NCM 107N LEC | BSN-2A Nursing Diagnoses: Preparation for Childbirth and

Parenting
Chapter 14: Preparation for Childbirth and
Parenting  Health-seeking behaviors related to learning
more about childbirth and newborn care
Childbirth Education  If there is a lack of a support person
• Childbirth educators  Ineffective coping related to lack of a support
person
• Childbirth teaching methods  Anxiety related to absence of significant other
 For a couple unable to make a decision about
• Efficacy of childbirth education classes a childbirth setting
• Preconception classes – Decisional conflict related to lack of
information about advantages and
• Expectant parenting classes disadvantages of various childbirth setting
 If there are older children in the family
– Sibling education classes – Anxiety related to sibling role in pending
– Breastfeeding classes birth event and sibling ability to welcome new
family member
– Preparation for childbirth classes  Prenatal exercises
– Prenatal yoga- to manage stress throughout
• Pain management education
life not only pregnancy - caution on balancing
– A woman needs to come into labor informed – Perineal and abdominal exercises - to
about what causes labor pain and prepared with strengthen pelvic and abdominal muscles to
breathing exercises to use to minimize pain make these muscles stronger and more
during contractions. supple for labor
 Perineal and abdominal exercises
– A woman experiences less pain if her abdomen -Abdominal muscle contractions- help prevent
is relaxed and the uterus is allowed to rise freely constipation and help restore abdominal tone
against the abdominal wall with contractions. after pregnancy.
– Using the gating control theory of pain -Strong abdominal muscles can also
perception, distraction techniques can be contribute to effective second-stage pushing
employed to alter how pain is received. during labor.

• Birth setting education

– Woman’s health and that of her fetus – Tailor Sitting
Couple’s preferences
– How much and what kind of supervision couple Stretches perineal muscles without
wants for birth occluding blood supply to the
lower leg

Squatting
Kegel’s Exercise
-are helpful in the postpartum
period to reduce pain and
promote perineal healing. They
also have long-term effects of
increasing sexual responsiveness
and helping prevent stress
incontinence
Pelvic Rocking - physical and emotional health for children
-mother gets emphatic understanding from
Helps relieve backache partner, nurse, and physician
during pregnancy and
early labor by making the
lumbar spine more flexible 3. Lamaze Method (Psychoprophylactic
It not only increases her method)
flexibility but also helps
relieve back pain and -based on stimulus
make her more – response conditioning
comfortable during the night - (Pavlov Theory of Classical Conditioning)
- where unfavorable responses are replaced by
favorable conditioned responses
-high level of activity can excite higher brain
Birthing Aids centers to inhibit other stimuli as pain
• use for distraction such as playing cards or -woman is taught to replace responses of anxiety,
listening to specific music; fear and loss of control with more useful activity
• further into labor, she should plan what she
could use as a greater distraction for even
stronger contractions such as singing out loud, Lamaze techniques
having her partner massage her back, or center Conscious relaxation
intently on breathing exercises. Cleansing breath
• can use an exercise ball, a Jacuzzi tub, or Conscious controlled breathing
change of position such as squatting, swaying Effleurage
with a partner, or rocking in a chair Focusing
Second-stage breathing
Pain Management Methods -Conscious Relaxation – learning to relax muscles
deliberately
Also known Childbirth Preparation Class
-Cleansing Breath – woman breathes in deeply
– Bradley (partner coached)
and exhales deeply
– Psychosexual
-Consciously Controlled Breathing (Set of
– Lamaze philosophy
breathing Patterns)
– Dick-Read

Lamaze Method (cont)

1. Bradley (Partner-Coached) Method
Consciously Controlled Breathing (Set
-stresses the important role of the husband during
breathing Patterns)
pregnancy, labor and early newborn period
-Level 1 – full respiration, 6 – 12cpm, early
-woman uses muscle toning exercises
contraction -Level 2 – lighter, 40cpm, 4 - 6cm
-limits or omits food that contain preservatives,
dilated
animal fat and high salt content
-Level 3 – more shallow, 50 - 70cpm, transition
-abdominal breathing exercise
contraction
-woman is encouraged to walk during labor
-Level 4 – pant blow pattern, 3-4 quick breaths
-use of dissociation technique
then forceful expiration
-Level 5 – continuous chest panting (60cpm),
2. Dick-Read Method strong contraction and 2nd stage of labor

- tension (psychic and muscular) is aroused by Lamaze method

fear and anticipation of pain tension >>>fear
>>>Pain -relaxation of involved muscles;
- sympathetic stimulation brought about by fears -mouthing silently words or songs with rhythmical
causes contraction of the circular muscle of the tapping of fingers; supportive person nearby in a
cervix - prenatal courses and training reduce fear, calm environment
educate and boost self-confidence
- Covers:
- fetal development and childbirth
- pain relief methods
- muscle strengthening exercises
- breathing techniques
- abdominal breathing contraction
Nursing Care for a Family Preparing for
Childbirth and Parenting
• Birth setting
– Hospital birth
– Alternative birth center
– Home birth
– Hydrotherapy and water birth
– Unassisted birth

Alternative Birthing Methods

*Leboyer Method
-The contrast of intrauterine environment and the
external world causes infant to suffer
psychological shock at the time of delivery
-Birthing room is darkened
- Soft music
-Gentle controlled delivery
-Covers: Relaxing the craniosacral axis by
supporting the head, neck and sacrum
-Restoring body heat loss by warm bath
-Allowing infant to breathe spontaneously
-Delaying cutting of cord to permit placental blood
flow
-Bonding mother and infant by skin to skin contact
*Hydrotherapy -Infant placed immediately into
warm-water bath
*Unassisted birth
Chapter 15: Nursing care of a family During
labor and birth
Components of Labor
LABOR AND DELIVERY  Passageway
-Labor is a process is a process whereby with time  Passenger
regular uterine contractions brings about progressive  Power
effacement and dilatation of the cervix, resulting in  Psyche
the delivery of the fetus and expulsion of the
placenta. I. Passageway(maternal)
- Route from uterus to external perineum
Critical factors affecting the process of labor: – size and type of pelvis, ability of the cervix to efface
-Passage and dilate, and distensibility of vagina and introitus
-Passenger  Pelvis – the bony ring through which the
-Power fetus passes during labor and delivery;
-Psyche: Psychological outlook  Measurements – may be obtained by
-Position internal and external pelvic examination
 X-ray pelvimetry (used rarely in pregnancy
THEORIES OF LABOR ONSET and only late in third trimester or in
1. Uterine Stretch Theory – Any hollow muscular labor), and ultrasound
organ when stretched to the capacity will contract
and empty Pelvic types:
The uterine muscle stretches from the increasing size a. Gynecoid – classic female pelvis inlet, well rounded
of the fetus, which results in release of prostaglandins (oval); ideal for delivery
2. Oxytocin Theory – The fetus presses on the cervix, - most ideal for childbirth (50% of women)
which stimulates the release of oxytocin from the b. Android – resembling a male pelvis, narrow and
posterior pituitary heart-shaped; usually requires cesarean section or
3. Progesterone Deprivation Theory – as pregnancy difficult forceps delivery (20% of women)
nears term, estrogen increased while progesterone c. Platypelloid – flat, broad pelvis; usually not
level drops, hence uterine contraction occurs. adequate for vaginal delivery (5% of women)
- Rising fetal cortisol levels reduce progesterone d. Anthropoid – similar to pelvis of anthropoid ape;
formation and increase prostaglandin formation. long, deep, and narrow; usually adequate for vaginal
- Changes in the ratio of estrogen to progesterone delivery (25% of women
occurs, increasing estrogen in relation to
progesterone, which is interpreted as progesterone
withdrawal.
4. Prostaglandin Theory – when pregnancy reaches
term, the fetal membranes , the fetal membrane
begins to produce prostaglandins, which stimulate
contractions.
5. Theory of the aging Placenta – as the placenta ages
it becomes less efficient.
The placenta reaches a set age, which triggers
contractions.

Assessing for Preliminary Signs of Labor

 Presentation
-part of fetus that presents to (enters) maternal pelvic
II. Passenger (fetal) inlet
– Structure of fetal skull 1. Cephalic/vertex – head presentation (>95% of
– Diameters of fetal skull labor)
– Molding 2. Shoulder
– Fetal presentation and position
• Attitude
• Fetal lie 3. Breech presentation
• Engagement  Complete – flexion of hips and knees
• Station  Frank (most common) – flexion of hips and
extension of knees
Molding  Footling/incomplete – extension of hips and
• is overlapping of skull bones along the suture lines, knees
which causes a change in the shape of the fetal skull
to one long and narrow, a shape that facilitates
passage through the rigid pelvis.
• sagittal and coronal sutures

Attitude/ habitus
-relationship of fetal parts to each other; usually
flexion of head and extremities on chest and abdomen
to accommodate to shape of uterine cavity
 Vertex – head is maximally flexed -
full/complete flexion
 Military – head is partially flexed
II. Passenger (fetal)
 Brow – head is maximally extended
Size – primarily related to fetal skull Fetopelvic
relationships
Lie – relationship of spine of fetus of spine of mother;
-longitudinal (parallel)
-transverse (right angles)
-oblique (slight angle off a true transverse lie)

TYPES OF FETAL PRESENTATION

 Face – head is partially extended