j. Positioning During Labor. Assist the patient in turning from side to side.
Elevate the head of the bed 30 degrees; this makes it easier for the patient to breathe.
Try to keep the patient off her back to prevent supine hypotensive syndrome. This
syndrome results in pressure of the enlarged uterus on the vena cava, reduces blood
supply to the heart, decreases blood pressure, and reduces blood circulation to the
uterus and across the placenta to the fetus. The patient may complain of being
nauseated and feeling cool and clammy. The best position for the patient is on her left
side since this increases fetal circulation.
k. Prevention of Infection. Handwashing is essential before and after
performing any procedure. Fresh, clean scrub suits should be worn in the delivery area.
Unauthorized persons should not be allowed in the area. A patient with infections
should be separated from other patients.
l. Vaginal Exams. Only the physician or a trained nurse performs this exam.
It is done to evaluate cervical effacement, cervical dilatation, status of membranes, and
station of presenting part. Care must be taken to perform good perineal cleansing
before and after the procedure (vaginal exam). Once membranes rupture, the exam
should be limited even further to prevent the risk of infection. See figure 2-6 for vaginal
palpation of cervical dilatation, effacement, amniotic membranes, and presenting part.
Figure 2-6. Vaginal exam.