OB - Exam 2 - Nursing Care During Labor and Birth
questions and answers Graded A+
Intrapartum nurses are responsible to know
when to tell a pregnant patient to head to the birth center or hospital.
When to come to the Birth Facility for Labor: contractions
- Increasing intensity
- Increasing frequency
- Increasing duration
- Regular contractions
- Nullipara: q 5 min lasting for 60 sec for 1 hour
- Multipara: q 10min lasting 60 sec for 1 hour
When to come to the Birth Facility for Labor: SROM
- A gush or a trickle of fluid should be evaluated, regardless of contractions
- Risk for infection for mom and neonate!
When to come to the Birth Facility for Labor: other factors
- Number of previous pregnancies
- Duration of labors
- Distance from the hospital
- Transportation availability
- Risk Status (GBS+, placental issues) Other Factors
Labor is not the only reason that a patient should
be directed to the birth facility
Other reasons to head to the birth facility: decreased fetal movement
- Substantial decrease in FM always requires evaluation.
- Kick Counts: 10 movements in 2 hours while focusing on movements
- Countthekicks.org
• Iowa's stillbirth rate decreased by 32% during the first 10 years of the Count the
Kicks campaign
,Other reasons to head to the birth facility: bleeding
- Bright red bleeding NEEDS prompt evaluation with or without pain.
- Abruption?
- Previa?
- Pink or brown tinged mucus is a normal part of bloody show or loss of mucus
plug.
- Eval: intercourse,IPV quantity, color?
Other reasons to head to the birth facility: other concerns
- Fall
- High BP
- Abdominal pain
The Initial Interview
- Purpose: To obtain information about the patient's pregnancy or any conditions
that could affect her care
- Intro: How do you prefer to be addressed? Most prefer 1st name Do you want
partner/family present during questions?
- Trauma Informed Model of Care
- Culture/Language: Assess the need for a translator, chaplain, males?
- Must provide a translator in their primary language, Don't rely on family
The Interview (Communication)
- Non-Verbal: Observe behaviors (sedation, combative- illicit drug use)
- Latent Phase: sociable and mildly anxious
- Active Phase: concentrates intently on contractions
- Imminent: "baby is coming", grunting sounds, bearing down with abdominal
muscles, sitting on one buttocks
The Interview Prenatal Info
- Reason for triage: What brings you here?
- Prenatal care: Approximate gestation age at first prenatal visit (EARLY and
REGULAR prenatal care ensure health of mom and baby)
- Estimated Due Date: Term 37-42 weeks, <37 or >42 are associated with > fetal
issues
, - G, T, P, A, L
- Pregnancy history
- Present Pregnancy
- Past Pregnancy
- Intimate Partner Violence: Are you safe at home? Evaluate the psychosocial well
being
The Interview
- Labor Status: When did contractions start or become regular?
- Contractions: Duration, Frequency, and perceived intensity
- Membrane Status: Did your water break? Time, Color, Amount Amnisure, Fern
Test, pH: used to determine SROM has occurred
- Allergies: Iodine allergy (contrast media), latex, drug allergies
- Food intake: Last ate or drank (C-section, safe for anesthetic)
- Recent Illness: UTI or STIs can cause preterm labor. HSV-started on Acyclovir for
suppression, Active lesions?
- Medications: OTC & prescribed, Medicated Assisted Therapy for Substance Use
Disorder Try to remain non-judgmental
- Alcohol or Tobacco: Tobacco-low birth weight (constriction of blood vessels),
ETOH- most common reason for birth defects
Fetal Membranes, Amniotic Fluid, and Cord Considerations
• SROM: Spontaneous rupture of membranes
• AROM: Artificial Rupture of Membranes (Amniotomy: using an amnihook the
provider ruptures the membranes)
• Chorioamnionitis: inflammation of the amniotic sac usually caused by a bacteria
or virus (Foul smelling fluid or cloudy appearance)
• Polyhydramnios: excessive fluid, AFI: >25 (Common reasons: Maternal DM,
multiple gestation)
• Oligohydramnios: abnormally small quantity of amniotic fluid, AFI: <5 ( Kidney
issues of the newborn)
• Prolapse of the cord: when the cord slips below the head after rupture
• Abruptio Placenta: Can occur with polyhydramnios after rupture.
False Labor
questions and answers Graded A+
Intrapartum nurses are responsible to know
when to tell a pregnant patient to head to the birth center or hospital.
When to come to the Birth Facility for Labor: contractions
- Increasing intensity
- Increasing frequency
- Increasing duration
- Regular contractions
- Nullipara: q 5 min lasting for 60 sec for 1 hour
- Multipara: q 10min lasting 60 sec for 1 hour
When to come to the Birth Facility for Labor: SROM
- A gush or a trickle of fluid should be evaluated, regardless of contractions
- Risk for infection for mom and neonate!
When to come to the Birth Facility for Labor: other factors
- Number of previous pregnancies
- Duration of labors
- Distance from the hospital
- Transportation availability
- Risk Status (GBS+, placental issues) Other Factors
Labor is not the only reason that a patient should
be directed to the birth facility
Other reasons to head to the birth facility: decreased fetal movement
- Substantial decrease in FM always requires evaluation.
- Kick Counts: 10 movements in 2 hours while focusing on movements
- Countthekicks.org
• Iowa's stillbirth rate decreased by 32% during the first 10 years of the Count the
Kicks campaign
,Other reasons to head to the birth facility: bleeding
- Bright red bleeding NEEDS prompt evaluation with or without pain.
- Abruption?
- Previa?
- Pink or brown tinged mucus is a normal part of bloody show or loss of mucus
plug.
- Eval: intercourse,IPV quantity, color?
Other reasons to head to the birth facility: other concerns
- Fall
- High BP
- Abdominal pain
The Initial Interview
- Purpose: To obtain information about the patient's pregnancy or any conditions
that could affect her care
- Intro: How do you prefer to be addressed? Most prefer 1st name Do you want
partner/family present during questions?
- Trauma Informed Model of Care
- Culture/Language: Assess the need for a translator, chaplain, males?
- Must provide a translator in their primary language, Don't rely on family
The Interview (Communication)
- Non-Verbal: Observe behaviors (sedation, combative- illicit drug use)
- Latent Phase: sociable and mildly anxious
- Active Phase: concentrates intently on contractions
- Imminent: "baby is coming", grunting sounds, bearing down with abdominal
muscles, sitting on one buttocks
The Interview Prenatal Info
- Reason for triage: What brings you here?
- Prenatal care: Approximate gestation age at first prenatal visit (EARLY and
REGULAR prenatal care ensure health of mom and baby)
- Estimated Due Date: Term 37-42 weeks, <37 or >42 are associated with > fetal
issues
, - G, T, P, A, L
- Pregnancy history
- Present Pregnancy
- Past Pregnancy
- Intimate Partner Violence: Are you safe at home? Evaluate the psychosocial well
being
The Interview
- Labor Status: When did contractions start or become regular?
- Contractions: Duration, Frequency, and perceived intensity
- Membrane Status: Did your water break? Time, Color, Amount Amnisure, Fern
Test, pH: used to determine SROM has occurred
- Allergies: Iodine allergy (contrast media), latex, drug allergies
- Food intake: Last ate or drank (C-section, safe for anesthetic)
- Recent Illness: UTI or STIs can cause preterm labor. HSV-started on Acyclovir for
suppression, Active lesions?
- Medications: OTC & prescribed, Medicated Assisted Therapy for Substance Use
Disorder Try to remain non-judgmental
- Alcohol or Tobacco: Tobacco-low birth weight (constriction of blood vessels),
ETOH- most common reason for birth defects
Fetal Membranes, Amniotic Fluid, and Cord Considerations
• SROM: Spontaneous rupture of membranes
• AROM: Artificial Rupture of Membranes (Amniotomy: using an amnihook the
provider ruptures the membranes)
• Chorioamnionitis: inflammation of the amniotic sac usually caused by a bacteria
or virus (Foul smelling fluid or cloudy appearance)
• Polyhydramnios: excessive fluid, AFI: >25 (Common reasons: Maternal DM,
multiple gestation)
• Oligohydramnios: abnormally small quantity of amniotic fluid, AFI: <5 ( Kidney
issues of the newborn)
• Prolapse of the cord: when the cord slips below the head after rupture
• Abruptio Placenta: Can occur with polyhydramnios after rupture.
False Labor
