PROLONGED LABOR RISKS
*Infection, maternal exhaustion, post partum hemorrage, fetal distress, fetal injury or asphixia, low apgar scores, seperation of motherbaby, difficult recovery, post partum depression, caregiver exhaustion leading to poor descisions.
* To reduce the risk of infection*
* preserve membranes
*Limit internal exams
* Avoid intrernal devices
* Keep mother hydrated and rested
* maintain a clean enviroment
* Risk of distress created by*
* Stimulated labor
* Artificial rupture of membranes( water bag)
* Maternal low blood suger FEAR > TENSION > PAIN!
* Maternal supine ( laying down) position
* coached pushing acidocis
* Manual extraction ( forceps, suction cup)
* Reduce the risks by*
* Monitor carefully and unobtrousively, Listen to baby> You can hear with your ear from the back as well as the front.
* Augment labor conservtively, assist all involved to be patient
* Encourage intact membranes
* Avoid maternal supine position ( lying down)
* Encourage active upright positions and sidelying ( simms or left lateral)
* detect and correct malpositions early
* Maintain maternal blood suger witth food , liquid or suger
LOVE > RELAXATION > JOY!
* Assess mother and baby*
* monitor closely for signs or symptoms of infection
* Elevated maternal temperature
* Rising pulse
* Increased uterine or abdominal tenderness
* DONT DO AN INTERNAL EXAM FOR NO REASON - IF YOU DO ONE , DO A GOOD ONE!
* signs of true maternal exhaustion
* rising pulse and temperature
* Is there progress?*
* There must be progress even if there is slow progress
* mother and baby must remain in a good position
* Detect heart decelerations
* Know when to quit*
* Signs of disproportion btwn head and pelvis
* high head - head not engaged and cant be made to engage
* Asynclitism ( head off to the side not aligned to the bone of the pelvis) - especially increasing degrees
* Strong contractions ( rushes , surges) without progress or dilitation( cervix opening)
* Failure of head to flex and decend wirh strong cotractions and good pushing
* Large and growing caput ( swelling formed on the babys head by pressure from the dilating cervix) but with no descent when measured above the pubic bone
*Signs of potential Uterine ( womb) rupture
* A thinning lower uterine segment( may feel like a balloon)
* Full bladder
* Rising contraction ring
* Formation of Bandls Ring ( exteme thickening of the ring of normal labor when labor is obstructed It is able to be felt with the hands as a hard ridge across the tummy)
* DONT EVER LET THINGS GET THIS FAR!
* BE PRUDENT, GET HELP
* RULE OUT OBSTRUCTED LABOR!