m. Artificial Rupture of Membranes.
(1) Rupture of the membranes is done by the physician to induce or hasten
labor. Apply an internal fetal monitor lead or a uterine catheter.
(2) The FHTs should be checked immediately following rupture.
Determining fetal distress is secondary to compression of the cord. The cord may be
displaced by the sudden "gush" of waters, which may yield a prolapsed cord.
(3) Fluids should be carefully examined for meconium if the fetus is in the
vertex presentation, (that is, head first). You should check for:
(a) Slight green color--called light meconium.
Green to dark color--called moderate meconium.
Dark green with chucks of meconium--called heavy meconium.
Record the following information:
(a) Time of the procedure (rupture of membranes).
Amount of fluid expelled (small, moderate, or large).
(c) Color--clear or meconium stained (extent of staining--light,
moderate, or heavy).
(d) Fetal heart rate immediately after the procedure and five minutes
after the procedure.
(e) Instrument used, if other than an amnihood, to provide a slow,
controlled release of fluid. Other instruments may be a fetal scalp electrode or spinal
The amnihood is used to tear a small opening in the amniotic sac.
n. Emotional Support.
(1) First phase--laten. Offer support and explanations. Instruct or reinforce
breathing techniques (breathe slowly and deeply and use deep chest or abdominal
breathing). Remind the patient to not push down during the first stage since it could
causes cervical edema. It could also cause cervical lacerations and fetal hypoxia.
(2) Second phase--active. Continue to give support, offer encouragement,
and give explanations. Include significant other in these procedures. Reinforce
breathing and relaxation techniques. Accelerated shallow panting may be used, and
also, effleurage (stroking movement used in massage, usually of the abdomen).