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Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Birth-Related Procedures
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome
Explain the methods, purpose, and contraindications of external and podalic
versions that determine nursing care management.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
External Version
• May be done after 36 weeks’ gestation to change breech presentation to cephalic presentation
• Physician applies external manipulation to maternal abdomen
• Fetal part must not be engaged
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
External Version
• Reactive NST performed to establish fetal well-being
• Tocolytic given during procedure to relax the uterus
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Internal Version
• Podalic version – used to turn second twin during vaginal birth
• Used only if second fetus does not descend readily and heartbeat is not assuring
• Physician reaches into uterus and grabs feet of fetus and pulls them down through cervix
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Internal Version
• Tocolytic given during procedure to relax uterus
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome
Describe the use of amniotomy and the nursing care management of woman and
fetus.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Purpose of Amniotomy
• Stimulate or induce labor• Apply internal fetal or contraction monitors• Obtain fetal scalp blood sample for pH
monitoring• Assess color and composition of amniotic
fluid
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome
Compare the methods for inducing labor, explaining their advantages and
disadvantages in determining the nursing management for women during labor
induction.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Cervical Ripening
• Consists of effacement and softening of the cervix
• May be used at or near term to enhance success of and reduce time needed for labor induction when continuing pregnancy is undesirable
• May hasten beginning of labor or shorten course of labor
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Cervical Ripening
• May cause hyperstimulation of uterus• Pharmacologic agents include Cytotec and
prostaglandin agents – can cause uterine stimulation after insertion
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Stripping of the Membranes
• Mechanical method: Gloved finger inserted into internal os and rotated 360 degrees twice – separating amniotic membranes lying against lower uterine segment
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Stripping of the Membranes
• Does not require monitoring or other assessments – often done as outpatient service
• May not induce labor – if labor is initiated, it typically begins within 48 hours
• May cause bleeding
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Pitocin Infusion
• Usually effective at producing contractions – may cause hyperstimulation of the uterus
• Requires small, precise dosage• Maximum rate and dosing interval based
on facility protocol, clinician order, individual situation, and maternal-fetal response
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Pitocin Infusion
• Palpating uterus essential, unless IUPC in place
• May initially decrease blood pressure
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome 23-4
Describe the measures to preventepisiotomy, the types of episiotomy and associated nursing care management.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Episiotomy Types
• Surgical incision of perineal body to enlarge outlet – commonly used to avoid spontaneous laceration
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Episiotomy Types
• Two types– Midline: Incision begins at bottom center of
perineal body and extends straight down midline to fibers
– Mediolateral: Incision begins in midline of posterior fourchette and extends at 45 degree angle downward to right or left
• Episiotomy usually performed with regional or local anesthesia
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Types of Episiotomy
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Nursing Care
• During procedure, provide mother with support and comfort
• Use distraction if needed – if procedure is uncomfortable, act as advocate for mother
• Document type of episiotomy in records and report to subsequent caregivers
• After procedure, provide comfort and apply ice pack
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Nursing Care
• Assess perineal area frequently – inspect every 15 minutes during first hour after birth for redness, edema, tenderness, ecchymosis, and hematomas
• Apply ice pack immediately in fourth stage• Instruct mother in perineal hygiene and
comfort measures
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome
Explain the indications, maternal and neonatal risks that impact nursing care
management during forceps-assisted birth.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Indications
• Maternal heart disease• Maternal pulmonary edema• Maternal infection• Maternal exhaustion• Fetal stress
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Indications
• Premature placental separation• Need for shorter second stage of labor• Heavy regional block with ineffective
pushing
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Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Applications of Forceps
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Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Applications of Forceps
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Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Applications of Forceps
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Risks
• Newborn may experience– Bruising– Edema– Facial lacerations– Cephalhematoma– Transient facial paralysis– Cerebral hemorrhage
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Risks
• Woman may experience– Vaginal or perineal lacerations– Infection secondary to lacerations– Increased bleeding– Bruising– Perineal edema
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome
Describe the use of and risk of vacuum extraction use to assist birth.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Vacuum Extractor
• Assists birth by applying suction to fetal head
• Should be progressive descent with first two pulls, procedure should be limited to prevent cephalhematoma – risk increases if birth not within six minutes
• Increases risk for jaundice – due to reabsorption of bruising at cup attachment site
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Vacuum Extractor
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome
Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing
care.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Indications
• Most common indications for cesarean birth– Fetal distress– Active genital herpes– Multiple gestation (three or more fetuses)– Umbilical cord prolapse– Tumors that obstruct birth canal– Lack of labor progression
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Indications
• Most common indications for cesarean birth– Maternal infection– Pelvic size disproportion– Placenta previa– Previous cesarean section
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Preparation
• Preparation for cesarean birth requires– Establishing IV lines– Placing indwelling catheter– Performing abdominal prep
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Teaching
• Teaching needs include– What to expect before, during, and after
delivery– Why it is being done– What sensations the woman will experience– Role of significant others– Interaction with newborn
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Nursing Care
• Routine postpartal care including:– Fundal checks– Care of incision– Monitoring Intake & Output and maintaining IV
access– Administer and teach about post-op
medications– Assessment of respiratory system– Assessment of bowel sounds
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Uterine Incisions for Cesarean Birth
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Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Uterine Incisions for Cesarean Birth
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Uterine Incisions for Cesarean Birth
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Learning Outcome
Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth
following cesarean birth.
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Vaginal Birth After Cesarean Birth
• Can occur after trial of labor in cases of nonrecurring indications for cesarean birth
• Most common risks are– Hemorrhage– Surgical injuries– Uterine rupture– Infant death or neurological complications
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Nursing Care
• Continuous EFM• Internal Monitoring• IV fluids• Avoid Pitocin if at all possible• Classic or T uterine incision is
contraindication to VBAC
Copyright ©2011 by Pearson Education, Inc.All rights reserved.
Maternal & Child Nursing Care, Third EditionLondon • Ladewig • Ball • Bindler • Cowen
Nursing Care
• Important for nurse to support couple, explore their feelings, and provide information throughout labor