Nursing Management of Second Stage of Labour

What Do You Mean By Second Stage of Labor?

The second stage of labour begins with the complete dilation of the cervix and ends with the expulsion of the fetus. This stage is concerned with the descent and delivery of the fetus through the birth canal.

Nursing Management of Second Stage of Labor:

1. Confirmation of 2nd stage of labour by-

a) Character of pain-

  • Intensity,
  • Interval between pains,
  • Duration of contraction,
  • Bearing down pain,
  • Cervix fully dilated.

b) Rupture of membranes with gush out liquor.

c) After rupture of membranes P/V exam done to confirm 2nd stage-

  • Further confirmation presenting part,
  • Character of liquor,
  • To exclude cord prolapsed.

2. After confirmation, the patient is shifted to the labour room.

3. Psychological support is given.

4. All diet by mouth withheld if necessary nutrition maintained by IV fluid.

5. Monitoring of maternal and fetal condition: Pulse, BP, Temperature, Dehydration-

a) Per abdominal examination:

  • Fetal heart rate,
  • No uterine contraction/10 minutes,
  • Duration of uterine contraction,
  • Head fully engaged or not.

b) Per vaginal examination to see-

  • Station of presenting part,
  • Degree of rotation of presenting part,
  • Dilatation and effacement of cervix,
  • Membranes ruptures -condition of liquor.

6. If bladder is full catheterize modified dorsal position of the patient knee hip flexed buttock at the edge of labour table.

7. When crowing occurs the patient is asked to bear down at the time of contraction

8. With crowing of the head episiotomy is given either after local infiltration with 1% xylocaine or after pudendal block.

9. Head of the fetus/baby is to be maintained in a flexed position.

10. Delivery of head is done by extension in between contractions of uterus with guard over the perineum.

11. Following delivery of the head, mouth and nose are cleaned.

12. After delivery of anterior shoulder posterior shoulder is delivered by drawing the baby’s head in upward direction towards the mother’s abdomen.

13. Then trunk is delivered by lateral flexion.

14. Then the baby is put on a tray with head slightly tilled downwards.

15. The cord is to be clamped at 2 places and cord is divided in between the clamps after cessation of cord pulsation.

16. Immediate care of the new born –

  • Wrapped well with dry cloths,
  • Mouth and nose cleaned with sucker,
  • Mild stimulated to make it cry,
  • Identification.

Nursing Interventions of Second Stage of Labour:

  • Provide client support,
  • Assess and record v/s, FHR, uterine contractions,
  • Prepare place of birth in advance,
  • Convert the labor room to birth room,
  • Make the client select positioning for birth,
  • Promote second stage pushing,
  • Clean perineum with warm antiseptic before birth.

As soon as head is about 8cm across:

  • Perform the Ritgen’s maneuver,
  • Encourage the woman to continue pushing until the o cciput of fetal head is firmly a the pubic arch,
  • Once head is delivered,
  • Note time of birth, announce sex of infant,
  • Cut and clamp the cord,
  • Introduce infant to initiate parent child relationship.

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