Midwifery Nursing | Intrapartum Care (Labor and Delivery Nursing) | Stages of Labor and Nursing Care |
Intrapartum Care (Labor and Delivery Nursing)
Introduction
Intrapartum care refers to the care provided to a woman and her baby during labor and delivery. It involves continuous monitoring, pain management, and timely interventions to ensure a safe birth process. Nurses play a crucial role in assessing labor progression, providing comfort, preventing complications, and supporting the mother and family.
Stages of Labor and Nursing Care :
Labor is divided into four stages, each with distinct physiological changes and nursing interventions.
1. First Stage of Labor (Latent, Active, and Transition Phase)
Introduction:
Begins with regular uterine contractions and ends with full cervical dilation (10 cm).
Latent Phase: Cervix dilates 0–3 cm (mild contractions).
Active Phase: Cervix dilates 4–7 cm (moderate to strong contractions).
Transition Phase: Cervix dilates 8–10 cm (intense contractions).
Signs in Mother:
Increasing contraction frequency and intensity.
Back pain, cramping, possible rupture of membranes.
Increased vaginal discharge (mucus plug, bloody show).
Nursing Care Plan:
Assessment: Monitor vital signs, fetal heart rate, and contractions.
Pain Management: Provide comfort, breathing techniques, massage, analgesia.
Hydration & Nutrition: Encourage fluids; avoid heavy meals.
Emotional Support: Encourage relaxation and partner support.
Monitor Progress: Use a partograph to track labor progression.
2. Second Stage of Labor (Delivery of the Baby)
Introduction:
Starts at full dilation (10 cm) and ends with birth.
The mother actively pushes during this stage.
Signs in Mother:
Urge to push, increased pelvic pressure.
Crowning of the baby's head, exhaustion.
Nursing Care Plan:
Guide Pushing Efforts: Encourage open glottis pushing.
Monitor Fetal Well-being: Observe fetal heart rate.
Positioning: Assist mother in a comfortable birthing position.
Support & Encouragement: Reassure and provide emotional support.
Sterile Techniques: Maintain a clean and sterile environment.
3. Third Stage of Labor (Delivery of the Placenta)
Introduction:
Begins after baby’s birth and ends with placenta expulsion (5–30 minutes).
Signs in Mother:
Mild contractions continue.
Gush of blood, lengthening of the umbilical cord.
Nursing Care Plan:
Monitoring: Observe for placental separation signs.
Controlled Cord Traction (CCT): Assist in placental delivery.
Check Uterine Tone: Massage uterus to prevent hemorrhage.
Monitor Bleeding: Watch for postpartum hemorrhage (PPH).
Ensure Placental Integrity: Confirm complete expulsion.
4. Fourth Stage of Labor (Immediate Postpartum Care)
Introduction:
Covers the first 1–2 hours post-placenta delivery, ensuring maternal stabilization.
Signs in Mother:
Uterus contracts, preventing bleeding.
Possible chills, fatigue, emotional responses.
Nursing Care Plan:
Monitor Vital Signs: Assess BP, pulse, temperature.
Fundal Massage: Ensure uterine contraction to prevent hemorrhage.
Encourage Bonding: Promote skin-to-skin contact.
Breastfeeding Support: Assist in initiating breastfeeding.
Monitor for Complications: Watch for excessive bleeding or uterine atony.
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