NURSING

RESPONSIBILITIES IN
DELIVERY ROOM
MONITORING AND
EVALUATION OF UTERINE
CONTRACTION
 Uterine contractions may be
monitored intermittently by hand
or continuously by an internal or
external system.
 Continuing to monitor the duration,
strength, and interval between
contractions can aid in tracking the
progress of labor.
 LENGTH OF
CONTRACTIONS
 To determine the beginning of a
contraction without a monitor, rest a
hand on the woman’s abdomen at the
fundus of the uterus very gently to
sense the gradual tensing and upward
rising of the fundus that accompanies
a contraction.
 The duration of a contraction is timed
from the moment the uterus first
tenses until it has relaxed again.
 INTENSITY OF
CONTRACTION
Contractions are rated as:
 MILD

 The uterus is contracting but does not

become more than minimally tense
 MODERATE
 The uterus feels firm
 STONG
 The contraction is so intense the uterus
feels as hard as a wooden board at the
peak of the contraction.
FREQUENCY OF
CONTRACTION
 The frequency is timed from the
beginning of one contraction to the
beginning of the next.
 Use as light a touch as possible on
the woman’s abdomen while
timing contractions or estimating
their strength.
FETAL POSITIONS
 The fetus moves into position as
your body prepares for delivery. In
the weeks before your due date,
the fetus may drop lower in the
uterus. Some positions can cause
problems for both mother and
baby.
Most Common Position
 Ideally for labor, the baby presents
head-down, facing the mother's
back, with its chin tucked to its
chest and the back of the head
ready to enter the pelvis.
Occiput or Cephalic
Posterior

 Sometimes the baby is presenting

head down as it should be, but it is
facing the mother's abdomen. This
increases the chance of painful
"back labor" and prolonged
delivery.
Occiput or Cephalic
Posterior
Frank Breech

 In a frank breech, the baby's

buttocks lead the way into the
birth canal. The hips are flexed,
the knees extended. This increases
the chance of forming an umbilical
cord loop that could precede the
head through the cervix and cause
injury to the baby if it is delivered
vaginally.
Frank Breech
Complete Breech
 This baby presents with the
buttocks first; both the hips and
the knees are flexed. Like other
breech presentations, this
increases the risk of forming an
umbilical cord loop that could
precede the head through the
cervix and cause injury to the baby
if it is delivered vaginally.
Complete Breech
Transverse Lie

 The baby lies crosswise in the

uterus, making it likely that the
shoulder will enter the pelvis first.
Most such babies are delivered by
cesarean.
Transverse Lie
Footling Breech

 Sometimes, one or both of the

baby's feet are pointed down
toward the birth canal. This
increases the chances of the
umbilical cord slithering down into
the mouth of the womb, cutting off
blood supply to the baby.
Footling Breech
Principles of Newborn
Care
When a baby is born to a mother
being treated for complications,
the management of the newborn
will depend on:
 whether the baby has a condition or

problem requiring rapid treatment;

 whether the mother’s condition permits

her to care for her newborn completely,

partially or not at all.
APGAR SCORE
Five factors are used to evaluate the
baby's condition and each factor is
scored on a scale of 0 to 2, with 2
being the best score:
 Activity and muscle tone

 Pulse (heart rate)

 Grimace response (medically known as

"reflex irritability")
 Appearance (skin coloration)

 Respiration (breathing rate and effort)

 APGAR
SCORING

Apgar Sign 2 1 0

Heart Rate Normal (above 100 beats per Absent

Below 100 beats per minute
(pulse) minute) (no pulse)

Breathing Normal rate and effort, good Slow or irregular breathing, Absent (no
(rate and effort) cry weak cry breathing)

Grimace (responsiveness or Pulls away, sneezes, or Facial movement only Absent (no response
"reflex irritability") coughs with stimulation (grimace) with stimulation to stimulation)

Activity
Active, spontaneous Arms and legs flexed with No movement,
(muscle tone)
movement little movement "floppy" tone

Appearance
Normal color all over (hands Normal color (but hands and Bluish-gray or pale
(skin coloration)
and feet are pink) feet are bluish) all over
 What Apgar Scores
Mean
A baby who scores a 7 or above on the test at
1 minute after birth is generally considered
in good health. However, a lower score
doesn't necessarily mean that your baby is
unhealthy or abnormal. But it may
mean that your baby simply needs some
special immediate care, such as suctioning
of the airways or oxygen to help him or her
breathe, after which your baby may
improve.
 At 5 minutes after birth, the Apgar score is
recalculated, and if your baby's score hasn't
improved to 7 or greater, or there are other
concerns, the doctors and nurses may continue
any necessary medical care and will closely
monitor your baby. Some babies are born with
heart or lung conditions or other problems that
require extra medical care; others just take a little
longer than usual to adjust to life outside the
womb. Most newborns with initial Apgar scores of
less than 7 will eventually do just fine