Know the Stages and phases of labor including the physiological changes, the normal progression
and the psychological impact to your patient. Know the
... [Show More] labs that are essential to have for your
patient prior to delivery of baby.
Stages of labor
First Stage- labor- variable
Second stage- delivery of baby- up to 3 hours (2 without anesthesia) Pushing stage.
Third Stage- delivery of placenta- 5-30 minutes
Fourth Stage- Recovery 2 hours
Within the first stage- we have 3 phases.
0-4cm- latent- most variable. Objective signs: cervical change, some effacement, communicative,
contractions 8-10 min apart, mild contractions
4-8 cm- active- Intensity in contractions; bloody show- This is where we medicate mom.. 4-6
hours. Contractions are getting closer together and stronger. Membranes may rupture,
contractions 2-5 min apart, more focused, less talking, risk to baby is greater, amount of
perfusion to baby is less, baby can get hypoxic during long labor with progression
8-10 cm- transitional- rectal pressure- need to bear down and want to push- about 2 hours or
less., may scream, writhe around in bed, will not feel any cervix around baby’s head
Make sure mom is in a comfortable position and her surroundings are calm and inviting.
Squatting or sitting is the best position.
CBC, Hep, Rubella, HIV, Syphilis, Group B, Blood type, RH, drug screen, urine analysis
2. Know the reasons and the findings of each vaginal exam.
Three pieces of information that we must get during a vaginal exam:
Dilation (cervix is opening), station # of cm above the ischial spine is a negative number, below
the ischial spine is a positive number, and effacement (from thick to thin)0%-100%
You can also get the presentation of the baby and feel is the membranes are intact.
Vaginal exams are done at admission for baseline, when membranes rupture, and when she asks
for pain meds, and when patient says she is ready to push.
3. Know the medications of labor and when to administer them.
Pitocin- Promotes uterine contractions. Used to begin labor, augment labor and postpartum. We
use 2 milliunits per minute which is equal to 6 ml per hour and it is titrated. Lactated Ringers.
Every 20-30 minutes we move it up depending on the patient. Frequency of contractions no
more than 2-3 minutes apart.
Magnesium Sulfate- Preterm labor and pre-eclampsia
Nubain and Stadol- Administer for Pain.
Methergine (IM and PO after-contraindicated for hypertension) and Hemabate- Prevents
hemorrhaging
Cytotec- Causes uterine contractions. [Show Less]