CARE FOR THE MOTHER AND THE GROWING FETUS

Intrapartum Care

INTRAPARTUM CARE

Intended Learning Outcomes:

At the end of the session, the students shall be able to:

A. Describe the process of labor in terms of the passenger, passageway, powers, placenta and
psyche.
B. Describe the nursing care needed during the different stages of labor.
C. Differentiate True and False labor
D. Trace the cardinal movements of the fetus during delivery.
E. Identify nursing responsibilities during the administration of analgesia and anesthesia.
F. Plan nursing care to promote safe and quality labor and delivery experience of the mother.

Content:

LECTURE: PPT presentation

 Labor and Delivery
 Labor_Maternal and Fetal Nursing Care

Intrapartum

Intrapartum - occurring or provided during the act of birth

Intranatal - occurring chiefly with reference to the child during the act of birth

Intrapartum Care

It is the care of healthy women and their babies during childbirth.

Definition of terms:

Fetal Presentation denotes the body part that will first contact the cervix or be born first. It is
determined by by the combination of the fetal lie and the degree of flexion(attitude)
 Breech presentation The presenting part is the bottom of the baby that leads the way
through the birth canal
 Cephalic presentation The presenting part is the head of the baby that leads the way
through the birth canal
Fetal attitude describes the relation of the fetal parts to each other. The normal fetal attitude is
commonly called the fetal position (good attitude): (a) The head is tucked down to the
chest. (b) The arms and legs are drawn in towards the center of the chest.
Fetal lie This refers to the relationship between the long axis of the fetus to the long axis of the
mother.
Fetal position the relationship of the presenting part to a specific quadrant and side of a
woman’s pelvis. It is indicated by an abbreviation of three letters.
Dilatation refers to the enlargement or widening of the cervical canal
Effacement is the shortening and thinning of the cervical canal
Engagement refers to the settling of the presenting part of the fetus far enough into the pelvis
that it rests at the level of the ischial spines, the midpoint of the pelvis (0 station)
Station refers to the relationship of the presenting part of the fetus to the level of the ischial
spines
Leopold’s maneuver is a series of systematic palpation of the gravid uterus. This method of
abdominal palpation is of low cost, easy to perform, and non-invasive. It is used to
determine the position, presentation, and engagement of the fetus in utero.

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Intrapartum Care

Labor is the series of events by which uterine contractions and abdominal pressure expel a
fetus and placenta from the uterus.

Theories on Labor (why labor begins)

Uterine Stretch Theory - any hollow body organ when stretched to capacity will
necessary contract and empty.

Oxytocin Theory - labor, being considered as an stressful event, stimulates the

hyphophysis to produce oxytocin from the posterior pituitary gland. Oxytocin causes
contraction of smooth muscles of the body.

Progesterone Deprivation Theory - progesterone, being the hormone designed to

promote pregnancy, is believed to inhibit uterine motility. Decreased Progesterone -
labor pains

Prostaglandin Theory - initiation of labor is said to result from the release of

arachidonic acid produced by steroid action on lipid precursors. Arachidonic Acid -
increase prostaglandin synthesis - uterine contraction.

Theory of Aging Placenta - decrease in blood supply causes uterine contraction

Chapter 15 Nursing Care of a Family during Labor and delivery

Silbert-Flagg, J. (2018). Maternal and child health nursing: care of the
childbearing and childrearing family, pp 326-371

Stages of Labor https://spup.lecturio.com/#/lecture/c/8352/28714

Labor Stage 1: Normal and Abnormal Labor https://spup.lecturio.com/#/lecture/c/8352/28716
Labor Stage 1: FHR Tracing https://spup.lecturio.com/#/lecture/c/8352/28718
Labor Stage 1:Obstetric Anesthesia https://spup.lecturio.com/#/lecture/c/8352/28720
Labor Stage 2: Normal and Abnormal Labor https://spup.lecturio.com/#/lecture/c/8352/28722
Labor Stage 3: Placenta Delivery https://spup.lecturio.com/#/lecture/c/8352/28728
Labor Stage 3:Laceration and Episiotomy https://spup.lecturio.com/#/lecture/c/8352/28734

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Intrapartum Care

Providing Comfort during Labor and Birth

The experience of childbirth is a subjective and multidimensional issue (Czech, et. Al,
2018) pain accompanies labor contractions for several different reason sand manifest
itself in different ways for each woman (Silbert-Flagg & Pillitteri,2018).

Pain is a localized or generalized unpleasant bodily sensation or complex of sensations that

causes mild to severe physical discomfort and emotional distress and typically results from
bodily disorder (https://www.merriam-webster.com/dictionary/pain).

Labor and Maguire (2008) as cited by Czech, et. Al (2018), labour pain has its two
elements: visceral and somatic. The visceral one occurs during the first stage of labour and
it is connected with the tension exerted on the cervix, which causes its dilatation. That is
felt by a parturient as a pain. The somatic kind of pain appears at the end of the first stage
and it lasts also in the second stage. It is a result of the force exerted on the vaginal part of
the cervix, the vagina and the perineum. Labour pain management is not only a crucial
concern for future mothers but also a great challenge in modern medicine.

Comfort and Non-pharmacological Measures

A. Support from Duola or Coach

The doula is a professional trained in childbirth who provides emotional, physical, and
educational support to a mother who is expecting, is experiencing labor, or has recently
given birth. Their purpose is to help women have a safe, memorable, and empowering
birthing experience (APA, 2019).

B. Complementary and alternative therapies

Alternative and complementary therapies are based on a balance of body, mind, and spirit
(Koehn, 2000). Muñoz-Sellés, Vallès-Segalés and Goberna-Tricas (2013) stated that
scientific evidence for Complementary and Altenative Medicine and Complementary and
Altenative Therapies in the field of obstetrics mainly covers pain relief in labor.

a. Relaxation
Relaxation keeps the abdominal wall from becoming tense, allowing the uterus to
rise with contractions without pressing against the hard abdominal wall.
b. Focusing and Imagery
Concentrating intently on an object is another methods of distraction
c. Spirituality
d. Breathing Techniques
e. Herbal Preparations
f. Aromatheraphy and Essential oil
Aromatherapy is the use of aromatic oils to complement emotional and physical
well-being.
g. Heat or Cold Application
The application of heat and cold has been investigated as effective ways to help
relieve the pain of labor. In a research conducted by Ganji, Shirvani, Rezaei-Abhari,
and Danesh (2013), it was concluded that intermittent local heat and cold therapy is a
no pharmalogical, safe and effective method to relief labor pain. Also, application
of heating pads, instant hot pack, or warm moist compress is said to extremely
comforting to lower back pain. Heat applied to the perineum also produces a double
effect by soothing and softening the perineum, thus decreases the risk of perineal
tears.

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h. Bathing and hydrotherapy

Hydrotherapy which is treated on the giving birth mother during the active phase is
proven effective in decreasing the pain and anxiety, preventing long parturition,
decreasing the action of obstetrics such as episiotomy and amniotomy, increasing the
prosperity of the mother and the newborn baby, and giving positive labor experience
for the mother. Hydrotherapy is effective in decreasing the labor pain (Rahayu,
Kurniawati & Nuzuliana, 2019)

One study each found that hydrotherapy reduced maternal anxiety and fetal
malpresentation, increased maternal satisfaction with movement and privacy, and
resulted in cervical dilation progress equivalent to standard labor augmentation
practices (Shaw-Battista, 2017)

i. Therapeutic touch and Massage

Therapeutic touch developed by Krieger in 1990 is defined as laying of the hands to
redirect energy fields that lead to pain. Touching ensures physical, emotional and
spiritual relaxation, confidence, peace, calmness and well-being, and increases
self-esteem. Women in the intervention group in a research conducted by Sukran and
Pinar (2021)reported a decrease in pain and anxiety levels, and more positive
attitudes towards childbirth after therapeutic touch.

Effleurage is a massage technique that encourages relaxation, blood circulation and

lymph flow. It increases circulation by increasing the temperature of muscles and
preparing them for more vigorous massage techniques.

j. Yoga and Meditation

Campbell and Nolan (2019) theorized that yoga for pregnancy enhances women's
self-efficacy for labour by building their confidence and competence through a
combination of techniques.

Yoga is an ancient and complex practice, rooted in Indian philosophy. It began as a

spiritual practice but has become popular as a way of promoting physical and mental
well-being (National Center for Complementary and Integrative Health, n.d).

Meditation, a type of mind-body medicine, has been practiced for thousands of years.
During meditation, you develop intentional focus — minimizing random thoughts
about the past or future (MayoClinic, n.d.).

k. Reflexology
Reflexology is a non-invasive complementary health therapy that can be effective in
promoting deep relaxation and wellbeing; by reducing stress in people’s lives can be
key in optimising good health and building resilience. It is a touch therapy that is
based on the theory that different points on the feet, lower leg, hands, face or ears
correspond with different areas of the body(Association of Reflexologists, n.d)

l. Hypnosis
Hypnosis, also referred to as hypnotherapy or hypnotic suggestion, is a trance-like
state in which you have heightened focus and concentration. Hypnosis is usually
done with the help of a therapist using verbal repetition and mental
images(MayoClinic, n.d.).

Hypnosis interventions can reduce the consumption of pain relief medicines, and
also increase the rate of normal vaginal delivery(Arab R, PourAsghar Arabi M,
Khani S, Khademloo M, Rahmani Z, Atarod Z et al .(2021).

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m. Biofeedback
Biodfeedback is based on the belief that people have control and can regulate
internal events such as heart rate and pain responses.

n. Transcutaneous Electrical Nerve Stimulation (TENS)

o. Intracutaneous Nerve Stimulation

p. Acupuncture and Acupressure

Pharmacologic Measures

“Never give a drug during labor unless you know it is safe for both of your clients: the mother and the fetus.”

Pharmacologic management of pain during labor and birth includes analgesia (reduces
or decreases pain) and anesthesia (partial or complete loss of pain sensation).

Analgesics and Anesthetics commonly used in Labor and Birth

Source: Silbert-Flagg, J. (2018). Maternal and child health nursing: care of the childbearing and childrearing family, pp 402

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a. Pain relief during labor

Goal: The ideal or goal of medication used during labor is to relax a woman and
relieve her discomfort and yet have minimal systemic effects on uterine contractions, the
pushing effort or the fetus.

Narcotic Analgesics

Regional Anesthesia
 Spinal Anesthesia
An anesthetic agent introduced into the CSF in the sub-arachnoid space

 Epidural Anesthesia
An anesthetic agent placed just inside the ligamentum flavum in the epidural
space,L4–5, L3–4, or L2–3 interspace block (provides pain relief for both labor
and birth)

The chief concern with epidural anesthesia is its tendency to cause hypotension because
of its blocking effect on the sympathetic nerve fibers in the epidural space. This
blocking leads to decreased peripheral resistance in the woman’s circulatory system.
Interventions:
 Woman remains on her side - prevent supine hypotension syndrome

*** If hypotension should occur, raising the woman’s legs and administering oxygen
and additional IV fluid, along with an agent such as ephedrine to elevate blood
pressure, may be necessary to stabilize cardiovascular status.

Other medications

b. Pain relief during birth

Stretching of the perineum causes the pain during birth. The simplest form of pain relief
for birth is the natural pressure anesthesia that results from the fetal head pressing
against the stretched perineum. For some women, however, additional medication
is needed to reduce the pain of birth.

 Local Infiltration
the injection of an anesthetic such as lidocaine (Xylocaine) into the superfificial
nerves of the perineum. It is used when the fetal head is too low to allow for a
pudendal block. The anesthetic is placed along the borders of the vulva. The
effect lasts for approximately 1 hour, allowing for a pain-free birth and suturing
of an episiotomy without additional anesthetic.

 Pudendal Nerve Block

the injection of a local anesthetic near the right and left pudendal nerves at the
level of the ischial spine. The injection, made through the vagina with the
woman in a lithotomy or dorsal recumbent position, provides relief of perineal
pain in 2 to 10 minutes that lasts for approximately 1 hour.
*** FHR and the mother’s blood pressure should be checked immediately after
the injection

Chapter 16 The nursing role in Providing Comfort during Labor and Birth
Silbert-Flagg, J. (2018). Maternal and child health nursing: care of the
childbearing and childrearing family, pp 326-371

School of Nursing and Allied Health Sciences cmbalganion/v2021

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CARE FOR THE MOTHER AND THE GROWING FETUS
Intrapartum Care

References:

Arab R, PourAsghar Arabi M, Khani S, Khademloo M, Rahmani Z, Atarod Z et al .(2021) Effect of

Hypnosis on Pregnancy and Delivery Outcomes: A Systematic Review. J Mazandaran Univ Med
Sci. ; 30 (194) :156-170

Silbert-Flagg, J. (2018). Maternal and child health nursing: care of the childbearing and childrearing
family

MedlinePlus (n.d.).Your baby in the birth canal.https://medlineplus.gov/ency/article/002060.html

Superville SS and Siccardi MA. (2020, Aug 21).Leopold Maneuvers. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK560814/

American Pregnancy Association (2019, April 25). What is a

duola?.https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/having-a-doula-616/

Koehn M. L. (2000). Alternative and complementary therapies for labor and birth: an application of
Kolcaba's theory of holistic comfort. Holistic nursing practice, 15(1), 66–77.
https://doi.org/10.1097/00004650-200010000-00009

Muñoz-Sellés, E., Vallès-Segalés, A. & Goberna-Tricas, J. (2013). Use of alternative and complementary
therapies in labor and delivery care: a cross-sectional study of midwives’ training in Catalan hospitals
accredited as centers for normal birth. BMC Complement Altern Med 13, 318
https://doi.org/10.1186/1472-6882-13-318

Czech I, Fuchs P, Fuchs A, Lorek M, Tobolska-Lorek D, Drosdzol-Cop A, Sikora J.(2018)

Pharmacological and Non-Pharmacological Methods of Labour Pain Relief—Establishment of
Effectiveness and Comparison. International Journal of Environmental Research and Public
Health; 15(12):2792. https://doi.org/10.3390/ijerph15122792

Ganji, Z., Shirvani, M. A., Rezaei-Abhari, F., & Danesh, M. (2013). The effect of intermittent local heat
and cold on labor pain and child birth outcome. Iranian journal of nursing and midwifery
research, 18(4), 298–303.

Shaw-Battista, J (2017). Systematic Review of Hydrotherapy Research.The Journal of Perinatal &

Neonatal Nursing, Volume 31, Number 4, October/December 2017, pp. 303-316(14)

Sukran, E, and Pinar, G (2021) The effect of therapeutic touch on labour pain, anxiety and childbirth
attitude: A randomized controlled trial, European Journal of Integrative Medicine,Volume 41,
101255, ISSN 1876-3820,https://doi.org/10.1016/j.eujim.2020.101255.

Campbell, V. and Nolan, M. (2019). ‘It definitely made a difference’: A grounded theory study of yoga
for pregnancy and women's self-efficacy for labour, Midwifery,Volume 68,Pages 74-83,ISSN
0266-6138,https://doi.org/10.1016/j.midw.2018.10.005.
(https://www.sciencedirect.com/science/article/pii/S026661381830305X)

Association of Reflexologists. (n.d.). What is reflexology?

Https://Www.Aor.Org.Uk/What-Is-Reflexology/. Retrieved March 11, 2021, from
https://www.aor.org.uk/what-is-reflexology/

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ACTIVITY:
Direction: Supply the appropriate responses for each item.

1. Compare and contrast TRUE Labor vs FALSE labor:

List down the True and False Signs and Symptoms of Labor

Signs and Symptoms of True Labor Signs and Symptoms of False labor

2. What are the components of labor? The Ps of labor:

Describe how each component influence labor and delivery.

Components of Labor Description/Influence to Labor and Delivery

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3. The Stages of labor: Fill the box accordingly.

Nursing
Stages of labor Description Onset/Duration Danger signs
Responsibilities/Action
1st
2nd
3rd
4th
*** include differences between primiparous and multiparous women

4. Differentiate the phases of the 1st Stage of Labor according to onset, duration, contraction, cervical dilation, etc.

Phases
Label/Description Onset/Duration Contraction Cervical Dilation Nursing Responsibilities/Action
(1st Stage of Labor)
1st
2nd
3rd
*** include differences between primiparous and multiparous women

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