Italicized/ [ ] /  - notes

 Partograph – used when the mother is about 4 cm cervical dilatation | the updated usage of it according to the
WHO is when the patient is at around 5 cm dilatation.
 Yellow color – signal to transport the patient to a hospital.
nd
 2 stage
 10 cm cervical dilatation to complete expulsion of the fetus
 Includes the seven mechanisms (engagement, descent, flexion, restitution, expulsion)
 Need to assist the mother on each mechanism to avoid laceration of the perineal area (there is also
involuntary uterine contractions but the patient needs further assistance for the same purpose).
 Instruct the mother to bear down when she is in 10 cm cervical dilatation (bear down when the uterus is
contracting)
 Multiparous
 The baby is easily delivered due to stretched perineal area.
rd
 3 stage of labor
 Delivery of the placenta | placental separation
 Usually occurs 5-10 minutes however, with the newly implemented Essential Intrapartum and
Newborn Care (EINC) Program, it is stated that the placenta should be out a few minutes after the
delivery of the baby (approximately around 3 minutes/ <3 mins.).
 Brandt-Andrews Maneuver
 Apply pressure on the abdominal area/cavity of the mother while pulling the placental area at
the same time to avoid uterine inversion.
 The other hand is holding the umbilical cord connected to the placenta.
 Pushing the abdomen upward while pulling the placenta downward (apply counter-traction)
 Calkin’s Sign
 Change in the size and shape of the uterus from flat into firm globular mass in the abdomen.
 Mass over the abdomen area
 Uterus becomes firm; hardening of the uterus
 Massage the uterus if it is very soft to avoid bleeding.
 Stimulate the uterus to contract by slightly massaging the uterus, placing ice cap over the
abdomen or placing the baby on top of the mother’s chest.
 To stimulate the uterus to contract if it is very soft:
 Slightly massage the uterus
 Place an ice cap over the uterus (postpartum bleeding management | to constrict the blood vessels
thereby limiting the blood flow)
 Let the baby suck – best way to stimulate the uterus to contract. |
 Let the baby stay in the chest of the mother for 45 minutes.
 Episiorrhaphy
 Vaginal repair (if wide)
 Muscle control – controlling the urination to tighten and gives lesser vaginal opening | can be a part of
family planning counseling.
 Oxytocin
 There is a normal production of this hormone in the body.
 Oxytocin drip – incorporate oxytocin drugs in the IV causing contraction and relaxation of the uterus.
 Placenta
 Slightly attached on the uterine cavity.
 Located on top of the uterus over the fundus and gradually detached once the baby is out.
 Apply controlled cord traction to avoid uterine inversion.
 Will be out spontaneously to avoid bleeding (apply traction)
 Hemorrhage
 Bleeding of more than 500 mL
 Possible for hypovolemic shock (losing blood) – intervention includes taking the BP of the patient.
 Hypovolemic shock is an early sign of very low blood volume.
 Internal bleeding (inside the uterine cavity) / external bleeding – evidence of fluctuating/dropping BP.
 Myometrium – middle layer of the uterus
 Uterine Atony – inability of the uterus to contract effectively.
 Insert IV line to control severe bleeding and save the life of the mother.
 It is hard to insert the IV fluid if the mother is a multiparous
 Candidates for Uterine Atony
1. Macrosomia – mothers that have very large babies | routine measurement of the fundic height
(28 weeks – around 36 centimeters).
2. Prolonged labor
3. Multiple Gestation – twins, triplets, etc. (severe bleeding due to uterine atony)
s Overdistended uterus
 Uterotonics – oxytocin, etc.
 Postpartum psychosis
 Same with depression; the mother is shocked and not well-prepared of having the baby
 Abrupt and physical changes that needs adjustments.
 Placental separation
 Wait for 3 mins.
 Gives warmth (placed the baby on top of the mother’s chest for at least 1 hour to give enough time for
the baby to adjust.
 Skin-to-skin contact/ embrace the baby for at least 1 hour before bringing the baby into the
nursery for anthropometric measurements.
 Gives stress to the baby if he/she is removed immediately on top of the mother’s chest.
s Stress – prone to infections – high incidence of death due to abrupt changes of the
baby’s environment outside the uterus that causes stress, leading to infections.
 13% protection for infxns. – breastfeeding and skin-to-skin contact of the baby with the mother for 1
hour.
 Fundus – top of the uterus
 During delivery, the placenta is slightly detached.
 In twins, sometimes there are 2 placenta.
 After the placenta is delivered, there is a mass on the abdomen which is a good sign that the uterus is
contracting.
 Lochia – vaginal bleeding
 Apply a fast drip IV fluid when the patient is losing blood before blood transfusion.
 Caesarian section – more or less 1000 mL of blood is loss (3 bags of blood is needed)
 Normal Spontaneous Delivery – 500 mL of blood is loss (2 bags of blood is needed)
 Placenta – gives nutrition to the baby.
 Maternal surface
 18-20 cotyledons (membranes’ completeness)
 Some portion may be left behind
 If the placenta is covered, no need to count the cotyledons.
 Fetal surface
 The part that is connected to the baby (nearest to the baby)
 Matthews-Duncan – placenta comes out sideways
 Cord clamp – place on the umbilical cord 2 cm only
 From the cord clamp, estimate 3 cm and place the forceps; cut the cord near the clamp with scissors
 Reason that the patient experiences labor pain was due to placental aging
 Placental aging – post term (>42 weeks): could not give nutrients to the baby
 Placenta previa – placenta is in the lower site of the abdomen.
 Placenta accreta
 Too much attachment of the placenta in the uterus
 The doctor will order emergency hysterectomy (total removal of the uterus) to avoid excessive
bleeding.
 Controlled cord traction
 While pulling the placenta, apply pressure to push back the uterus (1:14:00)
 Push back the uterus upward while slightly pulling the placenta to be sure that the uterus will not be
out with the placenta.
 Postpartum Management
 Apply cold compress
 Elevate buttocks
 Give IV fluid
 Call the doctor
 Let the baby suck
 Polyhydramnios – lots of amniotic fluid inside the uterus
 Induction – if the patient has IV, the doctor will incorporate oxytocin in the IV fluid to stimulate uterine
contraction (e.g., D5LR with oxytocin 10 units)

 EINC – Essential Intrapartum and Newborn Care

 Multiparous – 30 mins. labor
 Precipitate labor – labor with premature delivery
 Preterm – 37 below
 Full term – 38 – 42 weeks AOG (term infants)
 Post-term – 43 weeks and above
 AOG – computed with the Naegele’s Rule (most accurate way of computing AOG); asking the mother when
was the first day of her last menstruation, then add all the no. of days and ending with the date of consultation
then to be divided by 7. The result will be the AOG.
 Basis if the 1st day of last menstruation is forgotten:
 Ultrasound
 Estimation of the fundic height
 1st quickening/ 1st fetal movement: usually on 4-5 months pregnancy
 Specific way to determine if the baby is premature/mature/post-mature – based on the characteristics of the
baby after delivery.
 2nd stage of labor – nursing responsibility: update the mother on the progress of labor (such as to push only
when the uterus is contracting/ push when the uterus hardens as if in defecating)
 Early pushing/ bearing down may lead to edema of the pelvic area/ vulva; pelvic infections
 There is an involuntary uterine contraction but needs assistance to avoid laceration of the vagina.
 The WHO took 10 years before they release the findings regarding the immediate removal of the baby to the
side of the mother causing stress that leads to infections; thus, after the discovery, developed EINC.
 The cause of the baby’s infections is stress due to immediate removal of the baby on the mother’s side which
can lead to death.
 Neonatal period – 24 hours to 1 week after delivery
 EINC
 Place the baby on the abdomen of the mother immediately after delivery to stimulate the uterus for
faster contractions; do not remove the baby abruptly on the mother (for 1 hour)
 Introduced by WHO
 Bath the baby only after 6 hours.
 Old method:
 After 1 hour of delivery, the baby must be brought to the nursery for anthropometric
measurements,
 For oil bath to remove sticky secretions (vernix caseosa)
 Full bath (lukewarm water)
 Bring back the baby to the mother after 1 ½ hours for breastfeeding
 Unang Akap
 First embrace practice
 Implemented for the baby to adjust in its environment during the 1 st hour of life.
 Place the baby on the chest of the mother and let it suck the mother’s breast for breastfeeding.
 13% - protection from infections on the 1st hour of life due to breastfeeding and the first embrace.
 1% - protection from infections due to receiving of antibiotics.
 Perform IE every 4 hours to avoid irritation of the vulva of the mother.
 Placenta previa – the placenta is in the lower portion of the uterus; do not do IE because it can cause more
severe bleeding | painless vaginal bleeding | complication in the 3 rd stage of labor | before doing IE, interview
the patient for the characteristics of bleeding.
 In normal labor, there is pain and minimal bleeding with mixed amniotic fluid, and blood in mucoid coming
out (not purely blood).
 3 Phases:
 Increment – increasing in pain; can be detected using fetal monitoring: monitors the fetal heart of
the baby.
 Acme
 Decrement
 The production of progesterone decreases as pregnancy reaches the near of 9 months.
 Braxton-Hicks contraction – 1st contraction
 Oxytocin
 Oxytocin drip; used to augment/ induce labor
 Usually, 10 units of oxytocin is incorporated in the IV fluid.
 The role of the nurse is to check the regulation of the IV fluid.
 Fast IV regulation causes continuous contraction of the uterus (too much contraction)
 Psyche – mental conditioning of the mother while they are in labor.
 Stimulate the nipple of the mother for the uterus to contract.
 Contraction of the uterus = firm
 Relaxed uterus = smooth
 Phases of the 1st Stage of Labor
 Latent phase – 0-3 cm cervical dilatation
 Active phase – 4-7 cm
 Transition phase – 7-10 cm
 Multiparous mothers give birth easily.
 Power – light diet/ rest/ fatigue (power influences)
 Primary power – uterine contractions/ the uterus’ own capacity to contract
 Secondary power – bearing down of the mother
 Passageway – pelvis, pelvic bones, vaginal opening, etc.
 Macrosomia – usually common to diabetic mothers.
 Presentation – cephalic, breech, transverse
 Normal weight gain during pregnancy: 27 lbs.
 1st trimester (1-3) – 5 lbs.
 2nd trimester (4-6) – 11 lbs.
 3rd trimester (7-9) – 11 lbs.
 Duration – starts from the 1st contraction to the end of the same contraction.
 Frequency – beginning of 1 contraction to the beginning of the next contraction.
 Intervals – end of the 1st contraction to the beginning of the next contraction.
 The more the perineum is stretched, the more it is to deliver the baby (perform exercises to stretch the muscles
of the perineum).
 Cervical dilatation – 1 cm. / hr.
 Effacement – the more cervical dilatation, the more the cervix is thinning (e.g., 7 cm = 70% | 8 cm = 80%
effacement)
 Ischial spine – landmark in identifying birth stations.
 Above the ischial spine: -1, -2, -3
 Below the ischial spine: 1, 2, 3
 Occiput – basis for the position
 Posterior fontanel: triangular in shape
 Anterior fontanel: diamond shape
 Left occiput anterior, etc.
 Consistency – smoothness of the cervix
 Presenting part – cephalic, shoulder (transverse), etc.
 Status – rupture/ intact membranes
 Transverse
 13.5 cm = pelvis
 Lumbar to front = 10 cm
 Interspinous – 10.5 cm
 Passenger
 Anterior – closes 12 months after delivery
 Posterior – closes 4 months after delivery
 Caput succedaneum – mins. after birth
 The lesser the oxygen, the greater the brain cells that will die.
 Moulding – suture lines overlaps.
 Transverse – the vertebral column of the baby is parallel
 Before giving birth, administer 2 Dulcolax suppositories to soften the stool so that it will come out first prior
to the delivery of the baby.
 Within 30 seconds – dry the baby
 30-60 breaths/min. – normal respiratory rate of newborn.

 Videos
 Chapter 2
 Chapter 8
 Chapter 9