• Braxton Hicks: irregular painless contractions. Typically become more frequent and
noticeable during the last few weeks. Usually more felt and pronounced in Primigravida
women. If closer to the time of delivery she may think this is true labor pains.
• Cervical Changes: due to hormonal changes beginning about 35 weeks the cervix begins
to mature and ripen and becomes softer.
• Bloody Show: release of the mucus plug from the cervix. May happen before labor
begins; typically labor begins within 48 hours after losing the mucus plug. Some
womendon’t lose it until they are in labor at the hospital.
• Rupture of Membranes: rupture of amniotic fluid, the first sign for some women and
others
have to have their water artificially broken. Typically want you to deliver within 24
hours. Complications if you don’t go to the hospital: Risk for infection and prolapse
umbilical cord (when water breaks, the pressure can wash out the umbilical cord before
the presenting part of the baby.)
• Weight Loss: 1-3 lbs. from fluid and electrolyte shifts.
• Increased Backache: from the influence of the relaxant hormone on the pelvic joints.
• Diarrhea, Indigestion, Nausea, or Vomiting just before labor onset.
• Difference Between True and False Labor:
o True Labor: contractions are at regular intervals, intervals gradually shorten,
increase in duration and intensity, the discomfort begins in the back and radiates
aroundto the abdomen, intensity usually increases with walking, cervical
dilatation, and effacement are progressive, and contractions do not decrease
with rest or warm tub bath.
o False Labor: contractions are irregular and have no pattern between them, no
change
in intervals, no change in duration and intensity, discomfort is usually in the
abdomen, walking has no effect on or lessens contractions, no change in dilation
or effacement, and rest and warm tub baths lessen contractions.
Pain Management (Chapter 9):
• Pain Management Principles & Techniques: Research has shown that women report
higher levels of satisfaction with their labor experience when they feel a high degree of
control over the experience of pain. Always inform the woman of her pain management
options and be supportive of her choices.
• Nonpharmacological Pain Relief Methods:
o Continuous Labor Support: usually done with a trained nurse (Doula – a trained
layperson, who supports and coaches a woman during labor.)
o Comfort Measures: lip balm to keep lips moist, ice chips, lollipops, and clear
liquids to moisten the mouth. Keep the linens clean and dry and perineal care
when needed.
o Relaxation Techniques: patterned breathing – deep cleansing breaths; attention
focusing or guided imagery – a place that she can relax in or bring a picture of
another child; movement and positioning – whatever is comfortable for her,
, positioning or ambulating; touch and massage – Effleurage (a form of touch that
involves light circular fingertip movements on the abdomen – can do it herself or
have someone do it for her); water therapy – depends on the facility; and Hypnosis
–taking the mind to another place.
o Acupressure and Acupuncture: the goal is to restore balance by promoting the
flow
of energy which decreases muscle tension, promotes relaxation, and decreases the
sensation of pain. Acupressure – another form of massage & acupuncture – is an
actual puncture on a pressure point.
• Pharmacologic Pain Relief Methods:
o Analgesia: use of meds to reduce the sensation of pain.
o Anesthesia: use of meds to partially or block all sensations to an area of thebody.
o Sedatives: promote sedation and relaxation.
o Opioids: meds with opium-like properties, AKA Narcotic analgesics, most
frequently administered medications to provide analgesia during labor. Ex.
Demerol, Stadol, or sublimaze. Typically given IVs, help reduce but doesn't
eliminate pain sensations, always consider the risk of side effects, and these do
cross the placenta – respiratory depression is usually an issue with the newborn
(may give Narcan to the baby after delivery).
o Anesthesia: Three basic types – local, regional, and general.
▪ Local: used to numb the perineum just before birth to allow for
episiotomy and repair. If she needs suturing after delivery and hasn’t had
an epidural.
▪ General: when going into surgery – puts you completely out.
▪ Regional: involves blocking a group of sensory nerves that supply a
particular organ or area of the body.
• Pudendal Block: given just before the baby is born to provide pain
relief for the birth, where the physician injects a local anesthetic
bilaterally into the vaginal wall to block pain sensations to the
Pudendal nerve. Can be helpful for instrument assisted deliveries
and a repair of an episiotomy or a perineal tear.
• Paracervical Block: involves the injection of a local anesthetic in
the area close to the cervix. Provides significant pain relief during
the first stage of labor but can’t be used once the cervix is
completely dilated. Many physicians don’t perform because of the
risk of fetal bradycardia.
• Epidural: methods provide excellent pain relief often completely
blocking the pain sensation. Informed consent must be signed
before the consent of the paper. The anesthesiologist places a small
catheter into the epidural space and injects the catheter with a local
anesthetic or opioid to relieve pain. Potential for many Side
, Effects: maternal hypotension (#1 side effect), to prevent
hypotension a 500-2000 bolus (prevents hypotension, increases
volume) is required before epidural meds are administered. If
hypotension occurs, vasopressors are usually given to raise BP or
given ephedrine.
o Positioning for Procedure: involves the woman sitting up
on the side of the bed with the feet dangling and the spine
arched or side-lying. Can be more difficult to palpate the
spaces in the vertebrae in heavier women. HR, BP, &
O2Sat are monitored continuously. Dr. prepares a sterile
field, the woman’s back is prepped with alcohol or
betadine, a local is injected, a special needle is inserted into
the epidural space and a testing dose is administered to see
how the woman feels, if no problems then the catheter is
placed and the needle is removed and the catheter is taped
to the woman’s back. The medication is either bolus or
continuous (fentanyl).
o Advantages: Provides more effective pain relief than
opioid analgesia, often usually eliminates the pain, the
anesthesia can be continued indefinitely if the woman
needs a C-Section the epidural can be used to provide
anesthesia, and side effects are rare.
o Disadvantages: often impairs motor function which
decreases the ability to walk during labor. Women
frequently need a catheter. Increases the need for labor
augmentation with Oxytocin, particularly if given before
5cm dilation. Vacuum assistance and forceps are more
frequently required because she can’t feel the urge to push.
Increases the likelihood of maternal fever. It must be
administered by an anesthesiologist. It requires complex
nursing care (more monitoring of the woman).
o Side Effects: Maternal Hypotension, maternal fever,
shivering (uncontrollable), itching, accidental intrathecal
puncture [wet tap – usually results in a spinal headache –
will give a blood patch (giving 10-20mL of the woman’s
blood into the epidural space)], inadequate pain relief or a
failed block, and fetal distress.
04-08-2016
Intrapartum Nursing Assessment (Chapter 10)
, • Labor and Delivery nurses have responsibilities for recognizing and interpreting fetal
monitoring patterns, notifying physicians or nurse midwives of problems, and
initiating corrective and supportive measures when needed.
Upon Admission: (Things done as an immediate assessment)
• Check Birth Imminence – How likely is birth going to happen quickly?
• Fetal Status – hook her up to a Fetal Heart Rate Monitor
• Quick Risk Assessment – check membrane status – has their water broken, what color is
it? Are they having any vaginal bleeding? And any other problems they may report or you
may find.
• Maternal Status – vital signs, the overall health status of the mother.
Components of the Admission Health History:
• Obstetric History: GTPAL status, EDD, history of prenatal care for current pregnancy,
complications during pregnancy, childbirth preparation classes, and premature labor
and birth experiences.
• Current Labor Status: time of contraction onset, contraction pattern including
frequency, duration and intensity, and status of membranes.
• Medical-Surgical History: chronic illness, current medications
• Social History: marital status, support system, cultural/religious considerations that
affect care, and the use of tobacco, alcohol, or other drugs.
• Desires/Plans for Labor and Birth: birth plan, pain management preferences, presence
of a partner, coach, and/or doula.
• Desires/Plans for Newborn: plans for feeding, choice of a pediatrician,
circumcisionpreference on an infant, and rooming-in preference.
After History is obtained (Routine Orders)
• IV may be started, usually using a large bore catheter.
• The phlebotomist will come to draw labs (CBC)
• Hooked up to monitors
Evaluating Labor Process
• Uterine Activity Assessment:
o Palpation: a technique used to assess a uterine contraction by touch. The
nurse places the fingertips of one hand at the top of the uterus (Fundus) – can
assess frequency and duration.
o Electronic Monitor:
▪ External Method: done with a toco transducer – an external way of
monitoring uterine contractions, placed on the maternal abdomen at or
near the fundus, it’s held in place with an elastic band. Find the fundus;
noticeable during the last few weeks. Usually more felt and pronounced in Primigravida
women. If closer to the time of delivery she may think this is true labor pains.
• Cervical Changes: due to hormonal changes beginning about 35 weeks the cervix begins
to mature and ripen and becomes softer.
• Bloody Show: release of the mucus plug from the cervix. May happen before labor
begins; typically labor begins within 48 hours after losing the mucus plug. Some
womendon’t lose it until they are in labor at the hospital.
• Rupture of Membranes: rupture of amniotic fluid, the first sign for some women and
others
have to have their water artificially broken. Typically want you to deliver within 24
hours. Complications if you don’t go to the hospital: Risk for infection and prolapse
umbilical cord (when water breaks, the pressure can wash out the umbilical cord before
the presenting part of the baby.)
• Weight Loss: 1-3 lbs. from fluid and electrolyte shifts.
• Increased Backache: from the influence of the relaxant hormone on the pelvic joints.
• Diarrhea, Indigestion, Nausea, or Vomiting just before labor onset.
• Difference Between True and False Labor:
o True Labor: contractions are at regular intervals, intervals gradually shorten,
increase in duration and intensity, the discomfort begins in the back and radiates
aroundto the abdomen, intensity usually increases with walking, cervical
dilatation, and effacement are progressive, and contractions do not decrease
with rest or warm tub bath.
o False Labor: contractions are irregular and have no pattern between them, no
change
in intervals, no change in duration and intensity, discomfort is usually in the
abdomen, walking has no effect on or lessens contractions, no change in dilation
or effacement, and rest and warm tub baths lessen contractions.
Pain Management (Chapter 9):
• Pain Management Principles & Techniques: Research has shown that women report
higher levels of satisfaction with their labor experience when they feel a high degree of
control over the experience of pain. Always inform the woman of her pain management
options and be supportive of her choices.
• Nonpharmacological Pain Relief Methods:
o Continuous Labor Support: usually done with a trained nurse (Doula – a trained
layperson, who supports and coaches a woman during labor.)
o Comfort Measures: lip balm to keep lips moist, ice chips, lollipops, and clear
liquids to moisten the mouth. Keep the linens clean and dry and perineal care
when needed.
o Relaxation Techniques: patterned breathing – deep cleansing breaths; attention
focusing or guided imagery – a place that she can relax in or bring a picture of
another child; movement and positioning – whatever is comfortable for her,
, positioning or ambulating; touch and massage – Effleurage (a form of touch that
involves light circular fingertip movements on the abdomen – can do it herself or
have someone do it for her); water therapy – depends on the facility; and Hypnosis
–taking the mind to another place.
o Acupressure and Acupuncture: the goal is to restore balance by promoting the
flow
of energy which decreases muscle tension, promotes relaxation, and decreases the
sensation of pain. Acupressure – another form of massage & acupuncture – is an
actual puncture on a pressure point.
• Pharmacologic Pain Relief Methods:
o Analgesia: use of meds to reduce the sensation of pain.
o Anesthesia: use of meds to partially or block all sensations to an area of thebody.
o Sedatives: promote sedation and relaxation.
o Opioids: meds with opium-like properties, AKA Narcotic analgesics, most
frequently administered medications to provide analgesia during labor. Ex.
Demerol, Stadol, or sublimaze. Typically given IVs, help reduce but doesn't
eliminate pain sensations, always consider the risk of side effects, and these do
cross the placenta – respiratory depression is usually an issue with the newborn
(may give Narcan to the baby after delivery).
o Anesthesia: Three basic types – local, regional, and general.
▪ Local: used to numb the perineum just before birth to allow for
episiotomy and repair. If she needs suturing after delivery and hasn’t had
an epidural.
▪ General: when going into surgery – puts you completely out.
▪ Regional: involves blocking a group of sensory nerves that supply a
particular organ or area of the body.
• Pudendal Block: given just before the baby is born to provide pain
relief for the birth, where the physician injects a local anesthetic
bilaterally into the vaginal wall to block pain sensations to the
Pudendal nerve. Can be helpful for instrument assisted deliveries
and a repair of an episiotomy or a perineal tear.
• Paracervical Block: involves the injection of a local anesthetic in
the area close to the cervix. Provides significant pain relief during
the first stage of labor but can’t be used once the cervix is
completely dilated. Many physicians don’t perform because of the
risk of fetal bradycardia.
• Epidural: methods provide excellent pain relief often completely
blocking the pain sensation. Informed consent must be signed
before the consent of the paper. The anesthesiologist places a small
catheter into the epidural space and injects the catheter with a local
anesthetic or opioid to relieve pain. Potential for many Side
, Effects: maternal hypotension (#1 side effect), to prevent
hypotension a 500-2000 bolus (prevents hypotension, increases
volume) is required before epidural meds are administered. If
hypotension occurs, vasopressors are usually given to raise BP or
given ephedrine.
o Positioning for Procedure: involves the woman sitting up
on the side of the bed with the feet dangling and the spine
arched or side-lying. Can be more difficult to palpate the
spaces in the vertebrae in heavier women. HR, BP, &
O2Sat are monitored continuously. Dr. prepares a sterile
field, the woman’s back is prepped with alcohol or
betadine, a local is injected, a special needle is inserted into
the epidural space and a testing dose is administered to see
how the woman feels, if no problems then the catheter is
placed and the needle is removed and the catheter is taped
to the woman’s back. The medication is either bolus or
continuous (fentanyl).
o Advantages: Provides more effective pain relief than
opioid analgesia, often usually eliminates the pain, the
anesthesia can be continued indefinitely if the woman
needs a C-Section the epidural can be used to provide
anesthesia, and side effects are rare.
o Disadvantages: often impairs motor function which
decreases the ability to walk during labor. Women
frequently need a catheter. Increases the need for labor
augmentation with Oxytocin, particularly if given before
5cm dilation. Vacuum assistance and forceps are more
frequently required because she can’t feel the urge to push.
Increases the likelihood of maternal fever. It must be
administered by an anesthesiologist. It requires complex
nursing care (more monitoring of the woman).
o Side Effects: Maternal Hypotension, maternal fever,
shivering (uncontrollable), itching, accidental intrathecal
puncture [wet tap – usually results in a spinal headache –
will give a blood patch (giving 10-20mL of the woman’s
blood into the epidural space)], inadequate pain relief or a
failed block, and fetal distress.
04-08-2016
Intrapartum Nursing Assessment (Chapter 10)
, • Labor and Delivery nurses have responsibilities for recognizing and interpreting fetal
monitoring patterns, notifying physicians or nurse midwives of problems, and
initiating corrective and supportive measures when needed.
Upon Admission: (Things done as an immediate assessment)
• Check Birth Imminence – How likely is birth going to happen quickly?
• Fetal Status – hook her up to a Fetal Heart Rate Monitor
• Quick Risk Assessment – check membrane status – has their water broken, what color is
it? Are they having any vaginal bleeding? And any other problems they may report or you
may find.
• Maternal Status – vital signs, the overall health status of the mother.
Components of the Admission Health History:
• Obstetric History: GTPAL status, EDD, history of prenatal care for current pregnancy,
complications during pregnancy, childbirth preparation classes, and premature labor
and birth experiences.
• Current Labor Status: time of contraction onset, contraction pattern including
frequency, duration and intensity, and status of membranes.
• Medical-Surgical History: chronic illness, current medications
• Social History: marital status, support system, cultural/religious considerations that
affect care, and the use of tobacco, alcohol, or other drugs.
• Desires/Plans for Labor and Birth: birth plan, pain management preferences, presence
of a partner, coach, and/or doula.
• Desires/Plans for Newborn: plans for feeding, choice of a pediatrician,
circumcisionpreference on an infant, and rooming-in preference.
After History is obtained (Routine Orders)
• IV may be started, usually using a large bore catheter.
• The phlebotomist will come to draw labs (CBC)
• Hooked up to monitors
Evaluating Labor Process
• Uterine Activity Assessment:
o Palpation: a technique used to assess a uterine contraction by touch. The
nurse places the fingertips of one hand at the top of the uterus (Fundus) – can
assess frequency and duration.
o Electronic Monitor:
▪ External Method: done with a toco transducer – an external way of
monitoring uterine contractions, placed on the maternal abdomen at or
near the fundus, it’s held in place with an elastic band. Find the fundus;
