Second stage of labour

Second stage of labour

1. SECOND STAGE OF LABOUR SAKSHI RANA M.Sc. NURSING

2. LABOUR Series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called Labour,

3. Contt .. THERE ARE FOUR STAGES OF LABOR. 1 . FIRST STAGE OF LABOR: THINNING (EFFACEMENT) AND OPENING (DILATION ) OF THE CERVIX a. EARLY LABOUR b. ACTIVE LABOUR c . TRANSITION TO SECOND STAGE

4. CONTT.. 2. SECOND STAGE OF LABOUR: BABY MOVES THROUGH THE BIRTH CANAL 3. THIRD STAGE OF LABOR: AFTERBIRTH 4. FOURTH STAGE OF LABOR: RECOVERY

5. SECOND STAGE OF LABOUR The second stage of labour (also called ‘the pushing stage’) starts when cervix (the opening of womb) is fully open (10cm dilated) and ends when baby is born. At this stage, baby is moving from uterus into vagina and out into the world. The second stage can last from minutes to two hours (usually second or subsequent babies are quicker than the first). Contractions during this stage may be several minutes apart.

6. CONTT.. The forces at work in this stage uterine contractions, which occur every 2-3 minutes and last 50-60 sec.

7. PHASES The latent phase The descent phase The transition phase

8. PHYSIOLOGY OF SECOND STAGE OF LABOUR UTERINE ACTION

9. CONTT.. RUPTURE OF MEMBRANE

10. CONTT.. SOFT TISSUE DISPLACEMENT

11. RECOGNITION OF THE SECOND STAGE OF LABOUR 1. Presumptive evidence: Expulsive uterine contractions Expulsive rupture of the forewater Dilatation and gaping of the anus Anal cleft line. Appearance of the rhomboid of michaelis .

12. CONTT.. UPPER ABDOMINAL PRESSURE AND EPIDURAL ANALGESIA. SHOW. APPEARANCE OF THE PRESENTING PART

13. CONTT.. 2. CONFIRMATORY EVIDENCE: It is held that vaginal examination must be undertaken to confirm full dilatation of the cervical os .

14. MATERNAL PHYSIOLOGICAL CHANGES IN THE SECOND STAGE OF LABOUR BLOOD PRESSURE METABOLISM PULSE RATE TEMPERATURE GESTROINTESTINAL CHANGES RENAL AND HAEMATOLOGINAL CHANGES

15. POSITION FOR SECOND STAGE

16. KNEELING

17. BEING ON ALL FOURS

18. SQUATTING

19. LITHOTOMY POSITION

20. MECHANISM OF LABOUR The series of event that occur on the head in process of adaptation, during its journey through the pelvis, is called mechanism of labour

21. Principles common to all the mechanism are; 1. Descent takes place Whichever parts leads and first meets the resistance of the pelvis floor will rotate forwards until it comes under the symphysis pubis Whatever emerges from the pelvis will pivot around the pubic bone. At the onset of labour the most common presentation is the vertex and the most common position either left or right occipitoanterior; it is this mechanism which will be described. In this instance

22. CONTT.. 2. The lie is longitudinal The presentation is cephalic The position is right or left occipitoanterior The attitude is one of good flexion The denominator is the occiput The presenting part is the posterior part of the anterior parietal bone

23. MAIN MOVEMENTS OF THE FETUS

24. DESCENT

25. FLEXION

26. INTERNAL ROTATION OF THE HEAD

27. EXTENSION OF THE HEAD

28. RESTITUTION

29. INTERNAL ROTATION OF THE SHOULDERS

30. LATERAL FLEXION

31. INTRAPARTUM MONITORING

32. VITAL SIGNS

33. UTERINE ACTIVITY

34. LABOUR PROGRESS

35. INTAKE & OUTPUT

36. MANAGEMENT OF THE SECOND STAGE The transition of the first stage to the second stage is evidenced by the following features: Increasing intensity of uterine contractions Urge to defecate with descent of the presenting part Complete dilation of the cervix as evidenced on vaginal examination Appearance of bearing down effort

37. CONTT.. PRINCIPLES: To assist in the natural expulsion of the fetus slowly and steadily To prevent perineal injuries

38. CONTT.. GENERAL MEASURES: The patient should be in bed. Constant supervision is mandatory and the FHR is recorded at every five minutes. To administer inhalation analgesics Vaginal examination

39. PREPARATION FOR DELIVERY POSITION: Position of the woman during delivery may be lateral or partial sitting. Dorsal position with 15 degree left lateral tilt The accoucheur scrubs up and puts on sterile gown, mask and gloves and stands on the right side of the table Toileting the external genitalia and inner side of the thighs is done with cotton swabs soaked in Savlon or Dettol solution. To catheterize the bladder .

40. NURSING MANAGEMENT ASSESSMENT: Maternal blood pressure, pulse and respiration every 5-15 minutes. The FHR every 10-15 minutes. Labor progress: Cervical dilatation. Fetal descent .

41. CONTT.. Uterine contractions. The amount of bloody show. The woman’s urge to bear down. The woman’s response to labor. The woman’s coping pattern.

42. CONTT.. NURSING DIAGNOSIS: Pain Risk for infection. Anxiety related to knowledge deficit. Fatigue. Impaired skin integrity.

43. CONTT.. Anxiety related to outcome. Ineffective individual coping. Powerlessness. Impaired adjustment. Self-care deficit: Bathing/ Hygiene.

44. CONTT.. PLANNING: Promote a quiet, focused environment to enhance pushing efforts. Monitor maternal and fetal status. Provide encouragement for pushing efforts. Support ongoing comfort measures and pushing efforts.

45. CONTT.. IMPLEMENTATION: Continue assessment of maternal blood pressure, FHR and uterine contractions. Assist laboring woman into position of comfort and pushing efforts. Observe for approaching birth such as: Perineal bulging Appearance of fetal head

46. CONTT.. Provide comfort measures such as; Wiping face with wet washcloth Moistening the lips Supporting the woman’s body and / extremities during pushing efforts. Prepare for the delivery Complete perineal cleansing.

47. CONTT.. EVALUATION: Ensure that; The laboring woman is able to remain focus on pushing. The woman and fetus maintain physical parameters within normal limits. The woman feels encouragement. The woman feels comfortable.

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