(5) Discourage the patient from bearing down if the presenting part is a
head. Bearing down could cause damage to soft tissues. Preterm labor usually means
a small fetus. Less cervical dilations and effacement are required due to the small size
of the premature fetus. Administration of medications during labor is kept to a minimum
because the infant has an immature system that has difficulty metabolizing medication.
Medications have an increased effect on the fetus. Local anesthesia is used for delivery
rather than general anesthesia. This again is due to the increased effect that general
anesthesia has on the infant and the infant's decreased ability to metabolize the
anesthesia and to get it out of its system after delivery. Parents should be informed
about these decisions.
e. Delivery of the Preterm Infant.
(1) Perform only those procedures that are absolutely necessary. Injury can
occur easily and infection is of primary concern.
(2) Establish respirations then move the infant to a warm and humid
environment that contains adequate oxygen. Position the head slightly down to allow
for tracheal drainage and then position the head flat. Place the infant on its back with
the shoulders elevated slightly so the abdomen is lower than the thorax. Ensure that
the airway is kept clear. Place a folded towel or diaper under the infant's shoulders and
back. This allows for expansion of the thoracic cavity.
Introduce the newborn briefly to the parents.
Transfer the newborn to the special care nursery as soon as possible.
POSTTERM PREGNANCY AND DELIVERY
a. Definition. Postterm pregnancy is any pregnancy that goes beyond 42
b. Nursing Interventions in the Delivery of the Postterm Infant
(1) Notify and have a pediatrician present for delivery. The infant requires
immediate assessment of his condition. In addition, the infant may need immediate
intervention to establish adequate respiratory function.
(2) Perform tracheal suctioning immediately at delivery. In postterm
pregnancy, the amniotic fluid is frequently thick since it decreases after 38 weeks. The
infant frequently has a bowel movement (meconium) prior to or during labor due to
stress. This fluid tends to clog the air passages and irritates the lungs when aspirated.
Aspirated meconium-stained amniotic fluid can lead to meconium aspirations syndrome