Perry: Maternal Child Nursing Care, 6th Edition: Chapter 16: Nursing Care of The Family During Labor and Birth Key Points

Perry: Maternal Child Nursing Care, 6th Edition
Chapter 16: Nursing Care of the Family During Labor and Birth
Key Points
 The first stage of labor begins with the onset of regular uterine contractions and ends with
complete cervical effacement and dilation. The first stage of labor consists of two phases: the
latent phase (from the onset of labor to the beginning of the active phase) and the active phase (6
cm of dilation to complete cervical dilation at 10 cm).
 The familiar environment of her home is most often the ideal place for a woman during the
latent phase of the first stage of labor.
 The nurse assumes much of the responsibility for assessing the progress of labor and keeping
the primary health care provider informed about progress in labor and deviations from expected
findings.
 Regardless of the actual labor and birth experience, the woman’s or couple’s perception of the
birth experience is most likely to be positive when events and performances are consistent with
expectations, especially in terms of maintaining control and adequacy of pain relief.
 The cultural beliefs and practices of a woman and her significant others, including her partner,
can have a profound influence on their approach to labor and birth.
 The woman’s level of anxiety may increase when she does not understand what is being said to
her about her labor because of the medical terminology used or because of a language barrier.
 The FHR and pattern reveal the fetal response to the stress of the labor process.
 It is important for the nurse to assess uterine contraction frequency, intensity, duration, and
resting tone.
 Assessment of the laboring woman’s urinary output and bladder is critical to ensure her
progress and to prevent injury to the bladder.
 Coaching, emotional support, and comfort measures help the woman use her energy
constructively in relaxing and working with the contractions.
 The progress of labor is enhanced when a woman changes her position frequently during the
first stage of labor.
 Doulas provide a continuous supportive presence during labor that can have a positive effect on
the process of childbirth and its outcome.
 Siblings present for labor and birth need preparation and support for the event.
 The second stage of labor is the stage in which the infant is born. This stage begins with full
cervical dilation (10 cm) and complete effacement (100%) and ends with the baby’s birth.
 Women may have an urge to bear down at various times during labor; for some it may be
before the cervix is fully dilated, and for others it may not occur until the active phase of the
second stage of labor.
 When encouraged to respond to the rhythmic nature of the second stage of labor, the woman
normally changes body positions, bears down spontaneously, and vocalizes (open-glottis
pushing) when she perceives the urge to push (Ferguson reflex).
 Women should bear down several times during a contraction using the open-glottis pushing
method. They should avoid sustained closed-glottis pushing because this inhibits oxygen
transport to the fetus.
Copyright © 2018 by Elsevier Inc. All rights reserved.

Key Points 16-2
 The only certain objective sign that the second stage of labor has begun is the inability to feel
the cervix during vaginal examination, indicating that is fully dilated and effaced.
 Nurses can use the role of advocate to prevent routine use of episiotomy and reduce the
incidence of lacerations by empowering women to take an active role in their childbirth and
educating health care providers about approaches to managing childbirth that reduce the
incidence of perineal trauma.
 Objective signs indicate that the placenta has separated and is ready to be expelled; excessive
traction (pulling) on the umbilical cord before the placenta has separated can result in maternal
injury.
 During the fourth stage of labor the woman’s fundal tone, lochial flow, and vital signs should
be assessed frequently to ensure that she is physically recovering well after giving birth.
 Most parents and families enjoy being able to handle, hold, explore, and examine the baby
immediately after the birth.
 The woman who has given birth by cesarean or received regional anesthesia for a vaginal birth
requires special attention during the recovery period. A PAR score is determined for each
woman on arrival and is updated as part of every 15-minute assessment. Components of the PAR
score include activity, respirations, blood pressure, level of consciousness, and color.
Copyright © 2018 by Elsevier Inc. All rights reserved.

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Copyright © 2018 by Elsevier Inc. All rights reserved.

Copyright © 2018 by Elsevier Inc. All rights reserved.

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