hey guys good morning it's a rainy saturday and a good day to put on a powerpoint this is the last one for this test chapter 21 nursing management of labor and birth at risk and remember for the purpose of the test that you have four questions out of this chapter okay one of the things that when you talk about nursing labor risk you're talking about something that can happen called dystocia dystocia is a term used to describe difficult labor dystocia can occur because of maternal issues or fetal issues and it usually results in a c-section there's some associated factors such as problems of the powers which we talked about earlier problems of the powers are ineffective contractions or ineffective maternal pushing um ineffective contractions include we know we need regular coordinated contractions to move the baby through the process and reasons why contractions might not be effective maternal fatigue maternal inactivity fluid and electrolyte imbalance hypoglycemia excessive anesthesia and analgesia remember that numbs everything and slows everything down stress or pain disproportion between the maternal pelvis and the fetal presenting part and uterine over distension all of these can cause ineffective contractions hypotonic dysfunction um is when the contractions are too weak infrequent and brief in duration many times it occurs from uterine over distension because the uterine muscles is stretched to capacity and worn out management is to determine and treat the cause if possible okay do they need iv hydration do they need position change standing or sitting would a warm shower help speed up delivery amniotimiotomy or augmentation with oxytocin to get the cervix nice and soft and effaced hypertonic dysfunction is typically seen in early labor when contractions are uncoordinated and erratic in frequency duration and intensity contractions are painful but not doing the work um resting uterus resting uterine pressure is usually high decreasing placental blood flow think irritable uterus and again management is the key in finding the cause pain meds to relax them all warm shower to get the uterus nice and everything going may give tocolytic drugs to reduce uterine resting tone but you do not give oxytocin okay because that does not rest the uterine in fact that speeds it up and makes it move and you take a chance of a rupture ineffective maternal pushing may be caused by use of poor pushing position technique fear of injury decrease their absent urge to push maternal exhaustion analgesian anesthesia suppressing the urge and psychological unreadiness to let go of the baby again with all these that i've just talked about funding and treating the calls is the key finding and treating the cause and of course your uh power points also give some other ones like fetal birth weight over 8.8 pounds short maternal stretcher too when you have your women come in you look at them and they're five foot or less and they're very tiny you're like oh no we're going to have problems so that gives you a uh cue as well other risk factors for dystocia in your power points maternal age over 35 high caffeine intake it's important to cut your caffeine during pregnancy um gestational age over 41 weeks which would mean a big baby usually this is a picture showing you problems as far as risk factors for dystocia in your book um causes of dystocia now we're going to talk about the peas or we have already have talked about the piece we talked about hypertonic hypotonic problems with the passageway pelvic contraction um obstruction in maternal birth canal we're going to go over these because these are usually what causes dystocia problems with the passenger first of all fetal size is an issue especially when the infant weighs more than eight pounds thirteen ounces four thousand grams that's called macrosomia microsomia the infant's head or shoulders may not be able to pass through the maternal pelvis and keep in mind that the size is relative i have seen small framed women deliver large babies without difficulty and large framed women unable to deliver a normal size difference so it's not always science is not always an issue the shape of her pelvis dictates how easily the fetus will pass through so it's the pelvic shape that you need to look at shoulder dystocia is very difficult um it cause it can cause a delayed delivery delivery of the shoulder or shoulder dystocia or delayed delivery of the shoulders often because they become impacted or caught above the maternal synthesis pubis in the pelvis this is a very scary delivery for the medical team since the head is out and we don't know exactly where the cord is so you've got a cord that if it's compressed the chest is still inside the infant is unable to breathe the physician may fracture the infant's clavicles getting them delivered that's one problem with the shoulder delivery baby can get fractured clavicles um an abnormal fetal position presentation or position and we talked about this the best position for delivery was occipital posterior or i'm sorry was occipital anterior occipital interior head flexed because that was the narrowest diameter any other presentation presents a wider diameter and it's harder for the fetus to pass through the pelvis babies that are op or occipital posterior or ot occipital transverse are much more difficult to deliver these women usually have longer more painful labors with intense back and leg pain maternal position to attempt to rotate the baby is extremely important um some of the ways to do this hands and knees rocking the pelvis side lying on opposite side um lunge sideways five times with contractions you're trying to move the baby squatting sitting kneeling or standing while leaning forward anything upright to try to get that baby to come out bridge babies labor slower because the presenting part is softer most breech babies are delivered by c-section now but still can have complications even with the surgical delivery multi-fetal pregnancies multi-fetal pregnancies are often dysfunctional laborers because of uterine over distension hypotonic contractions or abnormal fetal presentation they're also at greater risk for postpartum hemorrhage due to the over distension of the uterus c-section is often used for multi-fetal pregnancies fetal anomalies such as hydrohydrocephalus umphisil spinal bifida may prevent fetal descent through the pelvis and it often delivered c-section when the anomaly is known and sometimes the problem is the anomaly is not known so following statement true or false psychological stress in the woman can contribute to dystocia we talked about that and the answer is yes it can because if they're afraid if they're uh a lot of anxiety they may try to hold back having the baby okay um let's move on with problems with the passage before we get to this power point i just brought up problems with the passage occur when the pelvis is small or abnormally shaped or there is a soft tissue obstruction such as the distended bladder or part of the bowel how do you prevent this voiding every two hours have mom void every two hours problems of the psyche this can occur um as a result of prolonged maternal stress uh coaching is very important here reassurance comfort education to the mother to help calm her down what's going on with her what's going on with the baby um length of labor is individual uh for each woman i've given you some time frames that women work within and they may be a little bit longer they may be a little bit shorter they're very individual um it can be abnormally long it can be abnormally short and this can cause problems for the mom and the fetus now we're going to talk and look at some procedures a woman might undergo during labor and delivery and when you're doing an assessment this powerpoint before we get to what i just said uh history of risk factors past deliveries that past labors that were dystocia of mind vital signs under contractions are they on set are they are they not um not strong enough are they too strong very important to keep up with fetal heart rate and fetal position um of course your nursing management table 21-1 promoting labor promoting physical and emotional excuse me comfort and promoting empowerment the woman needs to know you can do this you can do this we're almost there so that's why keeping them abreast of what's going on is very important um preterm labor is something that is um happens quite often we're going to talk about that in a minute but let's talk about amnioti in the atomy i cannot say that word amniotomy first artificial rupturing of the membranes often done when the woman in labor is induced or augmented to allow more accurate monitoring of the fetus remember you can't use internal monitoring monitoring until the membranes have ruptured stimulates uterine contractions this amniotomy helps stimulate uterine contractions the risk for it prolapse of the umbilical cord can drop with the gush of fluid um then the fetus drops down and compresses the cord infection uh with the bag of water gone organisms crawl into the vaginal area and they have a free entrance to the baby you need to start taking the temperature every two to four hours after membranes are ruptured and ideally deliver the baby with 24 hours in 24 hours abrepto placenta um especially in lgas or you have or excessive amniotic fluid pregnancies you will have to do an amniotomy um technique is a disposable plastic hook called a amni hook is used via vaginal exam to perform to perforate the sac don't do if the baby is not engaged in the pelvis yet okay do not do unless the baby's engaged in the pelvis nursing care get a good baseline strip of 20 to 30 minutes for comparison put several underpads under the woman because it is a big gush of fluid it is not painful um the hook is sterile you use sterile gloves sterile lubricant the procedure is sterile post procedure assess the fetal heart tone for one minute after the the sac is ruptured after the procedure note quantity color and outer fluid i may have white flecks which is vernix may have some greenish fluid which indicates the meconium due to stress may have some cloudy or odorous fluid which indicates infection uh measure temperature every two to four hours monitor for rising fetal heart rate and fetal tachycardia before maternal temp is noted because uh that could mean signs of infection change under pets frequently to keep the mom dry and comfortable okay um when you're talking about prolonged labor you're talking about active labor it should progress at a steady rate problems with prolonged labor include maternal infection neonatal infection maternal exhaustion anxiety and fear and subsequent labors when you're looking for intrapartum infections which can are common when they do an amniotomy but they're also very common if mom's membranes rupture outside of the hospital and that's why you always want to ask that because you're going to be on alert for an infection intrapartum infection signs of that include fetal tachycardia above 160 maternal fever above 100.4 foul or strong smelling amniotic fluid remember it should never smell cloudy or yellow appearance in the amniotic fluid cloudy or yellow appearance nursing measures for prolonged labor labor center around comfort conserving mom's energy emotional support position changes to make her more comfortable and assessing for signs and symptoms of infection because longer you're up there and you don't have that sac that amniotic fluid you're allowing all this bugs to crawl in maternal comfort measures uh lower the lights reduce the sound back rubs good hydration whether it be iv and or po um precipitate labor is a birth that occurs within three hours of its onset usually the woman often has abrupt onset with intense contractions um and a lot of times the precipitate labor is associated with the abruption abruption placenta fetal meconium maternal cocaine use okay now this slide preterm labor preterm labor is labor that begins after 20 weeks but before 37 of gestation babies born before 32 weeks often have many complications uh normal attempts are made to stop the labor if possible the possible causes of pre-labor maternal infection which we talked about dental disorders which is the but the bugs in the mouth goes straight down uh to baby and so it's important to keep them good dental hygiene during the labor um gestational diabetes hypertension from the mom drug abuse utis probably is one of the most common infection is one of the most common ones for preterm labor um another cause of preterm labor enhanced conceptions short cervical length multi-fetal gestations pre-term rupture membranes preeclampsia and bleeding disorders fatal conditions that go with preterm later labor growth retardation inadequate amniotic fluid chromosome abnormalities uh some demogra demographic factors that go with preterm labor race more common in african-american financial stability number of births and intervals in between okay social and environmental factors inadequate prenatal care domestic violence maternal smoking and housing deficiencies now i added what uh hygiene associated with uh no bathrooms uh outside bathrooms no water okay so housing deficiencies are very important signs and symptoms of preterm labor uh uterine contractions sensation that the baby is balling up and actually just inside of you just bawling into a ball cramps similar to menstrual cramps not strong enough to be contraction contractions constant low back pain and irregular low back pain sensation of pelvic pressure pain discomfort or pressure in vagina or thighs change or increase in vaginal discharge abdominal cramps with or without diarrhea in a sense of just feeling bad or like there's something wrong but you can't put your finger on it measures to prevent preterm labor improve access to early prenatal care probably number one access to early prenatal care access for risk factors this is a good where you take a good history in your mom's in your prenatal clinics promote adequate nutrition promote smoking cessation teach signs and symptoms of preterm labor like we went over and identify um the signs that are high risk and the women that are high risk and treat it stopping pre-term labor okay stopping pre-term labor identify and treat the infection identify and treat the other conditions like preeclampsia hypertension for polyhydrominous therapeutic amniocentesis limit activity hydration ivpo tocolytics are used before 34 weeks um there are no clear first line drugs for the totalytics they're used to stop contractions uh to allow in order to allow corticocos corticosteroids mag you need to have calcium glucan available you may get lethargy and sedation so it's very important if you are using like corticosteroids to monitor the baby if you're using mag along with your topolytics you need to monitor mom uh and also calcium gluconate reverses the effects of mag so you've got to have that close by calcium is an antagonist and it reduces smooth muscle contractions procardia can be used but it blocks calcium relaxing smooth uh blocks calcium prostaglandian synthesis inhibitors like intesin they block prostate glass uh prosteo gladden thereby stopping um contractions beta adenergics like tro uh brethine uh they have a lot of side effects and our i think breathing is off of the market i'm not quite sure but i think it is anyway look at page 713 for these medicines make sure that you know them benemethasone dexamethasone celtic zone these are all steroids corticosteroids if mom looks like she's going to have preterm labor these are given to speed up fetal lung before 34 weeks they are given to speed up fetal lung maturation before 34 weeks please remember that may reduce the severity of respiratory distress in the infant and they may use dexamethasone make sure you look at page 721 dexamethasone 12 milligrams i am and second dose is in 24 hours they get two doses make sure you look at teaching guidelines for preterm labor on page 724 and 725. prolonged pregnancy lasting longer than 42 weeks it's often detrimental to the fetus placenta starts to die remember i've talked about after 40 weeks when they deliver the placenta if they're a 42 week or look at it it's getting hard okay it's a die um and therefore if they're uh past 42 weeks they they uh it reduces placental and fetal exchange so please read about this very important to remember um the next slide talks about laboratory diagnostic tests for preterm labor cbc uranolysis amniotic fluid analysis cervical length via trans vaginal ultrasound they may have some other monitoring as well tocalytic administration we talked about client education is extremely important you have preterm labor your mom is going to be scared to death uh i can remember i had a pre-term labor and i was terrified just the thought what's going to happen is she going to live am i going to live because i had preeclampsia and help syndrome so it is extremely hard on mom and partner so make sure you give a lot of good education and a lot of good psychological support um good information about what's going on is extremely important i can remember when they came in and said that they were going to i have to take uh my daughter i was a i was at 25 weeks she was going to be a c-section um i was on the highest oh some mag that you could put and um i couldn't concentrate a whole lot on what they were saying but the anesthesiologist that was initially going to do my my anesthesia because they were going to put me under what came to me and explained and stood on my bedside and explained everything even though she's not the one that eventually did it everything that was going to happen everything she would be doing and i appreciated that so much it helped alleviate some fear and there was lots of fear there um talked about post-term labor um maternal risk of course the c-section dystocia birth trauma postpartum hemorrhage because the baby is so big tears lacerations if they would deliver vaginally which most of the time they don't fetal risk for post term microsomia because they're large shoulder dystocia brachial plexus injuries that's the clavicles low low apgar scores um cephalopelvic disproportion just a hard time uh if they deliver vaginally coming through mom okay assessment post term um make sure you know the estimated date of birth daily fetal movement counts non-stress tests twice weekly amniotic fluid analysis weekly cervical exams client understanding of what's going on um fetal surveillance is extremely important the decision for labor induction between mom partner physician extremely important at this time intrauterine fetal demise is something that is extremely traumatic and um when it does happen it affects mom it affects partner it affects all the family around and it also affects the unit the nurse the nursery nurses the um the physicians anyone who's involved in fetal demise will feel the effects there can be numerous causes um nursing assessment things you need to look for make sure inability to obtain fetal heart sounds if there aren't any fetal heart sounds that's um that's a horrible sign ultrasound to confirm absence of fetal activity and then of course they have to have induction of labor because they will not deliver on their own the big thing is assisting with the grieving process and referrals for the family afterwards okay um some of the things that i want to talk about now um placental abruption placental abruption placental abruption is an obstetric emergency it involves premature separation of the placenta from the mom risk factors include preeclampsia gestational hypertension seizures uterine rupture trauma smoking cocaine use coagulation defects and domestic violence the main thing is to maintain maternal circulation maintain maternal circulation that way you're maintaining maternal fetal oxygen perfusion um maintenance of maternal cardiovascular status stat c-section if viable fetus and vaginal c-section if fetal demise stat c-section if viable vaginal if fetal demise but you do want to get the baby out of there uterine rupture uterine rupture is again an obstetric emergency onset marked by sudden fetal bradycardia this is a tear in the uterine wall usually from pressure it's often seen when the woman has had previous uterine surgeries especially the classic or the vertical c-section incision the up and down that goes all the way from belly button down to symphysis pubis may be seen in women with many pregnancies a blunt abdominal trauma like a automobile accident or intense hypertonic contractions um maybe three types complete which is into the peritoneal cavity incomplete rupture not completely into the peritoneal cavity and dehiscence partial separation of an old uterine scar with no signs and symptoms um this is the one that you see a lot of times when they've had c-sections before back in the old days all they did was the up and down um cut for the c-section it went from the like i said the belly button to the symphysis pubis and that you also did that on the inside when you opened up the mom mom's uterus it was the same cut and that they found led to a lot of uterine eruption ruptures and subsequent pregnancies because of that that old scar de-hissing so that's when they decided to start doing the transverse where they um go across outside the mom and then inside when they get into the uterus they go across again signs and symptoms depend on the severity of the rupture 500 milliliters of blood to the uterus every minute is is serious abdominal pain tenderness chest pain pain between scapula pain on inspiration hypo hypovolemic shock which you could get tachycardia technique hypotension powder cool clammy skin anxiety with that signs of impaired fetal oxygenation which would include late d cells reduced variability bradycardia absent fetal heart sounds can happen cessation of uterine contractions can happen and palpitation of the fetus in the abdominal cavity okay uterine inversion um continuous fetal monitoring and uterine rupture is extremely important uterine inversion is something that you see happen as well um and this is the uterus completely or partially turns inside out it's uncommon but it can be seen it's potentially fatal pulling on the umbilical cord can cause it fundal pressure during birth increased abdominal pressure abnormally inherent placenta that just doesn't it's it's like glue um fundal placenta implantation signs and symptoms you're unable to palpate the fundus able to visualize uterus protruding through cervix into the vagina it's very scary massive hemorrhage it always brings shock and horrible pain with it the treatment is that the physician tries to replace the uterus back into the normal position vaginally of course second choice is going to be a laparotomy if if nothing else can be done a hysterectomy may be required and the patient's going to require lots of blood amniotic fluid embolism this is another obstetric emergency occurs when amniotic fluid and its particulates are drawn into the maternal circulation and carried to the lungs it carries a high mortality rate it's unable to predict it just happens before you even know what happens signs and symptoms include acute respiratory difficulty hypotension cyanosis seizure tachycardia coagulation failure dic disseminated intravascular coagulation which is a coag problem pulmonary edema adult rds respiratory distress syndrome and cardiac arrest all of this can happen to the mom supportive care they usually have to intubate they use vasopressors blood transfusions and oxytocin to contract the uterus okay um trauma another thing that can happen care is focused on stabilizing the mother once she's stable you then care for the baby so this is very impor important mom is the one you have to stabilize first turf foss which of the following assessment findings would lead the nurse to suspected amniotic fluid embolism respiratory distress hypertension acute abdominal pain or sun fetal distress and we just said this just a minute ago respiratory distress okay respiratory distress chest pain some of the your leading cues for um an embolism okay labor induction and augmentation induction means stimulating contractions via medical or surgical means augmentation means enhancing ineffective contractions after labor has begun what usually happens is the contractions start but then they either slow down or they just totally stop and then you have to give them some help some of the things that you do cervical ripening um cervical ripening is done to make the cervix softer and more likely to dilate it is usually started the day before iv induction mom is often admitted the evening before to receive the softening agent then transferred to l d in the morning to start induction um some things other things prosteoglandin e2 is given as an intravaginal gel very important to remember this osteoglandin e2 is given as an intravaginal gel intracervical gel or vaginal insert it produces softening and effacement some examples are cervidial or peppadil signs and symptoms you get cramping with it nausea vomiting and diarrhea but this is another cervical agent that is used for cervical ripening another agent is side attack cytotec is the prosteoglandin e1 analog that can be used as well signs and symptoms uterine irritability and contractions um all of these can cause hyperstimulation of the uterine contraction so fetal monitoring is done a minimum of every 30 minutes a minimum of every 30 minutes mom must lie flat for 15 to 20 minutes after they're inserted uh some other things you'll hear lamectal i'm sorry not limited lamisil laminaria dillipan these are moisture attracting inserts placed into the cervix where they absorb water swell and gradually dilate the cervix so all of these that i talked about osteoglues cytotec um lamisil laminar all of these are used uh cervidil all of these are used to soften the cervix and cause embasement so they're all used under the cervical ripening herbal supplements are used sexual intercourse with breast stimulation will help start the cervix kind of jump start it so it starts ripening oxytocin so make sure you look at the drug guide in your book and it talks about all these okay nursing assessment as far as what you do um relative gestational age you need to know the gestational age you need to know the fetal status and the maternal status and in your book it talks about bishop scores so make sure that you go over that bishop score uh look at care plan 21-1 for nursing management on labor and augmentation is the following statement true or false oxytocin is an important agent used to ripen the cervix for labor induction is that true or false false oxytocin is used to induce or argument labor once the cervix is ripe it is not a ripening agent once the cervix is right you put oxytocin on board to do what start the uterus contracting okay but you don't do that until you've got a ripe cervix amnioinfusion um amnio amnioinfusion indications uh severe decel variable d cells um oligohydromonas due to placental insufficiency post maturity premature labor with premature rupture of membranes thick meconium fluid all of this is indications for amnioinfusion amnio infusion is done with warmed sterile normal saline or lactated ringers and it's infused into the uterus through an iupc to increase fluid volume and provide cushioning to prevent cord compression or dilate meconium basically what you're saying is there's not enough amniotic fluid up there to do all this so you're artificially doing it you need to maintain bed rest for mom monitor vital signs and fetal heart tone strict ino monitor contractions and frequently change under pads because the the fluid does leak and monitor urinary output very important infusion is appropriate for a pregnant woman experiencing a prolonged second stage of labor is that true or false we just talked about amnio infusion false it is indicated for severe variable d cells due to cord compression not enough uh fluid which is eligible hydromonas uh in post-maturity rupture membranes pre-term labor with pre-term rupture of membranes and thick meconium fluid okay usually they have four sec forcep or vacuum assisted births uh that for a prolonged second stage of labor they don't use amnioinfusion okay uh forcep or forcep or vacuum assisted birth um you do take a risk of tissue trauma to mom and baby prevention is the key to try to prevent this from happening by early assessment by monitoring closely during the labor um sometimes prolonged second stage you'll have to do this a fetal heart rate pattern that gets kind of funky you'll have to get in there and do a vacuum assisted if the presenting part doesn't fully rotate and descend limited sensation sometimes that happens with analgesia and anesthesia and they'll have to do vacuum assisted maternal heart disease when you don't want the mom to do any more stress through labor they'll go ahead and do vacuum assisted maternal fatigue infection okay but again prevention is the key and this is an example showing you what the forceps look like and how they uh get on each side of the head usually a lot of times they do bruise especially in that little area you'll see little bruises where the vacuum the forceps were the vacuum assisted is where they put it on top of the head and pretty much it makes the seal and they pull they put some um pressure to pull help the baby come out c-sections cesarean births um we talked about there's a lot of these indications for that so syrian deliveries have been on an increase in the past few years and some of the reasons why women having induction of labor with their first baby are more likely to have a c-section two to three times women having induction of labor two to three times more likely to have a c-section um since women are having more c-sections first time delivery they're repeating their c-sections with the next pregnancies more women are having children later in life and these women are most likely older women are likely to have c-sections um possible problems prompting a c-section breach babies most of the time are delivered by c-section um many times physicians are just afraid to do a labor and delivery the normal way because there's such a big lawsuit uh community in um in maternal health maternal health nursing so they're afraid to do it so they'll do c-sections more women request c-sections so they can plan their birth experience and some women actually just don't like the molding of the head the baby looks like a cone head a c-section baby looks like the perfect baby no cone head or anything indications for c-section anytime you have a c-section um anytime you're waiting for vaginal delivery um it may not be safe for the mom and fetus dystocia is another reason you do a c-section um cephalopelvic disproportion baby can't come through the pelvis hypertension acute hypertension which usually leads to has a cause of preeclampsia or eclampsia with it maternal diabetes heart diabetes active genital herpes you would not want to deliver vaginally because that does what to the baby it can cause them to go blind and they can contract it through the passageway previous uterine surgeries talked about that already and how the uterus is already scarred and compromised persistent non-reassuring fetal heart rate uh you got d cells you're all over the place with your fetal heart rate c-section is better prolactin prolapsed umbilical cord if you don't float the umbilical cord away from the baby you might have a cord around the neck fetal mouth presentation and hemorrhagic conditions such as placenta abrupto or placenta previa um are indications for a c-section um contraindications for c-sections are when the benefits of surgery isn't worth the risk this is still considered major abdominal surgery and it has all the risk that's associated with major abdominal surgery okay so there's still that risk of hemorrhage there's still that risk of perforation of an organ all of that still exists even though it's a c-section um sequence of events for a c-section and keep in mind we'll talk about nursing pre-op and post-op in just a minute um sequence of events first you have to have lapse blood type because you always put blood on board just in case you're going to need it because remember you are opening them up you are doing major surgery blood type and cross cbc clotting times and blood is always put on standby anesthesia may be regional or general the regional we talked about the blocks the spinal um fetal heart monitoring this will continue right up until the abdomen is prepped and draped uh usually a wedge is placed under one hip to kind of uh displace a little bit grounding pad for cautery around the thigh um this will um keep the mom from being electrocuted foley catheter is always in place abdominal prep and drape incisions abdominal wall and uterine are the two you get two incisions the abdominal wall and then the uterus excuse me just one second as i answer my grandson grayson say hi hi i'm almost done okay um and bladder is visualized and secured so you may have to go in and actually look at the bladder with the little machine they always have on the floor membranes are ruptured if they haven't already in a c-section and again you note the color the odor the amount fetus then is delivered wiped off and suctioned cored clamped and cut okay that is the sequence of a c-section iv antibiotics many times single dose is given and they may put them on board after they go post delivery after you do after you deliver baby placenta is delivered oxytocin is usually added to the iv fluids to contract the uterus to prevent postpartum hemorrhage abdominal cavity is flushed and incision is closed many times they actually take the uterus out lay it on top and they flush the abdominal cavity uh it's quite interesting to watch post-op care um every 15 minutes vital signs first one to two hours and then every 30 minutes and then one hour vital signs respiratory status o2 fat level of consciousness and this is all for mom return of motion and sensation if they've had a block in their legs abdominal dressing very important to watch that abdominal dressing uh for bleeding uterine firmness imposition you still can get a boggy uterus so you've got to and this is a little bit more um of a challenge because mom has an incision so you've got to watch but sometimes you do have to rub to get the um the uterus to firm up note the locia the color the quantity presence and size of plots and remember i have said before with the c-section you probably won't see nearly the amount of logia watch urine output because again if a full bladder can cause postpartum hemorrhage iv infusion probably will have normal saline or lactated renders on board pain relief meds if they're needed scds stockings the stockings that are used the breathing incentives turn cough deep breathe support the incision when she coughs teach your mom to take a pillow and put it over the incision and not real tight but splint it with a little support when she's gonna cough it does help and position changes should be done every two hours so this is postop for us