MCN 273, NORMAL NEWBORNE: YOUR A+ GUIDE
THROUGH QUESTIONS AND ANSWERS.
Maternal Birthing Positions
Bed, birthing chiar, delivery table
Recumbent position, lithotomy
Semi-fowler's position - good for doctor, may hurt woman's hips, possible vena cava syndrome,
decreasing blood supply to perineum, increased risk of tearing
Left lateral sims position - opens hips up, improved circulation, less tearing, some patients may
feel awkward/imbalanced
Squatting position - good circulation to mom and baby, energy draining, legs may not support
her if she has an epidural, harder for the provider
Sitting position
Hands and knees position
Lacerations
Risk factors - young, nulliparous, FAVD/VAVD, episiotomy, Asian
Perineal lacerations are categorized by degree
Bright red bleeding in the presence of well-contracted uterus may indicate perineal, cervical, or
vaginal laceration
Degrees of Lacerations
First - perineal skin and vaginal mucous membrane
Second - through muscle of perineal body
Third - through anal sphincter muscle
Fourth - involves anterior rectal wall
Episiotomy
Surgical incision of perineal body
Performed to prevent damage to soft tissues and with regional/local anesthesia as crowing
occurs
Midline or mediolateral
Restricted use and not generally recommended - spontaneous tear is better because scar will
be stronger
Repaired before or after 3rd stage
Risk factors - lithotomy, "time limit" on 2nd stage
Midline Episiotomy
Vaginal orifice to fibers of real sphincter
,Mediolateral Episiotomy
Midline of posterior fourchette
45 degree angle downward to rightor left
Used for women with shorter perineum
Assisting with Infant's Birth
Support perineum
Palpate fetal neck for presence of cord
Restitution and external rotation - release anterior shoulder, bottom, then up)
Delayed cord clamp
Cut between two clamps
Cord blood collection
Examine cord (AVA)
Nursing Assessment: Delivery of Placenta
Placental separation
Signs include: gush of blood, lengthening o forced, bulge of perineum, rise of fundus in
abdomen
Over 30mins = retained = manual extraction
"shiny schultz" and "dirty Duncan"
Nursing Interventions: Delivery of Placenta
Pitocin (IV or IM) to decrease the amount of time it takes to deliver the placenta and to
minimize blood loss
Expelling the placenta through coaching maternal bear-down effort
Inspect placenta membranes and cotyledons
Vaginal and cervix inspected for lacerations
Disposal of placenta
Third Stage of Labor: Newborn Care
Assign APGARs
Newborn on mother's abdomen
Newborn in radiant-heated unit
Clear airway
Stimulate to cry
Respirations first priority
Provide and maintain warmth - dry infant, hat, skin to skin contact
Perform initial newborn assessment
"the golden hour"
Initiation of Attachment: Golden Hour
, Emotional time for family - prioritize over visitors
Lights can be dimmed
Complete assessment with baby on mother' chest, abdomen
Breastfeeding/skin-to-skin encouraged
Enhances attachment
Fourth Stage of Labor: Recovery: Nursing Assessment
~4hrs
Physiologic readjustment - EBL
Q15min - palpate fundus, VSx1hr (then 30mins until transfer to PP)
Look at fundal tone, position, accommodations
Accommodations for C/S
Assess vaginal bleeding (loch)
Assess perineum for edema, laceration, repair, hematoma)
Assess bladder
Fourth Stage of Labor: Recovery: Nursing Interventions
Continue bonding and breastfeeding
Initial latch w/in 1hf
Pain management of afterpains - involution
Report uterine atony (increased bleeding/PPH) and temp over 100.4
Comfort Measures for 4th Stage
Tremors common - heated blanket
General diet
Encourage rest
Assist with pericare and ambulation
BRP assist to void or straight Cath
Icepack/peripad, peribottle, dermoplast
Self-care - hygiene and stool softener
Transfer to PP unit when stable
Birth Related Procedures: Pre-delivery interventions
External cephalic version
IOL and augmentation of labor
Cervical Ripening
Birth Related Procedures: Delivery intervention
Forceps assisted vaginal delivery (FAVD)
Vacuum assisted vaginal delivery (VAVD)
THROUGH QUESTIONS AND ANSWERS.
Maternal Birthing Positions
Bed, birthing chiar, delivery table
Recumbent position, lithotomy
Semi-fowler's position - good for doctor, may hurt woman's hips, possible vena cava syndrome,
decreasing blood supply to perineum, increased risk of tearing
Left lateral sims position - opens hips up, improved circulation, less tearing, some patients may
feel awkward/imbalanced
Squatting position - good circulation to mom and baby, energy draining, legs may not support
her if she has an epidural, harder for the provider
Sitting position
Hands and knees position
Lacerations
Risk factors - young, nulliparous, FAVD/VAVD, episiotomy, Asian
Perineal lacerations are categorized by degree
Bright red bleeding in the presence of well-contracted uterus may indicate perineal, cervical, or
vaginal laceration
Degrees of Lacerations
First - perineal skin and vaginal mucous membrane
Second - through muscle of perineal body
Third - through anal sphincter muscle
Fourth - involves anterior rectal wall
Episiotomy
Surgical incision of perineal body
Performed to prevent damage to soft tissues and with regional/local anesthesia as crowing
occurs
Midline or mediolateral
Restricted use and not generally recommended - spontaneous tear is better because scar will
be stronger
Repaired before or after 3rd stage
Risk factors - lithotomy, "time limit" on 2nd stage
Midline Episiotomy
Vaginal orifice to fibers of real sphincter
,Mediolateral Episiotomy
Midline of posterior fourchette
45 degree angle downward to rightor left
Used for women with shorter perineum
Assisting with Infant's Birth
Support perineum
Palpate fetal neck for presence of cord
Restitution and external rotation - release anterior shoulder, bottom, then up)
Delayed cord clamp
Cut between two clamps
Cord blood collection
Examine cord (AVA)
Nursing Assessment: Delivery of Placenta
Placental separation
Signs include: gush of blood, lengthening o forced, bulge of perineum, rise of fundus in
abdomen
Over 30mins = retained = manual extraction
"shiny schultz" and "dirty Duncan"
Nursing Interventions: Delivery of Placenta
Pitocin (IV or IM) to decrease the amount of time it takes to deliver the placenta and to
minimize blood loss
Expelling the placenta through coaching maternal bear-down effort
Inspect placenta membranes and cotyledons
Vaginal and cervix inspected for lacerations
Disposal of placenta
Third Stage of Labor: Newborn Care
Assign APGARs
Newborn on mother's abdomen
Newborn in radiant-heated unit
Clear airway
Stimulate to cry
Respirations first priority
Provide and maintain warmth - dry infant, hat, skin to skin contact
Perform initial newborn assessment
"the golden hour"
Initiation of Attachment: Golden Hour
, Emotional time for family - prioritize over visitors
Lights can be dimmed
Complete assessment with baby on mother' chest, abdomen
Breastfeeding/skin-to-skin encouraged
Enhances attachment
Fourth Stage of Labor: Recovery: Nursing Assessment
~4hrs
Physiologic readjustment - EBL
Q15min - palpate fundus, VSx1hr (then 30mins until transfer to PP)
Look at fundal tone, position, accommodations
Accommodations for C/S
Assess vaginal bleeding (loch)
Assess perineum for edema, laceration, repair, hematoma)
Assess bladder
Fourth Stage of Labor: Recovery: Nursing Interventions
Continue bonding and breastfeeding
Initial latch w/in 1hf
Pain management of afterpains - involution
Report uterine atony (increased bleeding/PPH) and temp over 100.4
Comfort Measures for 4th Stage
Tremors common - heated blanket
General diet
Encourage rest
Assist with pericare and ambulation
BRP assist to void or straight Cath
Icepack/peripad, peribottle, dermoplast
Self-care - hygiene and stool softener
Transfer to PP unit when stable
Birth Related Procedures: Pre-delivery interventions
External cephalic version
IOL and augmentation of labor
Cervical Ripening
Birth Related Procedures: Delivery intervention
Forceps assisted vaginal delivery (FAVD)
Vacuum assisted vaginal delivery (VAVD)
