Question

Week 3 Discussion Board 1: Intrapartum

a. Explain fetal lie, fetal attitude, and fetal position.
b. How will you teach a pregnant mother to differentiate between true and false labor?
c. Describe the 4 stages of labor and the nursing interventions associated with each stage. Provide rationales.

Answer 1

1)Intrapartum

The time period spanning childbirth,from the onset of labour through delivery of placenta.intrapartum can refer to both the woman and the foetus

1a)Fetal lie

Fetal lie refers to the relationship between the long axis of the foetus with respect to the long axis of the mother.The possibilities include a longitudinal lie,a transverse lie,and on occasion an oblique lie.

.Fetal attitude

The fetal attitude describes the position of the parts of your baby's body.The normal fetal attitude is commonly called the fetal position.The head is tucked down to the chest .The arms and legs are drawn towards the centre of the chest

.Fetal position

Fetal position is the positioning of the body of a prenatal fetus as it develops.In this position,the back is curved,the head is bowed,and the limbs are bent and drawn up to the torso .This position is used in the medical profession to minimize injury to the neck and chest.

b)False vs True labour

The timing of the contraction is a big component for recognizing the difference between true and false labour.

It's false labour if;

.contractions don't come regularly and they don't get closer together

.They stop with walking or resting or with changes in position

.They are usually weak and don't get stronger,or start strong and yet weaker

.usually the pain is only felt in the front

Its true labor if;

.contractions come and get closer over time,lasting about 30-70 seconds each

.They continue regardless of movement or resting

.They progressively get stronger

. Usually they start in the back and move to the front

c) Stages of labor

There are four stages of labour

I)First stage of labour

Thinning (effacement )and opening (dilation) of the cervix.

During the first stage of labor,contractions help your cervix to thin and begin to open .This is called effacement and dilation.As your cervix dilates ,your health care provider will measure the opening in centimeters.The first stage of labor has three parts;

1)Early labor

Your cervix opens to 4 centimeters.you will probably spend most of early labor at home.Try to keep doing your usually activities.Relax,rest and drink fluids,eat light meals if you want to,and keep track of your contractions.contractions may go away if you change activity,but over time they will get stronger.when you notice a clear change in how frequent,how strong,how long your contractions are,and when you can no longer talk during a contraction,you are probably moving into active labor

2)Active labor

Your cervix opens from 4-7 centimeters.This is when you should head to the hospital.when you have contractions every 3-4 minutes and they each last about 60 seconds,it often means that your cervix is opening faster.

3)Transition to second stage

Your cervix open from 7-10 centimetres for most women,this is the hardest or most painfull part of labor.This is when your cervix opens to the fullest.contractions last about 60-90 seconds and come every 2-3 minutes

Nursing interventions for the first stage;

.inform patient on progress of her labor

.Assist patient with pant -blow breathing

.Monitor maternal vital signs and fetal heart rate every 30 minutes.

.when perineal bulging is noticeable prepare for delivery.checkroom temperature .The nurse should also notify staff and prepare necessary suppliment and equipment

II)Second stage of labour

Second stage of labor starts when cervical dilatation reaches 10 cm and ends when the baby is delivered.At this stage the patient feels an uncontrollable urge to push.The patient may also experience temporary nausea together with increased restlessness and shaking of extremities.The nurse at this stage must coach quality pushing and support delivery

nursing interventions;

a)Instruct patient for quality pushing.The abdominal muscles must aid the involuntary uterine contractions to deliver the baby out

b)provide a quiet environment for the patient to concentrate on bearing down

c)provide positive feedback as the patient pushes

d)Take note of the time of delivery and proceed to initiate essential newborn care,delayed cord clamping is recommended

e)Assist in restrictive episiotomy for patients who had vaginal births.

III)Third stage of labor

Third stage or the placental stage starts from birth of infant to delivery of placenta.it is divided into two separate phases;

Placental separation and placental expulsion.Five minutes after delivery of baby ,the uterus begins to contract again,and placenta starts to separate from contracting wall.blood loss of 300-500 mL occurs as a normal consequence of placental separation.The placenta is then expelled using gentle traction on the cord

Signs of placental separation;

1)lengthening of umbilical cord

2)sudden gush of vaginal blood

3)change in shape of the uterus

4)Appearance of placenta in the vaginal opening

Nursing interventions

a)Encourage skin to skin contact to facilitate bonding and early breastfeeding

b)Administer prophylactic oxytocin in as ordered

c)Utilize controlled cord traction technique for placental expulsion

d)Utilize absorbable synthetic suture materials for primary repair of episiotomy or perineal lacerations.

IV)Fourth stage of labor

Your baby is born,the placenta has delivered,and you and your partner probably feel enjoy,relief and fatique.Most babies are ready to nurse with in a short period after birth.others wait a little longer.Nursing right afterbirth will help your uterus to contract and will decrease the amount of bleeding

Nursing interventions

a)Early (<6 hours)resumption of feeding for patients who have vaginal birth

b)prophylactic Antibiotics for women who sustained third to fourth degree of perineal tear during delivery

c)In healthy women who delivered vaginally to term infants ,early postpartum discharge is recommended.

d)Bathing and sitz bath.to prevent infections after delivery.