Question

8. What is an amniotomy? 9. Nursing care during the fourth stage of labor includes what general care? 10. Summarize the initial care of the newborn. Nursing Management of Pain during Labor and Birth 1. What topics would you expect to cover in a childbirth preparation class?

Answer 1

Ans) 8) Artificial rupture of membranes, also known as an amniotomy, is performed by a midwife or obstetrician and was once thought to be an effective means to induce or accelerate labor.

9) Nursing care for 4th stage of labour:

a. Transfer the patient from the delivery table.

Remove the drapes and soiled linen. Remove both legs from the stirrups at the same time and then lower both legs down at the same time to prevent cramping. Assist the patient to move from the table to the bed.

b. Provide care of the perineum.

An ice pack may be applied to the perineum to reduce swelling from episiotomy especially if a fourth degree tear has occurred and to reduce swelling from manual manipulation of the perineum during labor from all the exams. Apply a clean perineal pad between the legs.

c. Transfer the patient to the recovery room.

This will be done after you place a clean gown on the patient, obtained a complete set of vital signs, evaluated the fundal height and firmness, and evaluated the lochia.

d. Ensure emergency equipment is available in the recovery room for possible complications.

(1) Suction and oxygen in case patient becomes eclamptic.

(2) Pitocin® is available in the event of hemorrhage.

(3) IV remains patent for possible use if complications develop.

e. Check the fundus.

(1) Ensure the fundus remains firm.

(2) Massage the fundus until it is firm if the uterus should relax

(3) Massage the fundus every 15 minutes during the first hour, every 30 minutes during the next hour, and then, every hour until the patient is ready for transfer.

(4) Chart fundal height. Evaluate from the umbilicus using fingerbreadths. This is recorded as two fingers below the umbilicus (U/2), one finger above the umbilicus (1/U), and so forth. The fundus should remain in the midline. If it deviates from the middle, identify this and evaluate for distended bladder.

(5) Inform the Charge Nurse or physician if the fundus remains boggy after being massaged.

f. Monitor lochia flow. Lochia is the maternal discharge of blood, mucus, and tissue from the uterus.

This may last for several weeks after birth.

(1) Keep a pad count. Record the number of pads soaked with lochia during recovery.

(2) Identify presence of bright red bleeding or blood clots.

(3) Document thick, foul-smelling lochia.

(4) Observe for constant trickle of bright red lochia. This may indicate lacerations.

(5) Identify lochia amounts as small, moderate, or heavy (large) .

(6) Document lochia flow when the fundus is massaged.

(a) Every fifteen (15) minutes times one hour.

(b) Every thirty (30) minutes times one hour.

(c) Every hour until ready for transfer.

. Observe the mother for chills.

The cause of the mother being chilled following birth is unknown. However, it refers primarily to the result of circulatory changes after delivery. The best means of relief is to cover the mother with a warm blanket.

h. Monitor the patient’s vital signs and general condition.

(1) Take BP, P, and R every 15 minutes for an hour, then every 30 minutes for an hour, and then every hour as long as the patient is stable. Take the patient’s temperature every hour.

(2) Observe for uterine atony or hemorrhage.

(3) Observe for any untoward effects from anesthesia.

(4) Orient the patient to the surroundings (bathroom, call bell, lights, etc.).

(5) Allow the patient time to rest.

(6) Encourage the patient to drink fluids.

i. Observe patient’s urinary bladder for distention.

10) Directly after birth there should be attention to the condition of the newborn. The World Health Organisation (WHO) states that such attention is an integral part of care in normal birth. Immediate care involves:

- Drying the baby with warm towels or cloths, while being placed on the mother's abdomen or in her arms. This mother-child skin-to-skin contact is important to maintain the baby's temperature, encourage bonding and expose the baby to the mother's skin bacteria.
- Ensuring that the airway is clear, removing mucus and other material from the mouth, nose and throat with a suction pump.
- Taking measures to maintain body temperature, to ensure no metabolic problems associated with exposure to the cold arise.
- Clamping and cutting the umbilical cord with sterile instruments, thoroughly decontaminated by sterilisation. This is of utmost importance for the prevention of infections.
- A few drops of silver nitrate solution or an antibiotic is usually placed into the eyes to prevent infection from any harmful organisms that the baby may have had contact with during delivery (e.g. maternal STDs ).
- Vitamin K is also administered to prevent haemorrhagic disease of the newborn .
- The baby's overall condition is recorded at 1 minute and at 5 minutes after birth using the Apgar Scale .
- Putting the baby to the breast as early as possible. Early suckling/breast-feeding should be encouraged, within the first hour after birth and of nipple stimulation by the baby may influence uterine contractions and postpartum blood loss but according to the WHO, this should be investigated.
- About 6 hours or so after birth, the baby is bathed, but the vernix caseosa (whitish greasy material that covers most of the newborn's skin) is tried to be preserved, as it helps protect against infection.

1) A childbirth class is a great way to prepare for labor and birth. Depending on where you go, classes range from a one-day intensive workshop to weekly sessions lasting a month or more. Also learns techniques to help to relax and cope with labor.

- childbirth classes go over everything modern medicine has to offer—epidurals, analgesics, narcotics.

- preparation to go through the stages of labour.

- Keeps motivating and provides self esteem.