Care During Pregnancy and Childbirth

1. 22 Care During Pregnancy and Childbirth

2. Objectives • Define the following terms: • Amniotic fluid • Amniotic sac • Birth canal • Bloody show • Breech birth • Cervix • Crowning • eclampsia • Ectopic pregnancy • Fallopian tube • Fontanel (continued)

3. Objectives • Define the following terms: • Full term • Imminent delivery • Labor • Meconium • Miscarriage • Newborn • Nuchal cord • Ovary • Ovum (continued)

4. Objectives • Define the following terms: • Placenta • Placenta previa • Preeclampsia • Prenatal care • Prolapsed cord • Spotting • Supine hypotensive syndrome • Trimester • Umbilical cord • Uterus • Vagina (continued)

5. Objectives • Describe the function of the following anatomy related to childbirth: amniotic sac, birth canal, cervix, placenta, umbilical cord, and uterus. • Describe the three stages of labor and when each begins and ends. • Describe the signs of an imminent delivery. • Explain the steps for preparing for a field delivery. (continued)

6. Objectives • Explain the steps for assisting with a field delivery. • Explain the purpose of each of the items in a typical field obstetrics (OB) kit. • Explain the priorities of care for the newborn following a field delivery. • Explain the priorities of care for the mother following a field delivery. • Explain the common causes of vaginal bleeding during the first trimester. (continued)

7. Objectives • Explain the common causes of vaginal bleeding during the third trimester. • Explain the appropriate care for a pregnant patient with vaginal bleeding. • Describe the signs and symptoms of supine hypotensive syndrome. • Explain the appropriate care for a patient with signs and symptoms of supine hypotensive syndrome. • Describe the signs and symptoms of preeclampsia. (continued)

8. Objectives • Explain the appropriate care for a patient with signs and symptoms of preeclampsia. • Explain the common complications related to a field delivery and how to properly care for each. • Demonstrate the ability to identify the signs of an imminent delivery. • Demonstrate the steps for preparing for and assisting with a field delivery. (continued)

9. Objectives • Demonstrate the proper care of the infant following a field delivery. • Demonstrate the proper care of the mother following a field delivery. • Demonstrate the ability to identify a complicated delivery. • Demonstrate the proper assessment and care for a complicated field delivery. • Value the importance of proper body substance isolation (BSI) precautions when assisting with a field delivery.

10. Media Slide 14 Female Reproductive Anatomy Animation Slide 15 Female Reproductive Anatomy Labeling Exercise Slide 21 First Stage of Labor Video Slide 23 Second Stage of Labor Video Slide 24 Transition Stage of Labor Video Slide 43 Vacuum Extractor Video Slide 45 Umbilical Cord and Apgar Scoring Video Slide 52 Placenta Delivery Video

11. Topics • Understanding Childbirth • Delivery • Complications and Emergencies

12. UNDERSTANDING CHILDBIRTH

13. Understanding Childbirth • Anatomy of Pregnancy • Fetus: unborn baby • Ovum: unfertilized egg produced by the mother • Uterus: muscular structure that holds baby during pregnancy • Full term: pregnancy achieved complete gestation of between 38 and 40 weeks (continued)

14. Click here to view a three-dimensional animation of the female reproductive system. BACK TO DIRECTORY

15. Click here to participate in an interactive labeling exercise of female reproductive anatomy. BACK TO DIRECTORY

16. Understanding Childbirth • Anatomy of Pregnancy • Trimester: three months of pregnancy • Labor: process body goes through to deliver fetus • Cervix: opening of uterus • Bloody show: normal discharge of bloody mucus prior to delivery • Vagina: birth canal (continued)

17. Anatomy of pregnancy.

18. Understanding Childbirth • Anatomy of Pregnancy • Crowning: showing of baby's head at opening of vagina. • Imminent delivery: delivery that is likely to occur within a few minutes. • Amniotic sac: fluid-filled sac that surrounds developing fetus. • Rupture of membranes: sac breaks during labor; the fluid flows out of vagina. (continued)

19. Understanding Childbirth • Anatomy of Pregnancy • Placenta: organ of pregnancy that serves as filter between mother and developing fetus. • Umbilical cord: structure that connects baby to placenta.

20. Understanding Childbirth • Stages of Labor • First stage: begins with onset of regular contractions; ends when cervix is fully dilated allowing baby to enter birth canal. • Second stage: begins when baby enters birth canal; ends when born. (continued)

21. Click here to view a video on the first stage of labor and delivery. BACK TO DIRECTORY

22. Understanding Childbirth • Stages of Labor • Third stage: begins when baby is born; ends when placenta (afterbirth) delivered. • Normal to have vaginal discharges throughout labor. • Contractions of uterus cause labor pains.

23. Click here to view a video on the second stage of labor and delivery. BACK TO DIRECTORY

24. Click here to view a video on the transition stage of labor and delivery. BACK TO DIRECTORY

25. Stages of labor.

26. Stages of labor.

27. Stages of labor.

28. Understanding Childbirth • Stages of Labor • Contraction time: span of time from beginning of contraction until it relaxes. • Interval time: span of time from start of one contraction to beginning of next contraction. • Braxton Hicks contractions (false labor): not as regular and rhythmic as true labor contractions.

29. Measure the contraction intervals by counting the beginning of one contraction to the beginning of the next contraction.

30. Understanding Childbirth • Supplies and Materials • Personal protective equipment • Towels, sheets, blankets; gauze pads • Rubber bulb syringe; clamps and ties • Sterile scissors or single-edged razor • Sanitary pads or bulky dressings • Basin and plastic bags • Red, plastic biohazard bags

31. Think About It • You respond to the home of a young couple expecting their first child. They had planned to deliver at home, but grew nervous when the pain of labor became too strong. • What questions will you include in your assessment? • How will you proceed?

32. DELIVERY

33. Algorithm for assisting a mother in a normal delivery.

34. Delivery • Preparing for Delivery • Wear PPE. • EMS activated. • Encourage patient to remain lying down. • Place clean sheets or towels under buttocks. • Obtain medical history of pregnancy. (continued)

35. Delivery • Preparing for Delivery • If mother is having contractions two minutes apart or less, delivery is imminent. • Find out if she has taken a childbirth preparation class. • Control scene so mother has privacy. • Position mother on back with knees bent, feet flat, legs spread wide apart. (continued)

36. Delivery • Preparing for Delivery • Feel abdomen for contractions. • Prepare mother for examination. • Check for crowning. • Do not attempt any type of internal or vaginal exam.

37. Emergency care algorithm for an imminent delivery.

38. Delivery • Normal Delivery • Crowning evident as head emerges from vagina. • Use both hands to support head as it delivers; check neck for umbilical cord. • Guide baby's head downward to facilitate delivery of top shoulder. • Use both hands to support baby following delivery. (continued)

39. Crowning is evident as the head emerges from the vagina.

40. Use both hands to support the head as it delivers and check the neck for presence of the umbilical (nuchal) cord.

41. Guide the baby's head downward to facilitate delivery of the top shoulder.

42. Use both hands to support the baby following delivery.

43. Click here to view a video on use of the vacuum extractor during delivery. BACK TO DIRECTORY

44. Delivery • Normal Delivery • Dry baby and cover to conserve heat. • Clamp cord in preparation for cutting. (continued)

45. Click here to view a video on Apgar scoring and caring the neonate. BACK TO DIRECTORY

46. Carefully dry the baby and cover him to conserve heat.

47. Once the cord has stopped pulsating, clamp it in preparation for cutting.

48. Delivery • Normal Delivery • Cut cord between the clamps. • Assess breathing and pulse rate for newborn. • Expect delivery of placenta 20 to 30 minutes following delivery of baby.

49. Cut the cord between the clamps.

50. Assess breathing and pulse rate for the newborn.