Changes
taking place during the stages of the labour :
Labour is the expulsion or extraction of viable fetus out of the uterus. Delivery may be vaginal [either spontaneous or aided] or it may be abdominal.
Labour is a series of events that takes in the genital organs in an effort to expel the viable products of conception out of the uterus through the vagina. Usually it occurs between 38-42 weeks of pregnancy. If labour occurs before 37 weeks, it is termed as preterm labour.
Expulsion of conceptual products before 28 weeks is called abortion.
Normal labour:
Normal labour (Eutocia) occurs at term and is spontaneous in onset with the fetus presenting by the head. The process is completed within 18 hours and no complications arise. by which the fetus, placenta and membrane are expelled through the birth canal.
Stages of labour:
A First stage:
This is the stage of dilatation of the cervical OS. It begins with the onset of true labour contractions to full dilatation of the cervix. Duration of first stage is an average of 13 hours for nullipara and 7.5 hours for multipara.
The first stage is clinically manifested by progressive uterine contraction, progressive taking up of the cervix and ultimate rupture of membranes.
B Second stage:
It is the stage of fetal expulsion. It begins with full dilation of cervical OS and ends with the birth of the baby. Second stage lasts for one to one and half hours for nullipara and 20 to 45 minutes in multipara.
D Third stage:
It is the stage of separation and expulsion of the placenta and membranes. It begins with birth of the baby until the expulsion of placenta and membranes. The third stage may last from few minutes to thirty minutes.
E Fourth stage:
The fourth stage lasts from the delivery of placenta and membranes until the postpartum condition of the women has become stabilized. This stage is usually one hour after delivery. In this stage the mother must start breast-feeding her infant.
Changes
taking place during the first stage of the labour:
1.
Presence of show-profuse
cervical secretions, mixed with blood
is called show.
2.
Dilation and taking up of cervix: The cervical canal begins to dilate and takes up.
Formation of 'bag of waters': With the dilation of the
cervical canal, the lower pole of the fetal membranes becomes unsupported
and tends to bulge into the cervical canal.
Role of
nurse in caring of the woman in the first stage of labour:
1.
Take a brief history and assessment
2.
Encourage the woman to have a warm
bath or vulval toileting.
3.
Give a soap and water enema.
4.
When membranes are intact, allow the
woman to walk, sit or lie down in lateral position according to her
convenience. If membranes are ruptured bed rest must be advised. Analgesics may
be given as per doctor' s prescription
5.
Encourage the woman to take fluid
diet soup, fruit juice, salt lemon juice or plain water. Food and oral fluids
to be withheld, when the woman is in active labour.
6.
Encourage the woman to empty her
bladder herself frequently.
7.
Monitor the progress of the labour
by recording a partograph.
The following are recorded in partograph.
Maternal vital signs
Cervical dilation
Station of fetal head
Cervical effacement
Presence or absence of membranes
Fetal heart rate, (Normal FHR is 110 - 150 per minute).
Drugs given
Watch for maternal and fetal well-being
Monitor pulse, blood pressure and temperature every second
hourly and FHR every hour
Monitor urine output
Observe the tongue to assess the hydration status.
Psychological
preparation of the mother and her family is equally important as her ambitions
play a great role in managing labour pain and discomfort.
Changes taking place during the
second stage of the labour:
The second stage is clinically manifested by
increased frequency and intensity of uterine contractions
Appearance of 'bearing down' efforts which result in
expulsion of the fetus
The mother may show features of exhaustion.
The role of nurse in caring the
woman in the second stage of labour is
1.To assist in the natural expulsion of the fetus slowly and
steadily.
2.To prevent perineal injures.
3.To assist labour under aseptic precautions
4.Vigilant monitoring of maternal vital sign and fetal heart
rate.
Changes
taking place during the third stage of the labour:
1.
The placental separation is achieved
by marked reduction in the uterine surface area of the placental site following
delivery of baby due to retraction.
2.
After separation of placenta it is
expelled by controlled cord traction. The bleeding is controlled by effective
contraction and retraction of uterus.
The role of nurse in caring the
woman in the third stage of labour is
1.
Watch for signs of placental
separation before taking efforts to remove the placenta. (lengthening of cord,
suprapubic bulge and fresh gush of blood from vaginum)
2.
The placenta is removed by
controlled cord traction.
3.
Injection Methergin may be given for
effective uterine contraction to control bleeding.
4.
Watch for maternal vital signs,
consistency of uterus, height of the uterus and amount of vaginal bleeding.
5.
The placenta
and membranes should be examined for any abnormality following their expulsion.
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