Birth-related procedures: Nursing

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Notes

BIRTH-RELATED PROCEDURES

KEY POINTS
NOTES
DEFINITION
  • Labor
    • Physiologic process where fetus and placenta are expelled from uterus
    • Most common delivery is vaginal
  • Delivery can require birth-related procedures
    • Labor induction and augmentation
    • Assisted vaginal delivery
    • Episiotomy 

LABOR INDUCTION & AUGMENTATION
  • Artificial methods that start labor process
  • Cervical ripening
    • Used to soften or ripen cervix for dilation
    • Pharmacological or mechanical
  • Pharmacological methods 
    • Prostaglandin E2 
      • Intravaginal gel, intracervical gel, or vaginal insert 
    • Prostaglandin E1 
      • Off-label use for cervical ripening 
    • Risks 
      • May cause tachysystole 
    • Contraindications 
      • Previous cesarean birth 
      • Major uterine surgery
  • Mechanical methods 
    • Trans-cervical balloon catheter 
      • Inserted and inflated at cervical os 
      • Applies pressure, releases prostaglandins 
    • Membrane stripping 
      • Manual separation of amniotic membrane from cervix 
  • Follow-up procedure 
    • Amniotomy 
    • Artificial rupture of membranes with plastic hook 
    • Shortens induction-to-delivery time

ASSISTED VAGINAL DELIVERY
  • Used when maternal or fetal health at risk 
  • Helps guide fetus through vaginal canal
  • Vacuum-assisted vaginal delivery 
    • Soft cup attached to fetal scalp 
    • Vacuum provides suction to hold cup in place 
    • Gentle traction applied during contractions 
    • Risks 
      • Scalp lacerations, hematomas, bleeding 
      • Retinal hemorrhage 
  • Forceps-assisted vaginal delivery 
    • Two curved blades inserted around fetal head 
    • Blades lock together for traction 
    • Gentle pulling during contractions 
    • Risks 
      • Vaginal or cervical lacerations 
      • Fetal bruising, lacerations, skull fractures 
      • Nerve injury

EPISIOTOMY
  • Surgical incision of the perineum 
  • Widens birth canal for fetal delivery
  • Median (midline) 
    • Straight incision toward anus 
  • Mediolateral 
    • Angled incision away from anus
  • Indications 
    • Vacuum or forceps-assisted delivery 
    • Face-up fetal presentation 
    • Breech delivery 
    • Macrosomia
    • Shoulder dystocia 
  • Complications 
    • Infection 
    • Perineal pain 
    • Spontaneous laceration 
    • Anal sphincter injury

Transcript

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Content Reviewers

Lisa Miklush, PhD, RNC, CNS,Gabrielle Proper, RN, BScN, MN

Labor, also called childbirth, is a physiologic process during which the fetus and placenta are expelled from the uterus. The most common form of delivery is vaginal, meaning that the baby passes through the vaginal canal. However, some deliveries require the assistance of healthcare providers in the form of birth-related procedures. These procedures include, labor induction and augmentation, assisted vaginal delivery, sometimes called operative vaginal delivery, and episiotomy.

Now, let’s discuss induction and augmentation of labor, which are artificial methods that start the labor process. One method is cervical ripening, which is used to ripen or soften the cervix so that it’s more likely to dilate with uterine contractions. Cervical ripening can be done pharmacologically or mechanically.

With pharmacological cervical ripening, prostaglandin E2, also known as dinoprostone, is most commonly used. It comes in the form of intravaginal gel, intracervical gel, or timed-release vaginal insert. Prostaglandin E1, also known as misoprostol, can also be used for cervical ripening, but it’s an off-label use. One setback of using prostaglandins for cervical ripening is that it also increases the contractility of the uterus, and can even result in tachysystole, or excessively frequent uterine contractions, so both the uterine activity and the fetal heart rate must be monitored when prostaglandin E2 is in place. When it comes to contraindications of cervical ripening, these include previous cesarean birth and major uterine surgery.

For mechanical cervical opening, there are two methods. The first can be done using a trans-cervical balloon catheter. A trans-cervical catheter is inserted through the internal cervical os, or cervical opening, and the balloon is inflated. Then, the balloon is retracted down against the cervical os. This creates direct pressure and induces release of endogenous prostaglandins.

On the other hand, membrane stripping involves the digital separation of the amniotic membrane from the cervical and uterine walls.