b. Once dilatation and effacement are complete, the patient is instructed to push
with each contraction to bring the presenting part down into the pelvis.
TRANSFER OF THE LABOR PATIENT TO THE DELIVERY ROOM
Transfer the mother to the delivery room and prepare her for delivery when
delivery seems imminent. Timing is dependent on the parity of the patient, size of the
infant, effectiveness of the patient's pushes, arrival of the physician, familiarity of the
staff with equipment, and need for additional preparation time. Parity refers to the
condition of the woman with respect to her having borne children.
a. Primigravida patients are transferred when the cervix is completely effaced
and dilated and the head or presenting part is crowning.
b. Multipara patients are transferred when the cervix is completely effaced and
dilated. The patient usually pushes (i.e., bears down) in the delivery room. She may be
transferred prior to complete dilatation (8 to 9 cm) if she is progressing rapidly and the
presenting part is descending. These patients are normally not encouraged to push
when in the labor room since delivery occurs more rapidly in the multipara patient.
NURSING CARE GIVEN WHILE IN THE DELIVERY ROOM
a. Never leave the patient alone once she has been transferred to the delivery
room. In addition, never turn your back on the perineum because the baby could push
through the vaginal opening while your back is turned.
b. Encourage the patient to rest between contractions and to push with
contractions. Only one person should coach. Verbal encouragement and physical
contact help reassure and encourage the patient.
c. Position the patient's legs in the stirrups for the lithotomy position. This is the
most common position for delivery. Facilities using birthing beds have the patient in an
upright position. Positioning also depends upon the type of anesthesia to be used and
C-section delivery. Each case may be different.
d. Prep the patient's perineum. A Betadine scrub and water are used with
4x4's. Clean the perineum by washing the pubic area, down each thigh, down each
side of the labia, down the perineum, and down the rectal area (see fig. 2-7). Begin
cleaning at number 1 and proceed through number 7. Discard used sponges after
each step. Rinse area with the remaining solution.
e. Monitor the patient's blood pressure and the fetal heart tones every 5 minutes
and after each contraction.