Maternal & Fetal Assessment During Labor - Maternal Assessment: take a thorough history - lab tests: Rh Status - if necessary

mom will get Rhogam at 28 weeks; Rubella Titer - if mom not immune she is immunized (with MMR) right after birth & she is not allowed to be near anyway w/Rubella during pregnancy; AFP can be a urine test; all screening tests are ONLY screening tests and abnormal results mean more testing is needed; serology is done for STD testing & mom can be treated if possible - subsequent visits: 20 wk fundal height umbilicus is benchmark, watch closely for IUGR, if moms systolic BP is 30 above normal or diastolic is 15 above normal, check for PIH - during progressive true labor contractions get longer as the time between them gets shorter; in the hospital mom is given milliunits of oxytocin before birth and after birth given whole units to induce introversion (Pitocin, Oxytocin, Methergine, Hemabate, and there is a pitocin nasal spray) - External Fetal heart monitoring: FHR best heard through the babies back d/t bone conducting sound better, - non-stress tests are done w/any mom who has chronic health problems or multiple fetuses & the purpose is to check the placentas ability to supply O2 when the baby needs it after movement or trauma - Internal Fetal heart monitoring: done w/scalp monitor, only during active labor once mom is 4-7cm dilated - FHR characteristics: Tachycardia (over 160) maybe d/t maternal fever, chorioamniotis, infection in fetus, turbutaline, magnesium sulfate (tocolytics) given to control preterm labor; Bradycardia (below 110) Down syndrome, CNS problems, moms using street drugs - you always want to see short and long term variability - long term variability shows responses to movement, short term shows beat to beat changes in HR - if only seeing short term variability baby may be asleep - paying attention to variability shows us whether or not baby can handle trauma of birth of if C/S delivery is necessary - variability is minimal in a mom w/anemia - Changes: Periodic: during a contraction - Non-periodic or Episodic: not during contraction, usually related to fetal movement, show healthy CNS - Decelerations: - early: head compression, during contraction, usually innocuous as long as FHR comes back up after contraction; this is normal during pushing - Variable: maybe tight nuchal cord, baby holding cord, knot in cord, not usually related to contractions, must be watched closely, may need C/S delivery

- Late: uteroplacental insufficiency: ALWAYS DANGEROUS, FHR still decreased at end of contraction, baby is not recovering from contraction, might need C/S - nursing actions: mom on her (right) side, increase O2, turn up Lactated Ringers IV, turn off Pit, call Dr. - Amnioinfusion: used to thin (dilute) meconium in utero, (meconium can cause late decels), only needed for severe decels; Lactated Ringers via IUPC

Management During Labor Latent Phase This is the best time to teach breathing techniques and to give instructions because the woman is still comfortable, cooperative and can still concentrate on a conversation well. Active Phase Coach woman on breathing and relaxation techniques. Abdominal breathing is recommended during the latent and active phase. Prescribed analgesics are given during the active phase. Before giving analgesics: assist woman to void, take maternal vital signs and FHT. After taking analgesics: instruct woman to remain in bed, keep noise to minimum, raise side rails, place woman on NPO ( no foods and fluids allowed) Check BP 30 minutes after giving analgesics to make sure it is not causing hypotension. Transition Phase Reassure woman that labor is nearing end and baby will be born soon. Reinforce breathing and relaxation techniques. Discourage bearing down if she feels the urge to do so. Encourage pant-blow breathing to remove the urge to bear down (take a deep breath at the beginning of a contractions the pant several times and blow) Clear fluids may be allowed. Position the patient in left lateral position.