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Second stage of labor
Objectives
At the end of this presentation student will be able
to :
Identify the etiology of pain during labor and birth
Identify types of labor support and advanced
nursing roles in normal labor and delivery care
Define Of Second Stage Of Labor.
Discuss The Mechanism Of Labor
Discuss Cultural and social aspects of labor and
delivery.
Analyze labor and delivery care in Jordan.
Etiology of pain during labor
Basic factors for pain in childbirth: physical and
emotional.
1. physical pain in labor is caused by:
Muscle cramps/ uterine contraction.
Stretching of cervix and perineum .
Medical tests and procedures (pelvic exams,IVs, catheterization,
and so forth)
Position of the baby and pressure of presenting part on tissue like
bladder,urethra,back,lower colon
Etiology of pain during labor
2. Emotional Factors
Many negative emotions can actually increase your perception of
pain:
Fear of pain
Fear of the unknown
Anxiety
Self-doubt
Lack of education
Exhaustion
Dehydration
Hunger
Labor support
Non pharmacological strategies
Emotional support
Instructional/informational support
Advocacy support
Pharmacological strategies
Endorphin
No limit to the time women can stay in bath and often they are
encouraged to stay in it as long as desired
In randomized controlled trial (RCT) to determine the efficacy of warm
showers on parturition pain and the birth experiences of women during the
first stage of labor
CONCLUSIONS
Acupuncture reduced the need for pharmacological and invasive
methods during delivery. Acupuncture is a good supplement to
existing pain relief methods.
(Borup, Wurlitzer, Hedegaard, Kesmodel, & Hvidman, 2009)
1. Nonpharmacologic strategies
5.Acupressure
Application of pressure or massage to heel of the hand
,fist or pads of the thumb and fingers
1. Nonpharmacologic strategies
6. Therapeutic touch and massage
Based on concept that body contains energy field when
increased lead to health and when decreased lead to illness
touch and massage work to relive pain by increase level of
endorphins
Effleurage is a form of therapeutic touch of gentle abdominal
massage
1. Nonpharmacologic strategies
7.Application of Heat and Cold
Heat Application :
• Effective in relief back pain and raises the pain threshold.
• To increase blood flow and relieves muscle ischemia.
• increases relaxation
Cold application:
• Applied to the back, chest,
and face to increase comfort
• slowing transmission of pain.
1. Nonpharmacologic strategies
9.Aromatherapy
Their used based on the principle that the sense of smell
plays a significant role in over all health , when essential oil
inhaled it’s molecule transported via olfactory system to
the brain and the brain respond to particular aroma with
emotional responses , when applied externally they
absorbed to the skin and then carried throughout
circulation .
Conclusion
This study revealed that aromatherapy decreased the labour pain,
but did not affect the duration of labour phases
(Ma°rtensson,2010)
The evidence
concluded that it was effective but it was based only on 4
studies they found suitable for analysis:
Ader et al compared sterile water to saline. Sterile water worked better
but there was no difference in the requirement for pethedin (Demerol)
12.Birthball
2. Emotional LSB
Definition:
The ability of subject participate and share in the laboring client’s
feelings (Sauls, 2004).
• Urinary retention
• Backache
• epidural may prolong second stage of labor ,pushing more difficult and
additional interventions such as Pitocin, forceps, vacuum extraction or
cesarean might become necessary
women who use this form of pain relief are at increased risk of
having an instrumental delivery
(anim-somuah,smyth,&howell,2008)
Time of adminestration of epidural analgesia
• ENTONOX-cylinders with a
capacity of 500 L are available.
The shoulders emerge next, first one and then the other
Finally, the medical attendant slowly eases the rest of the body out
of the birth canal and the baby is born.
Cardinal Movements in Labor
The mechanisms of labor, also known as the cardinal movements
refer to the changes in position of fetal head during its passage
through the birth canal.
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
Vaginal birth video
Nursing care during second stage
Sign that suggest onset of second stage
• 1. felling of urge to bush or need for bowel
movement
• 2. sudden appearance of sweat on upper lip
• Episodes of vomiting
• Increase bloody show
• Checking of extremities
• Increase restlessness
• Involuntary bearing down
Nursing care during second stage
Perform every 5-30 min v/s
Assess every 5-15min FHR
Assess every 10-15min vaginal show and signs of
fetal descent and maternal appearance
Assess every contraction and bearing down effort
Nursing care during second stage
Fundal pressure
Use of fundal pressure is not advised because there is no standard
techniques available for this maneuver also no current legal or
regulatory standard exist for it’s use and no evidence related to it
effectives in facilitating a safe vaginal birth is
available.(simbson,2008)
Bearing Down (pushing)
When the fetal head reaches the pelvic floor most women
experience the urge to bear down or push.
Monitor women’s breathing.
(AWHONN,2010)
Closed Glottis pushing/Valsalva's
Maneuver
This is when a woman, who in the second stage of labor or the
"pushing stage" has coached to push.
Instructs woman to hold her breath and push for 10
counts/seconds.
But
holding breath for 10 seconds not good during pushing.
Because of:
increase intrathoracic and cardiovascular pressure.
reducing cardiac output.
inhibiting perfusion of the uterus and the placenta.
resulting in fetal hypoxia.
When and how to push
The Best Way
A better approach based on current evidence is to delay pushing
until the woman feels the urge to push.
(AWHONN,2010)
Reaserch evidence
• The benefits of delayed pushing include less fetal
heart deceleration , fewer forceps and vacuum
assisted birth , less perenial damage
such as:
epidural.
local infiltration.
Hodnett E, Gates S, Hofmey G, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst
Rev 2007; (3): Art. No.: CD 003766
Cochrane Pregnancy and Childbirth Group’s Trials Register (31 January 2012)
Thorp, James A., Hu, Daniel H., Albin, Rene M., McNitt, Jay, Meyer, Bruce A., Cohen,
Gary R., & Yeast, John D. (1993). The effect of intrapartum epidural analgesia on
nulliparous labor: A randomized, controlled, prospective trial. American Journal of
Obstetrics and Gynecology, 169(4), 851-858. doi: http://dx.doi.org/10.1016/0002-
9378(93)900
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