Nursing tricks that make OB nursing stick

First stage: latent (0–6 cm, irregular contractions), active (6–10 cm, stronger/closer contractions), transition (8–10 cm, most intense). Assess: cervical dilation, effacement, station, fetal heart rate, contractions. Second stage: complete dilation to birth. Push with contractions (closed glottis). Monitor fetal heart rate. Third stage: placenta delivery — within 30 minutes. Signs of separation: gush of blood, lengthening of cord, uterine fundus rises and becomes firm. Fourth stage: first 1–4 hours after delivery. Assess: fundus (firm, midline, at umbilicus), lochia, perineum, BP, HR. Most common time for postpartum hemorrhage.

Early decelerations: mirror contractions (start and end together), caused by head compression, normal — no intervention needed. Variable decelerations: abrupt drop, variable timing, caused by cord compression. Intervention: change maternal position (left lateral, knee-chest), O2, stop oxytocin, fluid bolus — may need amnioinfusion. Late decelerations: begin AFTER peak of contraction, caused by uteroplacental insufficiency (placenta not delivering enough O2 to fetus). EMERGENCY — notify provider immediately. Interventions: left lateral position, O2 10 L nonrebreather, stop oxytocin, IV fluid bolus, prepare for delivery. Persistent late decels = C-section.

Most common cause: uterine atony (boggy uterus = not contracting). 4 Ts: Tone (70–80% — uterine atony), Trauma (lacerations), Tissue (retained placenta), Thrombin (coagulopathy). Assessment: fundus (boggy? midline? above umbilicus?), lochia (saturating pad in <1 hour = abnormal), vital signs (tachycardia first sign, then hypotension). Management of atony: massage fundus (never pummel), bimanual compression, oxytocin (Pitocin), methergine (not in HTN), carboprost (not in asthma), Bakri balloon, blood products. Monitor: I&O, H&H, coagulation studies.

Preeclampsia: onset >20 weeks gestation. Criteria: BP ≥140/90 on two occasions 4 hrs apart, plus proteinuria. Severe features: BP ≥160/110, platelets <100,000, creatinine >1.1, LFTs 2× normal, pulmonary edema, severe headache, visual disturbances, RUQ pain. HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets. Nursing: quiet, dim room (reduce stimuli), magnesium sulfate (seizure prophylaxis AND treatment — monitor for toxicity: absent DTRs, RR <12, urine <25 mL/hr), antidote = calcium gluconate. Eclampsia: grand mal seizure — give magnesium, protect from injury, O2, notify provider immediately. Delivery is the only cure.

Normal vitals: HR 120–160 (tachycardia if >160, bradycardia if <100), RR 30–60 (normal is fast!), Temp 36.5–37.5°C (axillary). Acrocyanosis: blue hands/feet normal for first few hours (peripheral circulation immature) — central cyanosis (lips, trunk) = abnormal. Caput succedaneum: edema crossing suture lines, present at birth, resolves in days. Cephalohematoma: bleeding under periosteum, does NOT cross suture lines, appears 24–48 hrs, resolves in weeks (risk for jaundice). Vernix (white coating), lanugo (fine hair), milia (white dots on nose) = all normal. Meconium: first stool within 24–48 hrs. Void within 24 hrs.

Good latch: baby's mouth covers areola (not just nipple), lips flanged outward, chin touching breast, audible swallowing, no pain. Feed on demand — 8–12 times per 24 hours (every 2–3 hrs). Duration: 10–15 min per breast. Signs of adequate intake: 6+ wet diapers/day by day 4, weight regain by day 10–14 (lose up to 10% initially), yellow seedy stools by day 4. Colostrum: first 3–5 days — high in antibodies (IgA), thick yellow, small amounts normal. Engorgement: frequent feeding, warm compress before feeding, cold compress after, supportive bra. Mastitis: breast infection — continue breastfeeding, antibiotics, warm compress, rest.

Immediate post-op: assess as for any surgical patient PLUS obstetric assessments. Fundus: firm, midline, at umbilicus. Lochia: rubra (red, first 3 days), serosa (pink, days 4–10), alba (white, days 11+). Incision: Pfannenstiel (bikini line — horizontal). Foley catheter: usually removed 12–24 hrs post-op. Pain: multimodal analgesia — IV opioids → oral NSAIDS + acetaminophen → wean opioids. Early ambulation: 12–24 hrs — prevents DVT, ileus, pneumonia. Sequential compression devices (SCDs) until ambulating. Patient teaching: no driving for 4–6 weeks, lift nothing heavier than baby, incision care. Next delivery: VBAC possible for some.

GDM: glucose intolerance first recognized during pregnancy. Screening: 24–28 weeks (1-hr glucose challenge test). Diagnosis: 3-hr OGTT. Pathophysiology: placental hormones → insulin resistance. Risks to baby: macrosomia (large baby → difficult delivery, shoulder dystocia), neonatal hypoglycemia (baby was compensating for mom's high glucose → baby's insulin remains high after birth — check newborn glucose at 1 hr). Risks to mother: UTIs, preeclampsia, C-section, future Type 2 DM (50% risk). Management: diet first (complex carbs, small meals), exercise, insulin if needed (NOT oral antidiabetics in pregnancy). Resolves after delivery.

Jaundice: yellow skin from bilirubin (RBC breakdown). Physiologic (normal): appears day 2–3 (after 24 hrs), peaks day 3–5, resolves day 7–10. Cause: immature liver, polycythemia. Pathologic (abnormal): appears within first 24 hours — Rh or ABO incompatibility, infection. EMERGENCY — needs immediate treatment. Phototherapy (bili lights): converts bilirubin to water-soluble form excreted in urine/stool. Nursing: eye shields (protect from light), turn every 2 hrs, increase feeds (hydration promotes excretion), monitor skin color and bilirubin levels, remove briefly for feeds. Kernicterus: bilirubin deposits in brain → permanent neurological damage.

Effectiveness (best to least): Implant (Nexplanon, >99%), IUD (Mirena/Paraguard, >99%), Sterilization (>99%), Depo-Provera shot (94%), Combined pill (91% typical use), Patch/Ring, Male condom (85% typical), Diaphragm (83% typical), Spermicide (72% typical). Estrogen-containing contraceptives CONTRAINDICATED in: smokers ≥35 years (DVT/PE risk), uncontrolled HTN, history of DVT/PE/stroke, breast cancer, migraines with aura, breastfeeding <6 weeks. Progestin-only (mini-pill, Depo, Mirena, Nexplanon): safer alternatives. Copper IUD (Paraguard): no hormones, also emergency contraception within 5 days.

Breasts: engorgement, nipple condition, signs of mastitis (red, warm, flu-like). Uterus: fundus firm (boggy = atony → massage), midline (deviated = full bladder), descends 1 cm/day, at umbilicus day 1. Bladder: void within 4–6 hrs of delivery, distension displaces uterus → hemorrhage risk. Bowel: bowel sounds present, first BM by day 2–3 (may be painful). Lochia: Rubra (red, days 1–3), Serosa (pink, days 4–10), Alba (white, days 11–14+). Report: foul odor, heavy saturation, large clots. Episiotomy: REEDA (Redness, Edema, Ecchymosis, Discharge, Approximation). Homans sign: calf pain with dorsiflexion (DVT — limited reliability). Emotional: baby blues vs postpartum depression (>2 weeks, affects functioning).