Birth related procedures 10

Birth-Related Procedures

Learning Outcome
Explain the methods, purpose, and contraindications of external and podalic versions that determine nursing care management.

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

External Version
Reactive NST performed to establish fetal well-being
Tocolytic given during procedure to relax the uterus

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

Internal Version
Tocolytic given during procedure to relax uterus

Learning Outcome
Describe the use of amniotomy and the nursing care management of woman and fetus.

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

Learning Outcome
Compare the methods for inducing labor, explaining their advantages and disadvantages in determining the nursing management for women during labor induction.

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

Cervical Ripening
May cause hyperstimulation of uterus
Pharmacologic agents include Cytotec and prostaglandin agents – can cause uterine stimulation after insertion

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

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

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

Pitocin Infusion
Palpating uterus essential, unless IUPC in place
May initially decrease blood pressure

Learning Outcome 23-4
Describe the measures to prevent episiotomy, the types of episiotomy and associated nursing care management.

Episiotomy Types
Surgical incision of perineal body to enlarge outlet – commonly used to avoid spontaneous laceration

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

Types of Episiotomy

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

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

Learning Outcome
Explain the indications, maternal and neonatal risks that impact nursing care management during forceps-assisted birth.

Indications
Maternal heart disease
Maternal pulmonary edema
Maternal infection
Maternal exhaustion
Fetal stress

Indications
Premature placental separation
Need for shorter second stage of labor
Heavy regional block with ineffective pushing

Applications of Forceps

Risks
Newborn may experience
Bruising
Edema
Facial lacerations
Cephalhematoma
Transient facial paralysis
Cerebral hemorrhage

Risks
Woman may experience
Vaginal or perineal lacerations
Infection secondary to lacerations
Increased bleeding
Bruising
Perineal edema

Learning Outcome
Describe the use of and risk of vacuum extraction use to assist birth.

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

Vacuum Extractor

Learning Outcome
Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing care.

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

Indications
Most common indications for cesarean birth
Maternal infection
Pelvic size disproportion
Placenta previa
Previous cesarean section

Preparation
Preparation for cesarean birth requires
Establishing IV lines
Placing indwelling catheter
Performing abdominal prep

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

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

Uterine Incisions for Cesarean Birth

Learning Outcome
Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth following cesarean birth.

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

Nursing Care
Continuous EFM
Internal Monitoring
IV fluids
Avoid Pitocin if at all possible
Classic or T uterine incision is contraindication to VBAC

Nursing Care
Important for nurse to support couple, explore their feelings, and provide information throughout labor

Birth related procedures 10

by Xtine Marie

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Birth related procedures 10 Presentation Transcript