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Care for women during childbirth
Exclusive to ysy, it includes factors affecting childbirth, care for women with normal childbirth, etc. It is introduced in detail and described comprehensively. I hope it will be helpful to those who are interested!
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Care for women during childbirth
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- Outline
Care for women during childbirth
Factors affecting childbirth
productivity
uterine contractility
rhythmicity
Labor sign. It starts from a weak crescendo (running phase) for a certain period of time (step phase) and then gradually fades from strong to strong (regressive phase) until it disappears into the intermittent phase. This happens repeatedly until the end of labor.
Symmetry and polarity
Starting from the uterine horns on both sides (the uterine horns are controlled by the pacemaker points), the microwaves are rapidly concentrated to the midline of the uterine fundus in left and right symmetry, and then spread to the lower uterine segment at a speed of 2cm/s, uniformly and harmoniously within about 15 seconds. Expands throughout the uterus.
shrinkage
The muscle fibers in the uterine body shorten and thicken with each contraction. Although the muscle fibers relax during the intermittent period, they cannot return to their original length. After repeated contractions, the muscle fibers will become shorter and shorter.
Abdominal muscle and diaphragm contractility
It is an important auxiliary force for the delivery of the fetus during the second stage of labor and can reflexively cause defecation movements. It is most effective when used in conjunction with effective uterine contractions at the end of the second stage of labor, and can promote the delivery of the fetus. The third stage of labor may result in delivery of the placenta with separation.
Levator ani muscle contraction force
It can assist the fetal presenting part to flex and internally rotate in the pelvic cavity
birth canal
bony birth canal
Pelvic entrance plane
Entrance front and rear diameter (true combined diameter)
The distance from the midpoint of the upper edge of the pubic symphysis to the middle of the upper edge of the sacral promontory. Normal value averages 11cm
entrance diameter
The maximum distance between the left and right iliopectineal margins. Normal value is 13cm
entrance slope
The distance from the sacroiliac joint on one side to the iliopectineal protuberance on the opposite side. Normal value averages 12.75cm
mid pelvic plane
Anteroposterior diameter of middle pelvis
The distance from the midpoint of the lower edge of the pubic symphysis through the midpoint of the line connecting the ischial spines on both sides to the lower end of the sacrum. Normal value averages 11.5cm
Mid-pelvic transverse diameter (ischial interspinous diameter)
The distance between the two ischial spines. Normal value averages 10cm
pelvic outlet plane
Exit front and rear diameter
The distance from the lower edge of the pubic symphysis to the sacrococcygeal joint. Normal value averages 11.5cm
Outlet transverse diameter (interischial tuberosity diameter)
The distance between the medial edges of the two ischial tuberosities. Normal value averages 9cm
sagittal diameter before exit
The distance from the midpoint of the lower edge of the pubic symphysis to the midpoint of the ischial tuberosity diameter. Normal value averages 6cm
Posterior sagittal diameter of exit
The distance from the sacrococcygeal joint to the midpoint of the ischial tuberosity diameter. Normal value averages 8.5cm
Pelvic axis and pelvic tilt
Imaginary curve connecting the center points of each plane of the pelvis When a woman is standing, the angle formed by the plane of the pelvic inlet and the ground plane is generally 60°
soft birth canal
formation of lower uterine segment
When not pregnant, the uterine isthmus is about 1cm long and gradually grows into part of the uterine cavity after 12 weeks of pregnancy. Regular uterine contractions after labor further elongate the lower uterine segment to 7~10cm
cervical changes
Cervical canal disappears
Cervical dilation
Changes to the vagina, pelvic floor tissues, and perineum
The perineal body is 5cm thick and becomes 2~4mm thin
fetus
fetal size
fetal skull
fetal head diameter
biparietal diameter
The distance between the two parietal protuberances is an average of 9.3cm at term, and the maximum transverse diameter of the head is
Occipitofrontal diameter
The distance from the top of the nose to the occipital protuberance is 11.3cm on average at term, and the fetal head is connected with this diameter line
Suboccipital fontanel diameter (small oblique diameter)
The distance from the center of the anterior fontanel to the bottom of the occipital protuberance is an average of 9.5cm at term.
Occipital mental meridian (large oblique diameter)
The distance from the center below the chin to the top of the posterior fontanel is an average of 13.3cm at full term.
fetal position
Fetal malformation
social psychological factors
Nursing care for women with normal childbirth
Mechanism of occipital presentation of delivery
connect
The biparietal diameter of the fetal head enters the pelvic inlet plane, and the lowest point of the skull is close to or reaches the ischium and level.
Most multiparous women have their fetuses welded after giving birth, but some first-time mothers can do so within 1 to 2 weeks before the expected date of delivery.
decline
The movement of the fetal head forward along the pelvic axis is the primary condition for the delivery of the fetus.
throughout the entire process of childbirth. It is intermittent, with the fetal head descending during contractions and retracting slightly during intermittent contractions. The degree of fetal head descent is an important marker for judging the progress of labor
Submission
When the fetal head descends from the occiputofrontal diameter to the pelvic floor, the fetal head, which was originally in semi-flexion, encounters the resistance of the levator ani muscle and uses the lever action to further flex it.
internal rotation
The fetal head rotates forward around the longitudinal axis of the pelvis so that the sagittal suture is consistent with the middle pelvis and the pelvic outlet.
End of first stage of labor completed
Stretch
The top, forehead, nose, mouth, and chin at the beginning are delivered from the front edge of the perineum in sequence.
Reduction and external rotation
After the fetal head is delivered, in order to restore the normal relationship between the fetal head and fetal shoulders, the fetal head occiput is rotated 45 degrees to the left side of the mother's body, which is called reset.
The fetal shoulder continues to descend in the pelvic cavity, the front shoulder rotates forward 45° toward the midline, the diameter of the fetal shoulders turns to the same direction as the anteroposterior diameter of the pelvic outlet, and the fetal head occipital part needs to continue to rotate 45° outward to the left side of the mother's body. Maintaining the vertical relationship between the fetal head and the fetal monitor is called external rotation.
Fetal shoulder and fetal delivery
labor
Regular and gradually increasing uterine contractions, lasting 30 seconds or more, with intervals of 5 to 6 minutes
Progressive effacement of the cervical canal, dilation of the cervix, and progressive descent of the fetal presenting part
Uterine contractions cannot be suppressed even with strong sedatives
Total labor stage and stages
First stage of labor (cervical dilation)
From the beginning of labor to the full dilation of the cervix
Incubation period: from regular uterine contractions to cervix dilation up to 6 cm. No more than 20 hours for first-time mothers and no more than 14 hours for multiparous women.
Active phase: the cervix dilates 6 cm to fully open. Some women enter the active phase when their cervix is dilated to 4~5cm. The cervical dilation speed during this period is ≧0.5cm/h
Second stage of labor (fetal delivery period)
The cervix is fully dilated until the fetus is delivered
If epidural anesthesia is not performed, it should not exceed 3 hours for first-time mothers and 2 hours for multiparous women.
Those who receive epidural anesthesia can extend this by 1 hour, that is, no more than 4 hours for first-time mothers and no more than 3 hours for multiparous women.
The third stage of labor (placenta delivery period)
After delivery of the fetus to delivery of the placenta
It takes 5~15 minutes and no more than 30 minutes
Care for women in the first stage of labor
nursing assessment
physical condition
general condition assessment
Uterine contractions will cause blood pressure to increase by 5 to 10 mmHg. Blood pressure should be measured every 4 to 6 hours during labor, and body temperature should be measured every 2 hours for mothers with ruptured membranes.
pain assessment
Fetal heart rate
The normal fetal heart rate is 110~160 beats/min. Auscultate once every hour during the latent period and once every 30 minutes during the active period. Auscultate and count for 1 minute after contractions.
uterine contractions
At the beginning, the duration of uterine contractions is short (30 to 40 seconds) and weak, and the intermission period is long (5 to 6 minutes). As labor progresses, the contractions last longer (50 to 60 seconds) and increase in intensity, and the intermission period becomes shorter (2 to 6 minutes). 3min)
Cervical dilation and fetal head descent
Cervical dilation: an important indicator for observation of labor
Descending fetal head: Whether the fetus can descend smoothly is an important observation indicator that determines whether the fetus can be delivered vaginally.
The relationship between the lowest point of the fetal skull and the plane of the ischial spine: When the lowest point of the fetal skull is level with the plane of the ischial spine, it is expressed as "0"; when it is 1cm above the plane of the ischial spine, it is expressed as "-1"; when it is 1cm below the plane of the ischial spine, Represented by "1". Generally, when the cervix is 4 to 5 cm dilated, the lowest point of the fetal head reaches the level of the ischial spine.
international 5-point scale
Partogram
Rupture of fetal membranes (rupture of membranes)
After the fetal presenting part is connected, the amniotic fluid is blocked into two parts, the front and the back. The amniotic fluid located in front of the fetal presenting part is called anterior amniotic fluid. About 100 ml helps to dilate the cervix. When the pressure within the amniotic cavity increases to a certain level, the fetal membranes naturally rupture. pH test paper can be used to detect the possibility of membrane rupture when pH≧7.0.
Nursing measures
General care and support
Provide a good environment
Pregnant women actively participate in childbirth
Replenish fluids and calories
Activities and rest
① The fetal membranes have been ruptured, the fetal head is high or in the breech position ② Combined with severe preeclampsia ③ Abnormal bleeding ④ Pregnancy complicated by heart disease should be bed rest
Urination and defecation
After labor, pregnant women are encouraged to urinate every 2 to 4 hours. When a pregnant woman complains of the urge to defecate, she should first check the degree of cervix dilation and not hold her breath for a long time to defecate.
keep clean
specialist care
Promote uterine contractions
Change body position, stimulate nipples, and inject low-dose oxytocin intravenously
Artificial membrane rupture
First determine whether the fetus is exposed into the pelvis first. Once the fetal membranes rupture, listen to the fetal heart immediately, observe the nature and outflow of amniotic fluid, whether there are uterine contractions, and record the time of membrane rupture. If the membranes have ruptured and have not given birth for more than 12 hours, antibiotics should be given to prevent infection as directed by the doctor. Pregnant women who screen positive for group B hemolytic streptococci should be given antibiotics as directed by their doctor after labor or membrane rupture.
Nursing care for women in the second stage of labor
nursing assessment
physical condition
general condition
Observe vital signs, measure blood pressure and pulse hourly, and assess bladder fullness
Uterine contractions and fetal heart rate
Contractions peak in frequency and intensity. The contractions last for about 1 minute or more, and the interval between contractions is only 1 to 2 minutes. Therefore, uterine contractions and fetal heart rate should be detected and recorded every 5 to 10 minutes, and fetal heart auscultation should be performed for 30 to 60 seconds between contractions.
Rupture of membranes and feeling of defecation
Fetal descent and delivery
During uterine contractions, the fetal head is exposed from the vaginal opening, and the exposed part continues to increase. During the interval between contractions, the fetal head will retract into the vagina, which is called fetal head exposure.
The two diameters of the fetal head cross the pelvic outlet, and the fetal head no longer retracts during uterine contractions. This is called crowning of the fetal head.
Nursing measures
General care and support
Encourage the intake of liquid, semi-liquid foods or liquids
specialist care
Guidance on delivery positions
The semi-recumbent position with knees bent is the most commonly used delivery position, but this position also compresses the pelvic blood vessels, affects the blood supply to the placenta, and is not conducive to the mother's use of abdominal pressure.
Instructing mothers to hold their breath and exert force
Correct use of abdominal pressure is key to shortening the second stage of labor.
Preparing for delivery
When the cervix of a primiparous woman is fully dilated, the cervix of a multiparous woman is 6 cm dilated, and the uterine contractions are regular and strong, preparations for delivery should be made.
Delivery
Assess the need for episiotomy
Protect the perineum and assist in the delivery of the fetal head
Treatment of umbilical cord wrapped around neck
If the umbilical cord is too tight around the neck or wraps around the neck for two or more weeks, use two hemostats to clamp one section of the cord and cut it off.
Assist in delivering the fetus
Nursing care for women in the third stage of labor
nursing assessment
physical condition
general condition
Observe whether the mother looks pale, has cold sweats, chills, or yawns
Uterine contractions and vaginal bleeding
signs of placenta detachment
The fundus of the uterus becomes hard and spherical. After the placenta is separated, it descends to the lower segment of the uterus. The lower segment passively expands, and the uterine body is pushed upward in a long and narrow shape. The fundus of the uterus rises above the umbilicus.
The stripped placenta descends to the lower segment of the uterus, and the exposed section of the umbilical cord at the vaginal opening extends on its own.
Small amount of vaginal bleeding
When you use the ulnar side of your palm to gently press the lower uterine segment above the maternal pubic symphysis, the uterine body will rise and the exposed umbilical cord will no longer be recovered.
Placenta delivery method
fetal face delivery
The placenta peels off starting from the center and then toward the periphery
The placenta was expelled first, and then a small amount of vaginal bleeding was seen.
maternal face delivery
The edge of the placenta begins to peel off first, and blood flows out along the peeling surface.
There is also more vaginal bleeding, and then the placenta is delivered
Placenta and fetal membrane integrity
perineal wound
Neonatal assessment
general condition
Newborn length, weight, body surface deformities, and birth injuries
Apgar rating
Skin color → respiration → muscle tone → reflexes → heart rate. Skin color is the most sensitive and heart rate is the indicator that eventually disappears
A score of 8 to 10 is considered a normal newborn, a score of 4 to 7 is considered mild asphyxia, and a score of 0 to 3 is considered severe asphyxia. Neonates with severe hypoxia should be evaluated again 5 to 10 minutes after birth until two consecutive scores are ≧8 points.
Nursing measures
Newborn care
Dry and keep warm
Starts in 5 seconds and completes in 30 seconds
clear respiratory tract
Treating the umbilical cord
Ligate the umbilical cord 30 to 60 seconds after birth or after the umbilical cord blood vessels have stopped moving.
Newborn exams and records
Assist in delivering the placenta
Check the placenta and fetal membranes
Check the soft birth canal
Two hours of postpartum care
general care
Measure respiratory pulse and blood pressure every 30 minutes, keep warm, wipe away sweat, and provide light, easy-to-digest diet.
Assess the amount of vaginal bleeding and prevent postpartum hemorrhage
Wait 30 minutes to observe the contraction of the uterus, the amount of vaginal bleeding, whether there is vaginal hematoma, and whether the bladder is full. If necessary, catheterize to prevent urinary retention. When the amount of bleeding exceeds 300 ml, it should be treated as postpartum hemorrhage
Promote parent-child interaction
Maintain skin-to-skin contact between mother and baby for at least 90 minutes, and assist in completing the first breastfeeding