Stages of Labor
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Five Ps of labor
The five Ps of labor refer to crucial determinants of the outcome of labor and how taxing the process will be. They include passenger, passage, placenta, psychology, and powers. The passenger defers in size, lie, and presentation. For instance, in breech presentation, the passenger makes it hard to carry out spontaneous vaginal delivery and can lead to poor outcome. The passage determines birth process especially when there are constraints such as narrow pelvic diameters. It results in obstruction for the passage of the fetus. The placenta determines the process of birth mainly due to the nature of the implantation. Placenta previa leads to higher chances of poor maternal and fetal outcomes. Power refers to the ability of the uterus to ensure a successful birth process. Poor contractions lead to protracted labor and poor fetal outcomes including cerebral palsy. The fifth P relates to the psychological wellbeing of the patient at the time of birth. The presence of extreme anxiety is associated with poor outcomes of labor (Kohn, 2018).
Hospital Delivery
Advantages include the presence of a holistic care team with ability to deal with emergency situations once they arise. There is also a high chance of inter-professional collaboration during care which leads to better outcomes and patient satisfaction. For instance, when dealing with obstructed labor due to large passenger or too narrow pelvic inlet, the whole team contributes to the formulation of the best course of action.
Disadvantages include the high cost of care. It is also best delivered when the individuals are able to take part in the necessary check-ups to ensure superior results in the prevention of disease.
Home Delivery
Advantages include the ability to tailor the delivery process to the specific wish of the patients including under water births and a reduction in anxiety when the home setting is used as the birth place.
Disadvantages include higher chances of poor outcome especially when there is no skilled labor around and the inability to respond to emergencies that may come up during the process.
Birthing Centre
Advantages include the presence of nurse midwives and immediate possibility of referral in case of emergencies.
Disadvantages include inability to cater to holistic needs of patients in the emergency situation with the only chance being the use of referral option.
Stages of Labor
The stages of labor include dilation of the cervix, delivery of the fetus, removal of the afterbirth, and the fourth stage is the recovery process. The first stage is marked by three stages being latent, active, and transition phases. The latent phase is initiated by the contractions of the uterus that are irregular and which lead to the softening of the cervix and subsequent opening. The active labor stage is marked by an increased rate of uterine contractions with a frequency of 2-3 minutes (Vitner, 2019). In the active phase, there is progression of cervix dilation past 4cm. In the transition phase, the contractions progress with almost no breaks in between leading to the second stage which is the process of birth. In the third stage, the afterbirth is expelled following the continued contractions of the uterus after the process of birth. In the fourth stage, there is drainage of liquor due to the damage conferred to the uterine wall following the birth process. There is also shrinkage of the uterus which is enhanced by the administration of oxytocin. It helps in the cessation of bleeding.
Mother Preparation for Scheduled C-Section
The mother should first be interviewed on the procedure to see how much she knows already. Next is to educate her about the procedure, the expected outcomes, and the rationale for the choice picked. The patient has to also be educated about the available alternatives. Also talk about the possible complications and why this is the best choice at the moment. Reassure the patient that the clinicians have her best interest at heart.
The risks include increased risks in future pregnancies, reaction to the medication being used, infection of the surgical wound, and too much bleeding after delivery of the baby. The crucial nursing assessments include the vitals of the patient and the baby before and after birth. Also carry out an aneia test before the process of birth to identify possible risk to poor outcome.
References
Kohn, J. R., Rao, V., Sellner, A. A., Sharhan, D., Espinoza, J., Shamshirsaz, A. A., ... & Cortes, M. S. (2018). Management of labor and delivery after fetoscopic repair of an open neural tube defect. Obstetrics & Gynecology, 131(6), 1062-1068.
Vitner, D., Bleicher, I., Levy, E., Sloma, R., Kadour-Peero, E., Bart, Y., ... & Gonen, R. (2019). Differences in outcomes between cesarean section in the second versus the first stages of labor. The Journal of Maternal-Fetal & Neonatal Medicine, 32(15), 2539-2542.