1 | P a g e
WEEK 2
McKinney: Maternal-Child Nursing, 4th Edition
Chapter 16: Giving Birth
• During labor, the woman’s cardiovascular, respiratory, gastrointestinal,
urinary, and hematopoietic systems, as well as her reproductive system,
experience significant changes.
• Normal labor contractions are coordinated, involuntary, and intermittent.
Each contraction consists of three phases. The increment occurs as the
contraction begins in the fundus
and spreads throughout the uterus. The peak, or acme, is the period during
which the contraction is most intense. The decrement is the period of
decreasing intensity as the uterus relaxes.
• The effect of labor contractions is enhanced because the downward push
from the upper uterus is accompanied by reduced resistance to fetal
descent in the lower uterus.
• Before birth, the fetal lungs are filled with fluid to allow normal airway
development. As the term approaches, lung fluid production decreases,
and absorption increases. As the fetal head and thorax are compressed
during passage through the birth canal, fluid is expelled from the upper
2 | P a g e
airways.
• During normal childbirth, the four Ps the powers, the passage, the —
passenger, and the psyche interact. The powers are uterine contractions —
and maternal pushing efforts. The passage
consists of the maternal pelvis and its soft tissues. The passenger is the
fetus plus the membranes and placenta. The psyche consists of the
woman’s psychological reactions and approach to labor.
• Before spontaneous labor begins, women usually notice at least one
premonitory sign, including more frequent Braxton Hicks contractions,
lightening as the fetus descends toward the
pelvic inlet, increased clear and nonirritating vaginal secretions, a bloody
show (a mixture of thick mucus and pink or dark brown blood), an energy
spurt, and a small weight loss of 2.2 kg to
6.6 kg (1 to 3 lb).
• The best distinction between true labor and false labor is that in true labor,
contractions cause progressive effacement and dilation. Nurses teach
women the differences between false labor and true labor and offer
guidelines for going to the birth center. Not everyone has a typical
labor, so a woman should be encouraged to go to the birth center if she is
uncertain or has other concerns.
• Women experience normal labor in four stages: cervical dilation and
effacement, the expulsion of the fetus, the expulsion of the placenta, and
physical recovery for the mother and
infant.
3 | P a g e
• The parous woman usually delivers more quickly than the nulliparous
woman. However, some nulliparas progress through labor quickly, whereas
labor for some parous women resembles that of women who have never
given birth.
• When the woman arrives at the birth center, the nurse has two priorities:
establishing a therapeutic relationship and assessing the condition of the
mother and fetus.
• The nursing priorities for an emergency birth in any setting are to prevent
or reduce injury to the mother and infant and to maintain the infant’s airway
and temperature after birth.
• The nurse uses therapeutic communication skills when caring for the
intrapartum family. As labor intensifies, the nurse adapts communication to
the situation, simplifying explanations and directions. Intense physical
sensations reduce the ability to comprehend complex
information.
5 | P a g e
Chapter 17: Intrapartum Fetal Surveillance Key Points - Print
• Fetal surveillance uses several methods to evaluate fetal condition during
pregnancy.
• The low-tech approach to intrapartum fetal assessment uses intermittent
auscultation of the fetal heart rate and palpation of uterine activity. The
high-tech approach uses electronic fetal monitoring. The routine use of
electronic fetal monitoring remains controversial because its
benefits to the fetus are not always clear.
• Adequate fetal oxygenation requires normal maternal blood flow to the
placenta, normal oxygen saturation in maternal blood, adequate exchange
of oxygen and carbon dioxide in the placenta, an open circulatory path
between the placenta and the fetus, and normal fetal
circulatory and oxygen-carrying functions.
• Interpretations of fetal heart rate patterns are divided into three categories
to guide interventions: normal (reassuring), indeterminate (equivocal or
ambiguous data), and abnormal (nonreassuring).
• Sympathetic stimulation increases the fetal heart rate and strengthens
myocardial contractions through the release of epinephrine and
norepinephrine. Parasympathetic stimulation reduces the fetal heart rate
and maintains variability through stimulation of the vagus nerve.
6 | P a g e
• The fetoscope detects actual fetal heart sounds. Unlike the fetoscope, the
Doppler transducer cannot reliably detect fetal dysrhythmias.
• Electronic fetal monitoring equipment consists of a bedside monitor unit
and either internal or external sensors for fetal heart rate and uterine
activity. External monitoring is less accurate than internal monitoring, but it
is noninvasive and suitable for most women in labor.
• The nurse should plan to promote adequate fetal oxygenation, intervene
to increase fetal oxygenation if necessary, report nonreassuring patterns to
the physician or nurse-midwife,
support the woman and her partner if a complication develops, and
document assessments and care.
Pain Management for Childbirth Key Points - Print
• Pain is subjective and personal.
• Childbirth pain differs from other pain in that it is normal, the woman has
time to prepare, and the pain has a foreseeable end.
• Pain that exceeds a woman’s tolerance can be harmful to her and the
fetus.
7 | P a g e
• Childbirth pain is visceral and somatic. Visceral pain is a slow, deep,
poorly localized pain often described as dull or aching. Somatic pain is a
faster, sharp, localized pain.
• In most labors, pain results from tissue ischemia, cervical dilation,
pressure and pulling on pelvic structures, and distention of the vagina and
perineum.
• Nonpharmacologic pain management techniques do not slow labor, cause
side effects, or pose a risk of allergy or sedation. In intrapartum care, the
types of nonpharmacologic pain management are relaxation, cutaneous
stimulation, mental stimulation, and breathing.
• Pharmacologic pain management includes systemic drugs, regional pain
management, and general anesthesia.
• Pharmacologic pain management requires these considerations: Drugs
can affect pregnant women in ways they do not affect others; drugs can
affect the fetus and alter the course and length of labor; and women who
take therapeutic drugs, use herbal or botanical preparations, or
abuse substances may have fewer safe choices for labor pain relief.
• Adverse maternal effects associated with epidural opioids may include
nausea and vomiting, pruritus, and delayed respiratory depression.
• Regional pain-control methods provide pain relief without loss of
consciousness. Thus, the woman can participate in birth yet still have good
pain control.
• An epidural or subarachnoid block may cause maternal hypotension.
8 | P a g e
• Gastrointestinal changes make a pregnant woman more vulnerable to
regurgitation and aspiration of acidic gastric contents during general
anesthesia.
