discharge occurs during first 3 days after delivery. -Inform nurse if mother saturates pad in 15-30 minutes. • The Uterus: size and firmness should be reported. Soft and enlarged=indicated excessive bleeding. • Fundus(top of the uterus) is massaged so stimulate muscles to contract, firming the uterus.
Postpartum Care • Measuring the height of Uterus:place fingers lengthwise across the abdomen between the fundus and the (umbilicus)navel. • Cramping- may occur as the uterus begins to return to its normal size, or during breastfeeding. • Voiding-should be encouraged 6-8 hours after the delivery. Monitor for signs of urine retention.(p.870). Infection control important when toileting. (p.870).
Apgar Scoring • Is an evaluation of the neonate. (0-10) • Made 1,5, and 10 minutes after birth. • Evaluates: -Heart rate -Respiratory effort -Muscle tone -Reflex, irritability -Color
Care of the Newborn • Vital signs are taken. Axillary temp taken q30-60 min. till stable. Then every 4 hours. • Eyes treated with silver nitrates or antibiotics. • Footprints taken • Baby is cleaned and kept warm • Male may be circumsized. • Instruct mother to wash hands/breasts before feeding.
Handling the Infant • When lifting, carrying, and positioning an infant, - Support head, neck, and back. -Hold baby securely -Back through doorways when carrying a baby -Never turn your back on an infant when on unproducted surface.
PKU Test • Blood is tested for presence of PKU. • PKU is a congenital, hereditary, abnormality that may lead to mental retardation if not detected and treated early. • In PKU, protein cannot be digested normally.
Elimination • Urinatation- normally 6 to 10x a day. • Elimination activity is recorded and color of stool documented. • Stools change from dark& pasty meconium stools to brown-yellow, to yellow and loose. • If circumcised, check circumcision every time diaper is changed.
Security • ID bands to wrist & ankle • Mother & father is given matching wristband • Policies on checking identification • Nursing personnel wear ID Badge • Infant abduction is an issue: prevention measures include, alarms, GPS, etc.