Institute of Nursing Intrapartum Care Handouts: Labor and Delivery Theories of Labor Onset
Institute of Nursing Intrapartum Care Handouts: Labor and Delivery Theories of Labor Onset
Institute of Nursing Intrapartum Care Handouts: Labor and Delivery Theories of Labor Onset
Institute of Nursing
Intrapartum Care Handouts
MECHANISM OF LABOR
E ngagement
D escent
F lexion
I nternal Rotation
E xtension
R estitution
E xpulsion of the body
Third Stage of Labor
Placental Separation
Signs: Change in the shape of the uterus
Lengthening of the umbilical cord
Sudden gush of blood
Shultze’s placenta
Duncan Placenta
a. Shultze’s placenta (separation starts at the center then the sides trapping the blood
inside; sudden gush of blood occurs after delivery of the placenta; shiny – fetal side
presenting at the vulva during placental expulsion)
b. Duncan Placenta (separation starts at the sides then the center; sudden gush of blood
occurs prior to placental expulsion; dirty or maternal cotyledons presenting during
placental expulsion.
Placental Expulsion
Credes manuever
From delivery of infant to delivery of placenta
5 to 30 mins. Duration
Nursing Care :
- Assess for placental separation
1. uterus become firm and globular
2. sudden gush of blood from the vagina
3. umbilical cord lengthens outside the vulva
4. uterine fundus rises in the abdomen
Inspection of placenta
- Monitor VS
- Initiate breastfeeding
- Administer oxytocic and antilactation as ordered
- Sending cord blood to laboratory if the mother is Rh-negative
- Allow bonding
Fetal Danger Signs
1. High or low fetal heart rate
2. Meconium –staining
3. Hyperactivity- hypoxia
4. Fetal acidosis –Ph below 7.2
Predicting first fertile day. If the shortest cycle is 26 days long, subtract 18 from 26. That leaves 8. If day
one was the fourth day of the month, the day that will be mark X will be the 11th. That's the first day to be
fertile. So on that day, start abstaining from sex or start using a cervical cap, condom, diaphragm, or
female condom.
Predicting the last fertile day. If the longest cycle is 30 days, subtract 11 from 30. That leaves 19. If day
one was the fourth day of the month, the day that will be mark X will be the 22nd. That's the last day
likely to be fertile during the current cycle. Start to have unprotected vaginal intercourse after that day.
In this example, the 11th through the 22nd are unsafe days. All the others are safe days.
Non Contraceptive Benefits
Protection from PID
a. Cervical mucus scanty and thick
b. Decrease menstrual flow
c. Decrease in uterine contractility
d. Protection from endometrial and ovarian cancer
e. Protection against iron deficiency anemia
f. Minimizes menstrual cramps (dysmenorrhea)
g. Protection against benign breast disease
h. Hormonal replacement in menopause
i. Minimizes acne problems
j. Regulation of menstruation
5 Warning Signals
A – abdominal pain
C – chestpain or shortness of breath
H – headache or hypertension
E – eye problems (blurred or double vision, blindness
S – swelling or severe leg pain
4. Intrauterine Devices
Small plastic object inserted into the uterus through the vagina where it remains in place
Before the client has had coitus, following the menstrual flow
Side effects :
Infection, PID (fever, lower abdominal pain, heavier flow)
Examples:
Progestasert
T-shaped, of permeable plastic with drug reservoir of progesterone in the stem
Copper T380
T-shaped plastic device wound with copper
5. Barrier Methods
Physical placement of a barrier between the cervix and sperm so that sperm cannot enter the
uterus and fallopian tubes
Changes the vaginal pH to strong acid level
Vaginally inserted spermicidal products (24 hrs)
Diaphragm – circular rubber disk (6 hrs)
Cervical cap – timber (48 hrs)
Condom – latex rubber