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The Family in Childbirth: Needs and Care

The Family in Childbirth: Needs and Care. Yili Ko, RN, EdD Department of Nursing Fu-Jen Catholic University 2008/10/13. Family-centered care. Consumer demand single birthing rooms Labor ,Delivery, Recovery, and Postpartum (LDRP) More relaxed

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The Family in Childbirth: Needs and Care

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  1. The Family in Childbirth:Needs and Care Yili Ko, RN, EdD Department of Nursing Fu-Jen Catholic University 2008/10/13

  2. Family-centered care • Consumer demand • single birthing rooms • Labor ,Delivery, Recovery, and Postpartum (LDRP) • More relaxed • More comfortable • Homelike atomosphere

  3. 基本概念 • 生產是正常自然過程 • 產婦應付生產的能力與自信，深受生產環境所提供的照護所影響 • 產婦及家屬均有機會去體驗一個正向生產經驗 • 產婦有權選擇其所要體驗的生產經驗且被尊重 • 產婦有權接受最正確生產相關資訊並參與決策

  4. Philosophy of Prepare Childbirth • Birth is normal,natural,and healthy • The experience of birth profoundly affects women and their families • Women’s confidence and ability to give birth is either enhanced or diminished by the care provider and place of birth • Women have the right to give birth free from routine medical intervention • Birth can safely take place in birth centers and homes

  5. Philosophy of Prepare Childbirth(續) • Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health,and to trust their inner wisdom

  6. Critical Factors in Labor • 4Ps • Passage (產道) • Passenger (Fetus;娩出物) • Power (娩出力) • Psyche (精神力量)

  7. Passage (產道) • 由骨骼構成的腔道 • Size of pelvis • diameter of pelvic inlet • midpelvis • outlet • CPD (Cephalopelvic disproportion)

  8. Passage (產道1) • Type of pelvis (p137) • gynecoid （女子型） • 50％ 婦女屬於此種型態 • android （男子型） • anthropoid （人猿型） • platypelloid （扁平型） • combination

  9. Passage (產道2) • ability • the cervix to dilate and efface • the vaginal canal • the external opening of the vagina

  10. Passenger (娩出物) • 分娩過程主要娩出物就是胎兒 • 影響胎兒是否順利經過產道的主要部位是胎頭及胎兒的肩膀 • 其中又以胎頭最具意義 • Fetal head • size • molding

  11. Passenger (娩出物1) • 胎兒頭部徑線

  12. Passenger (娩出物2) • Fetal attitude (胎勢) • 胎兒在子宮內的姿勢 (flexion)

  13. Passenger (娩出物3) • Fetal lie （胎兒軸線） • 指胎兒頭部至臀部的軸線 • 正常懷孕胎兒軸線與子宮軸線應是一致的 縱位 (longitudinal lie) • Fetal presentation （胎產式） • 指胎兒最先進入骨盆的身體部位 (presentation part)

  14. Passenger (娩出物4) • 90% cephalic presentation • 3% breech presentation • complete breech • single (frank breech) • footling breech

  15. Relationships of Presenting Part and Maternal Pelvis (1) • Engagement • floating • Fetal Position (胎位)：胎兒先露部位與母體骨盆前後左右位置的關係 • 通常以三個英文字母表示 如：LOA • (1)L胎兒先露部位在母體左側 • (2)O枕骨 • (3)A胎兒先露部位在母體前側

  16. Relationships of Presenting Part and Maternal Pelvis (2) • Vertex presentation (以O代表) • ROA Right-occiput-anterior • ROT Right-occiput-transverse • ROP Right-Occiput-posterior • LOA Left-occiput-anterior • LOT Left-occiput-transverse • LOP Left-occiput-posterior

  17. Relationships of Presenting Part and Maternal Pelvis (3) • Breech presentation (以S代表) • RSA Right-sacrum-anterior • RST Right-sacrum-transverse • RSP Right-sacrum-posterior • LSA Left-sacrum-anterior • LST Left-sacrum-transverse • LSP Left-sacrum-posterior

  18. Relationships of Presenting Part and Maternal Pelvis (4) • Face presentation (以M代表) • RMA Right-mentum-anterior • RMT Right-mentum-transverse • RMP Right-mentum-posterior • LMA Left-mentum-anterior • LMT Left-mentum-transverse • LMP Left-mentum-posterior Placenta (implantation site)

  19. Relationships of Presenting Part and Maternal Pelvis (5) • Fetal Station (胎兒高度)與產道關係 • engagement (胎頭固定) • station 0 胎兒先露部位到達ischeal spine (坐骨棘)時稱之 • station -1 • station -2 • station +1 • station +2

  20. Relationships (6)

  21. Power (娩出力) • 胎兒娩出須靠子宮收縮的力量 • 懷孕時子宮會維持8-10mmHg的張力 • 子宮收縮其強度over 15 mmHg才有陣痛感 • 產程末期子宮收縮強度可達55-60 mmHg • frequency • duration • intensity • Effectiveness of the maternal pushing effort • Duration of labor

  22. Power (娩出力續) • 子宮收縮及鬆弛圖

  23. Psyche (精神力量) • 疼痛和失去控制是待產婦常見的感受 (Butani,1980) • 影響因素 • Physical preparation for childbirth • Sociocultural heritage • Previous childbirth experience • Support from significant others • Emotional status

  24. 正常分娩過程(1)產程開始的可能原因 • Progestone Withdrawal Hypothesis • Prostaglandin Hypothesis • Corticotrophin-Releasing Hormone Hypothesis (CRH) • Myometrial Activity • primi effacement precedes dilatation • Intra-abdominal Pressure • bearing down (pushing) • Musculature Changes in the Pelvic Floor

  25. 正常分娩過程(2)生產的前兆 • Lightening • Braxton Contractions • Cervical Changes • Blood Show • Rupture of Membranes (ROM) • Sudden Burst of Energy • Others • weight loss 1 to 3 lb • Backache and sacroiliac pressure • diarrhea, indigestion or nausea and vomiting

  26. 正常分娩過程(3)產程的分期 • First Stage (第一產程):真陣痛開始至子宮頸口完全擴張 • 潛伏期(latent phase)0-4cm • 20-40’’/3-30 ’ • 活動期(active phase)4-7cm • 40-60 ’’ /2-5 ’ • 過渡期(transitional phase)7-10cm • 60-90 ’’ /1.5-2 ’

  27. 正常分娩過程(4) • Second Stage:子宮完頸全擴張至胎兒娩出 • Primigravida up to 2 hours • Multipara 15minutes • Crowning • Third Stage: 胎兒娩出至胎盤娩出(30分內) • Schultze • Duncan • Fourth Stage: 1-4hours after birth • normal blood loss range:250-500 mL

  28. Intrapartal Family：Need and Care • 家人的參與 • 準父親 • 母親 • 婆婆 • 其他（父親、公公或大的小孩） • 家人陪產參與的重要 • 正向生產經驗 • 提供促進舒適的方法 • 心理支持

  29. 護理診斷（第一產程） • 害怕(Fear)－待產的不適(discomfort)和未知的生產結果(unknown labor outcome) • 無效的家庭因應(Ineffective Family Coping)－待產的過程 • 疼痛(Pain)－子宮收縮(uterine contractions)，子宮頸口擴張的程度(cervical dilatation) 胎兒的下降(fetal descent) • 知識缺乏(Knowledge Deficit)－缺乏關於正常待產過程及減輕不適方法的資訊 • 焦慮(Anxiety)－未知的生產結果和不舒服

  30. 護理診斷（第二、三產程） • 疼痛 • 子宮收縮，生產過程，陰部裂傷 • 知識缺乏 • 用力的方法（子宮口開全Pushing methods） • 無效的個人因應機轉(Ineffective Individual Coping) • 生產過程 • 害怕 • 生產結果

  31. 護理診斷（第四產程） • 疼痛 • 會陰部的裂傷(perineal trauma) • 知識缺乏 • 復舊過程和自我照顧(involutional process and self-care needs) • 家庭過程的改變(Altered Family Processes) • 家庭成員的增加

  32. 第一產程（待產婦女的需要） • 個別性的照顧(Individual) －陪伴，提供安全感(security) • 稱讚(praise)－給予信心 • 平靜和自信(calm and confident)的態度 • 幫助呼吸(breathing)和鬆弛(relaxing)的技巧 • 尊重(respect)待產婦女的反應（Accepting woman said and did without judging her） • 解釋醫院的Routine • 真實的回答問題（用她們能了解的語言）

  33. 護理措施（第一產程續） • A clean, homelike environment • 中國文化的考量 • 羞怯(modesty) • 注意隱私部位暴露時保護 • 疼痛時的表達(Pain expression) • 鼓勵待產婦疼痛的表達

  34. 護理措施（第一產程續） • 促進舒適的方法 • 姿勢改變：側躺、枕頭支託 • 保持會陰部的乾爽清潔：如更換看護墊、會陰沖洗 • 協助便盆使用（1-2小時排空膀胱） • Touch • 用棉籤潤唇 • 穿毛襪保暖

  35. 護理措施（第一產程續） • 減輕焦慮的方法 • 提供information • 介紹環境、入院處置、Fetal monitor • 呼吸技巧的支持 • Massage、Distraction、Touch、冥想 • Patterned-Paced breathing • 注意避免Hyperventilation

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