NUR 4445 2nd Stage of Labor and Pain

NUR 4445 2nd Stage of Labor and Pain Management

• Describe the second stage of labor. What does cervical dilation and efface- ment look like?

What two phases make up the second stage of labor?

Answer

• The stage in which the infant is born

• full cervical dilation (10cm) and complete effacement (100%)

• Two phases the latent phase and the active pushing phase

• What forces facilitate an uncomplicated vaginal birth (3)?

Answer Force exerted by uterine contractions, gravity, and maternal bearing-down efforts facilitates achieve- ment of the expected outcome of a spontaneous, uncomplicated vaginal birth

• What do contractions look like in the second stage of labor?

Answer

• Contraction pattern is every 2-3 minutes progressing to every 1-2 minutes.

• Each contraction lasts 40-60 seconds.

• How often is fetal monitoring done in the second stage of labor? What about VS and cervix?

Answer

• Fetal monitoring should be done every 5-15 minutes, depending on risk status.

• VS are monitored every 5-30 minutes (maternal BP, pulse, and respiration)
• Cervix is monitored every 10-15 minutes.

• Describe the latent phase of the second stage of labor. What does the fetus do?

Answer

• delayed pushing, laboring down, or passive descent. 1 / 3

• Time from complete cervical dilation until the woman begins actively pushing.
• Fetus continues to descend passively through the birth canal and rotate to an anterior position

because of ongoing uterine contractions.

• What does the mother do during the latent phase of the second stage of labor?

Answer

• Woman is quiet and often relaxes with eyes closed between contractions.

• Urge to bear down is not strong - some women do not experience it at all or only during the

acme (peak) of a contraction.

• Describe the active phase of the second stage of labor. What does the woman do?

Answer

• woman has strong urges to bear down as the Ferguson reflex is activated

• Physiologic management involves spontaneous, rather than directed, pushing

• Describe the S/S of the active phase of the second stage of labor (6)?

Answer

• ring of fire (burning sensation of acute pain as vagina stretches and fetal head crowns)

• Feeling of powerlessness
• Decreased ability to listen or concentrate on anything but giving birth

• Alters respiratory pattern

short 4- to 5-second breath holds with regular breaths in between, 5-7 times per contraction

• Frequent repositioning
• Often shows excitement immediately after birth of head

• Describe the physiologic changes that occur in the second stage of labor

(5).Answer

• cervix is fully dilated and effaced 2 / 3

• bulging perineum
• significant decent of fetal head
• lots of pressure
• labia part

• episiotomy

Answer

• incision made in the perineum to enlarge the vaginal outlet.

• No role in modern obstetric care and should be avoided whenever possible.
• Indicated episiotomy may still be performed in specific situations, such as the need to hasten

birth when FHR abnormalities are present.

• What is a laceration? What are the different types (4)?

Answer

• occur naturally as the fetal head is being born.

• 1st degree extends through the skin and structures superficial to muscles.
• 2nd degree extends through muscles of the perineal body
• 3rd degree continues through anal sphincter muscle
• 4th degree extends completely through the anal sphincter and the rectal mucosa

• What nursing assessment is included with a laceration? What nursing action is necessary?

Answer

• Nursing assessment

redness (erythema), edema, ecchymosis (bruising), drainage, and approximation (REEDA)

• Nursing action

after necessary repairs, the nurse cleanses the vulvar area gently with warm water or NS and applies a perineal pad or an ice pack to the perineum

• What teaching do we provide to patients with a laceration?

Answer

• some discom- fort during post-birth vaginal exam
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