Introduction. Delivery Methods and Conditions
During delivery, nursing considerations entail stress management. Stress of the circumstance may influence the healthcare provider and patient’s capacity to comprehend the information necessary to make wise selections (Mohamed-Ahmed, 2019). If they do not comprehend the terms, they might be unable to process the new knowledge. As a result, they might need help digesting the new knowledge. Cesarean birth should be seen as an option rather than an abnormal circumstance to improve the safety and well-being of both the mother and the fetus.
Mal-Presentation/External Cephalic Version (ECV)
During pregnancy, a baby frequently changes position, and around 36 weeks most babies turn naturally so that they are in a head-down position in preparation for birth. The position is referred to as vertex or cephalic presentation and it is the most preferred position for a vaginal birth. In case a baby is breech after 36 weeks then the healthcare provider engages the patient in flipping the baby (Melo et al., 2019). However, not all persons can have an external cephalic version and the provider must discuss and educate the patient about its importance to see if it is an option. Failure of the ECV to turn the baby and remaining breached result in the potential of having a C-section delivery.
Continuation of ECV
Healthcare professionals use medical history and pregnancy to review the risks of ECV.
Healthcare professionals will employ the external cephalic version of treatment to turn a newborn from breech to head down. A baby is said to be in a breech position when its feet or buttocks emerge first or lie horizontally across its uterus.
Diagnostic Procedure
Fetal heart rate irregularities, which occur at a rate of 4.7%, are the most frequent ECV side effects. However, they typically resolve once the therapy is finished or abandoned. Less than 1% of ECV cases result in more severe complications, such as the need for an emergency cesarean surgery, early membrane rupture, cord prolapse, vaginal bleeding, placental abruption, fetomaternal hemorrhage, and stillbirth. ECV should be undertaken in settings where an emergency cesarean section can be performed, despite the rarity of problems. This is why some medical professionals opt to do ECV in the operating room, even though it is not required.
Nursing Considerations
Patient sometimes can experience a severe headache that does not go away and as such it requires getting help immediately. ECV can be performed when the patient has frequent experiencing of vision alterations like blurry or spotty vision, hands or face are swollen, bleeding or have vaginal spotting. In addition, a patient can feel warm water dripping or rushing from the vagina, or water ruptured. Patient education is important to help understand the side effects, importance, and safety of the process to both the mother and fetus.
VBAC/ TOLAC
Uterus rapture with a prior transverse incision has 0.2 to 1.5 percent risk. Uterine rupture likely follows vertical or T-shaped incisions (4 to 9 percent risk). It’s crucial to remember that the direction of the skin incision does not determine the uterine incision type or direction. Sometimes TOLAC results in a cesarean birth following a cesarean due to the need to alter the plan (CBAC). The advantage of a vaginal delivery is that it entails no surgery, no potential risks of surgery, a shorter hospital stay, and a quicker return to normal daily activities than having another C-section. VBAC may assist in avoiding the hazards of multiple cesarean deliveries, such as placental issues if you intend on having additional children.
Dehiscence differs from uterine rupture such that the outer serosal layer of the uterus remain intact while the underlying muscular layers open permitting visualization of the fetus and amniotic sac. Alternatively, all uterus layers can be separated but the fetus remains safe in the uterus through the small opening. Patients with uterine dehiscence are mostly asymptomatic. Patients attempting TOLAC sometimes can need cesarean delivery and when it is after labor it poses risks of wound separation, uterine atony, and postpartum infection that those with planned repeat cesarean section.
Shoulder Dystocia
During McRobert’s nursing considerations, the woman straightens her pelvic curve by flexing her thighs forcefully against her belly. A supported squat produces a similar result and gives her pushing attempts more gravity. A helper applies suprapubic pressure, which causes the anterior fetal shoulder to be pushed lower and away from the mother’s symphysis pubis. Fundal pressure should be avoided since it firmly forces the anterior shoulder against the mother’s symphysis.
During treatment obstetrician call for assistance from other health professionals including anesthesiologists and neonatologists and use the safety checklist. The obstetrician determine whether the patient require an episiotomy to help deliver the child under the heading “E” (evaluate for episiotomy). An episiotomy entails an incision in the perineum to widen the vaginal opening. Only when it is necessary to make room for rotation movements will the healthcare provider undertake this treatment. The obstetrician might do the McRoberts maneuver by instructing the patient to perform it by pressing their thighs on the abdomen. The technique allows the pelvis to flatten through rotation. Suprapubic pressure is applied by pressing the abdomen below the pubic bone. As a result it attempts to rotate and deliver the baby by using pressure on its shoulder. In addition, enter maneuvers can also be performed to turn the baby while the obstetrician reach up into the vagina.
Prolapsed Cord
Umbilical cord prolapse is an acute obstetric emergency that need immediate delivery of the baby through cesarean section. Doctor manually elevate the fetal presentation part until C-section is done to reduce the risk of fetal oxygen loss. Nursing considerations involves assessing of the laboring patient when the fetus is premature or small for gestational age and the fetal presenting portion is not engaged or the membranes have ruptured. Regularly check the FHR immediately (and again in 5 to 10 minutes) after a spontaneous or surgical membrane rupture.
AFE (Amniotic Fluid Embolism)
Umbilical cord prolapse is an acute obstetric emergency that need immediate delivery of the baby through cesarean section. Doctor manually elevate the fetal presentation part until C-section is done to reduce the risk of fetal oxygen loss. Nursing considerations involves assessing of the laboring patient when the fetus is premature or small for gestational age and the fetal presenting portion is not engaged or the membranes have ruptured. Regularly check the FHR immediately (and again in 5 to 10 minutes) after a spontaneous or surgical membrane rupture.
References
Andersen, V., Muller, S., Jensen, P. B., Muller, F. T., & Green, A. (2020). Caesarean delivery and risk of chronic inflammatory diseases (inflammatory bowel disease, rheumatoid arthritis, coeliac disease, and diabetes mellitus): A population based registry study of 2,699,479 births in Denmark during 1973–2016. Clinical Epidemiology, 12, 287.
Mohamed-Ahmed, O., Hinshaw, K., & Knight, M. (2019). Operative vaginal delivery and post-partum infection. Best Practice & Research Clinical Obstetrics & Gynaecology, 56, 93-106.
Melo, P., Georgiou, E. X., Hedditch, A., Ellaway, P., & Impey, L. (2019). External cephalic version at term: a cohort study of 18 years’ experience. BJOG: An International Journal of Obstetrics & Gynaecology, 126(4), 493-499.
Parveen, S., Rengaraj, S., & Chaturvedula, L. (2022). Factors associated with the outcome of TOLAC after one previous caesarean section: a retrospective cohort study. Journal of Obstetrics and Gynaecology, 42(3), 430-436.
Bothou, A., Apostolidi, D. M., Tsikouras, P., Iatrakis, G., Sarella, A., Iatrakis, D.,… & Zervoudis, S. (2021). Overview of techniques to manage shoulder dystocia during vaginal birth. European Journal of Midwifery, 5.
Wong, L., Kwan, A. H. W., Lau, S. L., Sin, W. T. A., & Leung, T. Y. (2021). Umbilical cord prolapse: revisiting its definition and management. American Journal of Obstetrics and Gynecology, 225(4), 357-366.
Fitzpatrick, K. E., Van Den Akker, T., Bloemenkamp, K. W., Deneux-Tharaux, C., Kristufkova, A., Li, Z.,… & Knight, M. (2019). Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS medicine, 16(11), e1002962.