DRESS CODE - SURGICAL ATTIRE
1. All persons who enter the semirestricted and restricted areas of the surgical suite should be in hospital laundered surgical attire intended for use only within the surgical suite at UTMB.
2. All possible head and facial hair, including sideburns and neckline, should be covered when in the surgical suite.
3. All persons entering an operating room or centerwell area should wear a mask.
4. All personnel entering the suite should have all jewelry confined or removed. Watches and plain wedding bands are acceptable. Earrings must be covered by the scrub cap.
5. Nail polish and artificial nails should not be worn within the suite.
6. Protective barriers (gloves, masks, protective eyewear, and face shields) are provided by the hospital and should be utilized to reduce the risk of exposure to potentially infective agents.
7. Shoes should be dedicated to the OR and shoe covers are not required. If shoe covers are necessary, the wearer should remove them before leaving the operating room to avoid tracking blood and debris through the department.
SURGICAL HAND SCRUB
1. A five (5) minute anatomical timed scrub will be used for all surgical hand scrubs.
2. Fingernails must be free of polish/enamel and of medium length. No jewelry is permitted on the hands and arms while performing as a member of the surgical team.
3. **Remember to put your mask on prior to starting you scrub.**
4. Wash hands and arms with solution to 2 inches above the elbow.
5. Clean fingernails with file. Take sterile brush in right hand. Wet brush with water and soap. Scrub fingernails of left hand.
6. Start scrubbing fingers of left hand, one at a time, treating each finger as four-sided; palm, knuckles, and back of hand. Repeat with right hand.
7. Scrub right wrist and continue up arm to 2 inches above elbow. Repeat with left arm. Discard brush. Rinse both hands and arms under running water keeping hands above level of elbow so that water runs off the elbows and not the hands.
Tuesday, June 16, 2009
Points to Remember about Aseptic Technique
Principles of Aseptic Technique Reflects One's Surgical Conscience.
1. The patient is the center of the sterile field.
2. Only sterile items are used within the sterile field.
A. Examples of items used.
B. How do we know they are sterile? (Wrapping, label, storage)
3. Sterile persons are gowned and gloved.
A. Keep hands at waist level and in sight at all times.
B. Keep hands away from the face.
C. Never fold hands under arms.
D. Gowns are considered sterile in front from chest to level of sterile field, and the sleeves from above the elbow to cuffs. Gloves are sterile.
E. Sit only if sitting for entire procedure.
4. Tables are sterile only at table level.
A. Anything over the edge is considered unsterile, such as a suture or the table drape.
B. Use non-perforating device to secure tubing and cords to prevent them from sliding to the floor.
5. Sterile persons touch only sterile items or areas; unsterile persons touch only unsterile items or areas.
A. Sterile team members maintain contact with sterile field by wearing gloves and gowns.
B. Supplies are brought to sterile team members by the circulator, who opens wrappers on sterile packages. The circulator ensures a sterile transfer to the sterile field. Only sterile items touch sterile surfaces.
6. Unsterile persons avoid reaching over sterile field; sterile persons avoid leaning over unsterile area.
A. Scrub person sets basins to be filled at edge of table to fill them.
B. Circulator pours with lip only over basin edge.
C. Scrub person drapes an unsterile table toward self first to avoid leaning over an unsterile area. Cuff drapes over gloved hands.
D. Scrub person stands back from the unsterile table when draping it to avoid leaning over an unsterile area.
7. Edges of anything that encloses sterile contents are considered unsterile.
A. When opening sterile packages, open away from you first. Secure flaps so they do not dangle.
B. The wrapper is considered sterile to within one inch of the wrapper.
C. In peel-open packages, the edges where glued, are not considered sterile.
8. Sterile field is created as close as possible to time of use.
A. Covering sterile tables is not recommended.
9. Sterile areas are continuously kept in view.
A. Sterility cannot be ensured without direct observation. An unguarded sterile field should be considered contaminated.
10. Sterile persons keep well within sterile area.
A. Sterile persons pass each other back to back or front to front.
B. Sterile person faces a sterile area to pass it.
C. Sterile persons stay within the sterile field. They do not walk around or go outside the room.
D. Movement is kept to a minimum to avoid contamination of sterile items or persons.
11. Unsterile persons avoid sterile areas.
A. Unsterile persons maintain a distance of at least 1 foot from the sterile field.
B. Unsterile persons face and observe a sterile area when passing it to be sure they do not touch it.
C. Unsterile persons never walk between two sterile fields.
D. Circulator restricts to a minimum all activity near the sterile field.
12. Destruction of integrity of microbial barriers results in contamination.
A. Strike through is the soaking through of barrier from sterile to non-sterile or vice versa.
B. Sterility is event related.
13. Microorganisms must be kept to irreducible minimum.
A. Perfect asepsis is an idea. All microorganisms cannot be eliminated. Skin cannot be sterilized. Air is contaminated by droplets.
1. The patient is the center of the sterile field.
2. Only sterile items are used within the sterile field.
A. Examples of items used.
B. How do we know they are sterile? (Wrapping, label, storage)
3. Sterile persons are gowned and gloved.
A. Keep hands at waist level and in sight at all times.
B. Keep hands away from the face.
C. Never fold hands under arms.
D. Gowns are considered sterile in front from chest to level of sterile field, and the sleeves from above the elbow to cuffs. Gloves are sterile.
E. Sit only if sitting for entire procedure.
4. Tables are sterile only at table level.
A. Anything over the edge is considered unsterile, such as a suture or the table drape.
B. Use non-perforating device to secure tubing and cords to prevent them from sliding to the floor.
5. Sterile persons touch only sterile items or areas; unsterile persons touch only unsterile items or areas.
A. Sterile team members maintain contact with sterile field by wearing gloves and gowns.
B. Supplies are brought to sterile team members by the circulator, who opens wrappers on sterile packages. The circulator ensures a sterile transfer to the sterile field. Only sterile items touch sterile surfaces.
6. Unsterile persons avoid reaching over sterile field; sterile persons avoid leaning over unsterile area.
A. Scrub person sets basins to be filled at edge of table to fill them.
B. Circulator pours with lip only over basin edge.
C. Scrub person drapes an unsterile table toward self first to avoid leaning over an unsterile area. Cuff drapes over gloved hands.
D. Scrub person stands back from the unsterile table when draping it to avoid leaning over an unsterile area.
7. Edges of anything that encloses sterile contents are considered unsterile.
A. When opening sterile packages, open away from you first. Secure flaps so they do not dangle.
B. The wrapper is considered sterile to within one inch of the wrapper.
C. In peel-open packages, the edges where glued, are not considered sterile.
8. Sterile field is created as close as possible to time of use.
A. Covering sterile tables is not recommended.
9. Sterile areas are continuously kept in view.
A. Sterility cannot be ensured without direct observation. An unguarded sterile field should be considered contaminated.
10. Sterile persons keep well within sterile area.
A. Sterile persons pass each other back to back or front to front.
B. Sterile person faces a sterile area to pass it.
C. Sterile persons stay within the sterile field. They do not walk around or go outside the room.
D. Movement is kept to a minimum to avoid contamination of sterile items or persons.
11. Unsterile persons avoid sterile areas.
A. Unsterile persons maintain a distance of at least 1 foot from the sterile field.
B. Unsterile persons face and observe a sterile area when passing it to be sure they do not touch it.
C. Unsterile persons never walk between two sterile fields.
D. Circulator restricts to a minimum all activity near the sterile field.
12. Destruction of integrity of microbial barriers results in contamination.
A. Strike through is the soaking through of barrier from sterile to non-sterile or vice versa.
B. Sterility is event related.
13. Microorganisms must be kept to irreducible minimum.
A. Perfect asepsis is an idea. All microorganisms cannot be eliminated. Skin cannot be sterilized. Air is contaminated by droplets.
Characteristics of Surgical Scrubbing
Characteristics of a Surgical Scrub
Performance characteristics for a surgical scrub agent generally fall into four categories:
1. Antimicrobial Action--an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms. This agent would have to work rapidly. An agent that does not work rapidly may not provide adequate bacterial reduction before being rinsed off.
2. Persistent Activity--an agent offering persistent activity keeps the bacterial count low under the gloves. It is not unusual for a surgery to last in excess of two hours. Studies have shown the rate of glove failures (non-visible holes) increases with the duration of surgery.4 In addition, studies show bacteria grow faster under gloved than ungloved hands.5,6,7
3. Safety--the ideal agent would be non-irritating and non-sensitizing. It must have no appreciable ocular or ototoxicity, be safe for use on the body, and not be damaging to the skin or environment.
4. Acceptance--probably most important to achieving compliance in using a new product is its acceptance by the healthcare worker. A product that has ideal antimicrobial action and an excellent safety profile is of little value to good infection control if the user population fails to support its use. Although each is important in its own right, all four characteristics should be present for a complete package.
Surgical scrub agents come in many forms. Not all forms meet all characteristics.
1. Liquid or foam soaps. These are the most common products for surgical scrubs and are used in conjunction with water and dry scrub brushes or sponges. The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor, or PCMX (parachlorometaxylenol). These agents are very drying and with repeated scrubbing with the scrub brush can cause skin damage.
2. Impregnated scrub brushes/sponges. Scrub brushes/sponges are preloaded with CHG, iodophor, or PCMX and are water-aided products.
3. Brush-free surgical scrub. These products use an antimicrobial agent and water but no scrub brush.
Conclusion
No matter what agent is used, or which scrub technique you practice, there is only one goal: infection prevention. Effective surgical scrubs are one of the most powerful strategies of infection prevention in the OR. Glove usage gives a false sense of security against bacteria. Gloves provide an ideal environment for bacterial growth, moisture and warmth, which makes good hand-scrub techniques and aseptic gowning and gloving an important part of the total infection prevention platform. It is important for healthcare management to help the personnel understand the cause/effect cycle of surgical scrubs as they relate to infection prevention.
Performance characteristics for a surgical scrub agent generally fall into four categories:
1. Antimicrobial Action--an ideal agent would have a broad spectrum of antimicrobial activity against pathogenic organisms. This agent would have to work rapidly. An agent that does not work rapidly may not provide adequate bacterial reduction before being rinsed off.
2. Persistent Activity--an agent offering persistent activity keeps the bacterial count low under the gloves. It is not unusual for a surgery to last in excess of two hours. Studies have shown the rate of glove failures (non-visible holes) increases with the duration of surgery.4 In addition, studies show bacteria grow faster under gloved than ungloved hands.5,6,7
3. Safety--the ideal agent would be non-irritating and non-sensitizing. It must have no appreciable ocular or ototoxicity, be safe for use on the body, and not be damaging to the skin or environment.
4. Acceptance--probably most important to achieving compliance in using a new product is its acceptance by the healthcare worker. A product that has ideal antimicrobial action and an excellent safety profile is of little value to good infection control if the user population fails to support its use. Although each is important in its own right, all four characteristics should be present for a complete package.
Surgical scrub agents come in many forms. Not all forms meet all characteristics.
1. Liquid or foam soaps. These are the most common products for surgical scrubs and are used in conjunction with water and dry scrub brushes or sponges. The most common antimicrobial agents in these products are CHG (chlorhexidine gluconate), iodophor, or PCMX (parachlorometaxylenol). These agents are very drying and with repeated scrubbing with the scrub brush can cause skin damage.
2. Impregnated scrub brushes/sponges. Scrub brushes/sponges are preloaded with CHG, iodophor, or PCMX and are water-aided products.
3. Brush-free surgical scrub. These products use an antimicrobial agent and water but no scrub brush.
Conclusion
No matter what agent is used, or which scrub technique you practice, there is only one goal: infection prevention. Effective surgical scrubs are one of the most powerful strategies of infection prevention in the OR. Glove usage gives a false sense of security against bacteria. Gloves provide an ideal environment for bacterial growth, moisture and warmth, which makes good hand-scrub techniques and aseptic gowning and gloving an important part of the total infection prevention platform. It is important for healthcare management to help the personnel understand the cause/effect cycle of surgical scrubs as they relate to infection prevention.
Surgical Scrub Technique
How To Perform Surgical Hand Scrubs
By Deborah Gardner, LPN, OPAC, and Ellen Anderson-Manz, RN, BSN
Human hands are the most important tools for caring. Hands feel, diagnose, cure, prod, and provoke as they are placed upon each patient who is hoping for answers, understanding, and healing remedies. The hands can also be a portal and transmitter of infection. While handwashing may be the simplest way to control infection, it is often not practiced where warranted.
Surgical site infections greatly contribute to nosocomial infections. Some of the risk factors for nosocomial infections include the behavior of OR personnel regarding decontamination practices, hand hygiene/antisepsis, and compliance with universal precautions. Most surgical professionals agree on the importance of good surgical hand-washing practices in infection prevention. Hand transmission is a critical factor in the spread of bacteria, pathogens, viruses that cause disease, and nosocomial infections in general.
The purpose of surgical hand scrub is to:
* Remove debris and transient microorganisms from the nails, hands, and forearms
* Reduce the resident microbial count to a minimum, and
* Inhibit rapid rebound growth of microorganisms.1
Surgical Scrub Techniques
All sterile team members should perform the hand and arm scrub before entering the surgical suite. The basic principle of the scrub is to wash the hands thoroughly, and then to wash from a clean area (the hand) to a less clean area (the arm). A systematic approach to the scrub is an efficient way to ensure proper technique.
There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol.
The procedure for the timed five minute scrub consists of:
* Remove all jewelry (rings, watches, bracelets).
* Wash hands and arms with anitmicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash with for the recommended amount of time. However, because cold water prevents soap from lathering properly, soil and germs may not be washed away.
* Clean subungual areas with a nail file.
* Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two minutes.
* Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
* Wash each side of the arm to three inches above the elbow for one minute.
* Repeat the process on the other hand and arm, keeping hands above elbows at all times. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been contaminated.
* Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
* Proceed to the operating room suite holding hands above elbows.2
* If the hands and arms are grossly soiled, the scrub time should be lengthened. However, vigorous scrubbing that causes the skin to become abraded should be avoided.
* At all times during the scrub procedure care should be taken not to splash water onto surgical attire.2
* Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique. You are now ready to don your gown and sterile gloves.
When gowning oneself, grasp the gown firmly and bring it away from the table. It has already been folded so that the outside faces away. Holding the gown at the shoulders, allow it to unfold gently. Do not shake the gown.
Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do not allow hands to slide outside the gown cuff. The circulator will assist by pulling the gown up over the shoulders and tying it.
To glove, lay the glove palm down over the cuff of the gown. The fingers of the glove face toward you. Working through the gown sleeve, grasp the cuff of the glove and bring it over the open cuff of the sleeve. Unroll the glove cuff so that it covers the sleeve cuff. Proceed with the opposite hand, using the same technique. Never allow the bare hand to contact the gown cuff edge or outside of glove.
The scrubbed technologist or nurse gowns the surgeon after he or she has performed the hand and arm scrub. After handing the surgeon a towel for drying, the technologist or nurse allows the gown to unfold gently, making sure that there is enough room to prevent contamination by nonsterile equipment. To glove another person, the rules of asepsis must be observed. One person's sterile hands should not touch the nonsterile surface of the person being gloved.
* Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them so that a wide opening is created. Keep thumbs under the cuff.
* The surgeon will thrust his or her hand into the glove. Do not release the glove yet.
* Gently release the cuff (do not allow the cuff to snap sharply) while unrolling it over the wrist. Proceed with the left glove, using the same technique.
Formal guidelines and recommended practices for hand washing have been published by professional organizations (e.g., Association for Professionals in Infection Control (APIC), Association of periOperative Registered Nurses, Inc. (AORN). AORN recommends the use of a traditional standardized anatomical timed scrub or counted stroke method for surgical hand scrub and encourages institutions to follow the scrub agent manufacturer's written recommendations when establishing policies and procedures for scrub times. On this basis, for example, the typical scrub procedure for a PVPI-containing product based on manufacturer's labeling would require the use of a scrub brush and two applications of five minutes each, whereas the typical procedure for a CHG-based product would require a three-minute scrub followed by a three-minute wash. In actual practice, however, variations in surgical hand scrubbing times may be of shorter duration than manufacturer's recommendations for a number of reasons:
* Staff time constraints.
* Desire to reduce poor hand health.
* Acceptance of data from other sources suggesting those scrub times shorter than those recommended by manufactures are adequate.3
Hand condition is emerging as an increasingly important factor in personnel compliance and infection control. Frequent surgical scrubbing can cause dermatitis of the hands and arms. Most antimicrobial agents are drying to the skin, especially when coupled with a scrub brush.
By Deborah Gardner, LPN, OPAC, and Ellen Anderson-Manz, RN, BSN
Human hands are the most important tools for caring. Hands feel, diagnose, cure, prod, and provoke as they are placed upon each patient who is hoping for answers, understanding, and healing remedies. The hands can also be a portal and transmitter of infection. While handwashing may be the simplest way to control infection, it is often not practiced where warranted.
Surgical site infections greatly contribute to nosocomial infections. Some of the risk factors for nosocomial infections include the behavior of OR personnel regarding decontamination practices, hand hygiene/antisepsis, and compliance with universal precautions. Most surgical professionals agree on the importance of good surgical hand-washing practices in infection prevention. Hand transmission is a critical factor in the spread of bacteria, pathogens, viruses that cause disease, and nosocomial infections in general.
The purpose of surgical hand scrub is to:
* Remove debris and transient microorganisms from the nails, hands, and forearms
* Reduce the resident microbial count to a minimum, and
* Inhibit rapid rebound growth of microorganisms.1
Surgical Scrub Techniques
All sterile team members should perform the hand and arm scrub before entering the surgical suite. The basic principle of the scrub is to wash the hands thoroughly, and then to wash from a clean area (the hand) to a less clean area (the arm). A systematic approach to the scrub is an efficient way to ensure proper technique.
There are two methods of scrub procedure. One is a numbered stroke method, in which a certain number of brush strokes are designated for each finger, palm, back of hand, and arm. The alternative method is the timed scrub, and each scrub should last from three to five minutes, depending on facility protocol.
The procedure for the timed five minute scrub consists of:
* Remove all jewelry (rings, watches, bracelets).
* Wash hands and arms with anitmicrobial soap. Excessively hot water is harder on the skin, dries the skin, and is too uncomfortable to wash with for the recommended amount of time. However, because cold water prevents soap from lathering properly, soil and germs may not be washed away.
* Clean subungual areas with a nail file.
* Start timing. Scrub each side of each finger, between the fingers, and the back and front of the hand for two minutes.
* Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
* Wash each side of the arm to three inches above the elbow for one minute.
* Repeat the process on the other hand and arm, keeping hands above elbows at all times. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been contaminated.
* Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
* Proceed to the operating room suite holding hands above elbows.2
* If the hands and arms are grossly soiled, the scrub time should be lengthened. However, vigorous scrubbing that causes the skin to become abraded should be avoided.
* At all times during the scrub procedure care should be taken not to splash water onto surgical attire.2
* Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique. You are now ready to don your gown and sterile gloves.
When gowning oneself, grasp the gown firmly and bring it away from the table. It has already been folded so that the outside faces away. Holding the gown at the shoulders, allow it to unfold gently. Do not shake the gown.
Place hands inside the armholes and guide each arm through the sleeves by raising and spreading the arms. Do not allow hands to slide outside the gown cuff. The circulator will assist by pulling the gown up over the shoulders and tying it.
To glove, lay the glove palm down over the cuff of the gown. The fingers of the glove face toward you. Working through the gown sleeve, grasp the cuff of the glove and bring it over the open cuff of the sleeve. Unroll the glove cuff so that it covers the sleeve cuff. Proceed with the opposite hand, using the same technique. Never allow the bare hand to contact the gown cuff edge or outside of glove.
The scrubbed technologist or nurse gowns the surgeon after he or she has performed the hand and arm scrub. After handing the surgeon a towel for drying, the technologist or nurse allows the gown to unfold gently, making sure that there is enough room to prevent contamination by nonsterile equipment. To glove another person, the rules of asepsis must be observed. One person's sterile hands should not touch the nonsterile surface of the person being gloved.
* Pick up the right glove and place the palm away from you. Slide the fingers under the glove cuff and spread them so that a wide opening is created. Keep thumbs under the cuff.
* The surgeon will thrust his or her hand into the glove. Do not release the glove yet.
* Gently release the cuff (do not allow the cuff to snap sharply) while unrolling it over the wrist. Proceed with the left glove, using the same technique.
Formal guidelines and recommended practices for hand washing have been published by professional organizations (e.g., Association for Professionals in Infection Control (APIC), Association of periOperative Registered Nurses, Inc. (AORN). AORN recommends the use of a traditional standardized anatomical timed scrub or counted stroke method for surgical hand scrub and encourages institutions to follow the scrub agent manufacturer's written recommendations when establishing policies and procedures for scrub times. On this basis, for example, the typical scrub procedure for a PVPI-containing product based on manufacturer's labeling would require the use of a scrub brush and two applications of five minutes each, whereas the typical procedure for a CHG-based product would require a three-minute scrub followed by a three-minute wash. In actual practice, however, variations in surgical hand scrubbing times may be of shorter duration than manufacturer's recommendations for a number of reasons:
* Staff time constraints.
* Desire to reduce poor hand health.
* Acceptance of data from other sources suggesting those scrub times shorter than those recommended by manufactures are adequate.3
Hand condition is emerging as an increasingly important factor in personnel compliance and infection control. Frequent surgical scrubbing can cause dermatitis of the hands and arms. Most antimicrobial agents are drying to the skin, especially when coupled with a scrub brush.
Monday, June 15, 2009
Stages of Labor
Stages of Labor
There are three stages of labor. The first stage occurs from the time true labor begins until the cervix is completely dilated and effaced. During the second stage the baby is delivered. The third stage follows the birth of the baby through the birth of the placenta.
* First Stage
* Second Stage
* Third Stage
* Labor and Delivery Checklist
First Stage
The first stage of labor is the longest. There are three phases within the first stage;
* Early or latent phase
* Active phase
* Transition phase
At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first child, this stage usually lasts 12 to 16 hours. For women having second or subsequent children, the first stage lasts around 6-7 hours.
Early Labor
During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first phase is the longest, averaging around 8 hours. Your contractions may be irregular, progressing to rhythmic and methodical. The pain felt at this early stage may be similar to menstrual pain: aching, fullness, cramping and backache. You will still be able to walk. Walking is usually more comfortable than sitting. Most women spend these hours at home, or they may be checked at the hospital and sent home until labor becomes more active. You may feel eager, excited and social. It is important that you conserve your energy for the work of labor.
Active Labor
Active labor is marked by regular contractions that become longer, stronger and closer together over time. Most providers recommend that you go to the hospital when your contractions are five minutes apart, lasting more then 60 seconds for at least an hour. Measure your contractions from the start of one contraction to the beginning of the next.
Your physician will want to know:
* How far apart are the contractions?
* How long they are lasting, and how intense?
* Are you using breathing techniques to manage the pain?
* Has your "bag of water" broken? Your provider will want to know the time this occurred, and any color or odor.
* Has there been any discharge, such as a bloody show?
If you have had previous deliveries, the active phase of labor can proceed more quickly. Your physician may want to be contacted sooner.
When you are in active labor, you will be concentrating on the task at hand, and will not feel like doing anything else. Your labor partner's support is important at this phase. Contractions are growing stronger, longer and closer together. Contractions will be about 3-4 minutes apart, lasting 40 to 60 seconds. You may have a tightening feeling in your pubic area and increasing pressure in your back. If you have learned breathing techniques, begin using them now, if you haven't already. Pain medication is often given at this stage. If you have chosen to have an epidural anesthetic, it is usually given at this stage. Please see pain management for more information.
Transition
Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30 minutes to two hours. The cervix is opening the last few centimeters, from 7 to 10 centimeters. The pain may be intense, as the cervix stretches and the baby descends into the birth canal. All of your energy is concentrated on doing the work of labor. Try to remain calm and focused as your uterus works. At the end of transition, you may feel a strong urge to push the baby out. The baby is ready to be born.
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Second Stage
During the second stage the baby is born. This stage of labor lasts anywhere from one contraction to up to two hours. The baby's head stretches your vagina and perineum (the skin between the vagina and rectum). This may cause a burning sensation. Some women may feel as if they are having a bowel movement, and feel the urge to push, or bear down. The labor nurse or physician will tell you when it is time to push. It is important that you not push until instructed. Pushing too early will cause the cervix to become edematous, or swollen. "Crowning" occurs as the widest part of the head appears at the vaginal opening. In the next few pushes, the baby is born. Mucous and amniotic fluid will be removed from the baby's mouth and nose with a bulb syringe. The baby will take its first breath, and may begin to cry. Immediately after birth, the baby is still connected to the placenta by the umbilical cord. The cord is clamped and cut.
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Third Stage
The third stage begins with the birth of the baby and ends with the delivery of the placenta. It is the shortest stage, lasting from 5 to 15 minutes. Your contractions may stop for awhile, then resume to deliver the placenta. You will be observed closely for the next few hours to make certain that your uterus is contracting and bleeding is not excessive. The nurse will massage your uterus, or your lower abdomen to check that the uterus is contracting. Take this time to rest and get acquainted with your new baby.
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Labor and Delivery Checklist
1. Prior to labor, discuss the following issues with your physician or nurse practitioner:
* What do I do if I think I am in labor?
* What pain management options are available?
* When is an episiotomy necessary?
* What are some reasons you might perform a cesarean delivery?
2. If you have not done so, take a hospital tour so you are familiar with the place where you will give birth.
3. Arrange for help to care for you and the baby after birth, if you can.
4. Shop and prepare food for the first weeks when you are home with the baby, and collect take-out menus.
5. Review Preparing for Baby checklist.
6. Make sure you always have gas in the car.
7. Pack your bags. See what to pack for the labor room.
There are three stages of labor. The first stage occurs from the time true labor begins until the cervix is completely dilated and effaced. During the second stage the baby is delivered. The third stage follows the birth of the baby through the birth of the placenta.
* First Stage
* Second Stage
* Third Stage
* Labor and Delivery Checklist
First Stage
The first stage of labor is the longest. There are three phases within the first stage;
* Early or latent phase
* Active phase
* Transition phase
At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first child, this stage usually lasts 12 to 16 hours. For women having second or subsequent children, the first stage lasts around 6-7 hours.
Early Labor
During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first phase is the longest, averaging around 8 hours. Your contractions may be irregular, progressing to rhythmic and methodical. The pain felt at this early stage may be similar to menstrual pain: aching, fullness, cramping and backache. You will still be able to walk. Walking is usually more comfortable than sitting. Most women spend these hours at home, or they may be checked at the hospital and sent home until labor becomes more active. You may feel eager, excited and social. It is important that you conserve your energy for the work of labor.
Active Labor
Active labor is marked by regular contractions that become longer, stronger and closer together over time. Most providers recommend that you go to the hospital when your contractions are five minutes apart, lasting more then 60 seconds for at least an hour. Measure your contractions from the start of one contraction to the beginning of the next.
Your physician will want to know:
* How far apart are the contractions?
* How long they are lasting, and how intense?
* Are you using breathing techniques to manage the pain?
* Has your "bag of water" broken? Your provider will want to know the time this occurred, and any color or odor.
* Has there been any discharge, such as a bloody show?
If you have had previous deliveries, the active phase of labor can proceed more quickly. Your physician may want to be contacted sooner.
When you are in active labor, you will be concentrating on the task at hand, and will not feel like doing anything else. Your labor partner's support is important at this phase. Contractions are growing stronger, longer and closer together. Contractions will be about 3-4 minutes apart, lasting 40 to 60 seconds. You may have a tightening feeling in your pubic area and increasing pressure in your back. If you have learned breathing techniques, begin using them now, if you haven't already. Pain medication is often given at this stage. If you have chosen to have an epidural anesthetic, it is usually given at this stage. Please see pain management for more information.
Transition
Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30 minutes to two hours. The cervix is opening the last few centimeters, from 7 to 10 centimeters. The pain may be intense, as the cervix stretches and the baby descends into the birth canal. All of your energy is concentrated on doing the work of labor. Try to remain calm and focused as your uterus works. At the end of transition, you may feel a strong urge to push the baby out. The baby is ready to be born.
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Second Stage
During the second stage the baby is born. This stage of labor lasts anywhere from one contraction to up to two hours. The baby's head stretches your vagina and perineum (the skin between the vagina and rectum). This may cause a burning sensation. Some women may feel as if they are having a bowel movement, and feel the urge to push, or bear down. The labor nurse or physician will tell you when it is time to push. It is important that you not push until instructed. Pushing too early will cause the cervix to become edematous, or swollen. "Crowning" occurs as the widest part of the head appears at the vaginal opening. In the next few pushes, the baby is born. Mucous and amniotic fluid will be removed from the baby's mouth and nose with a bulb syringe. The baby will take its first breath, and may begin to cry. Immediately after birth, the baby is still connected to the placenta by the umbilical cord. The cord is clamped and cut.
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Third Stage
The third stage begins with the birth of the baby and ends with the delivery of the placenta. It is the shortest stage, lasting from 5 to 15 minutes. Your contractions may stop for awhile, then resume to deliver the placenta. You will be observed closely for the next few hours to make certain that your uterus is contracting and bleeding is not excessive. The nurse will massage your uterus, or your lower abdomen to check that the uterus is contracting. Take this time to rest and get acquainted with your new baby.
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Labor and Delivery Checklist
1. Prior to labor, discuss the following issues with your physician or nurse practitioner:
* What do I do if I think I am in labor?
* What pain management options are available?
* When is an episiotomy necessary?
* What are some reasons you might perform a cesarean delivery?
2. If you have not done so, take a hospital tour so you are familiar with the place where you will give birth.
3. Arrange for help to care for you and the baby after birth, if you can.
4. Shop and prepare food for the first weeks when you are home with the baby, and collect take-out menus.
5. Review Preparing for Baby checklist.
6. Make sure you always have gas in the car.
7. Pack your bags. See what to pack for the labor room.
Parts and its Function
Uterus
The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes.
The uterus is a pear-shaped muscular organ. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. If the egg does not embed in the wall of the uterus, a woman gets her period and the egg is flushed away.
Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus.
On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy.
Ovaries
The ovaries are the place inside the female body where ova or eggs are produced. The process by which the ovum is released is called ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle.
After ovulation, the ovum is captured by the oviduct, after traveling down the oviduct to the uterus, occasionally being fertilized on its way by an incoming sperm, leading to pregnancy and the eventual birth of a new human being.
The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.
The uterus or womb is the major female reproductive organ of humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes.
The uterus is a pear-shaped muscular organ. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum becomes an embryo, develops into a fetus and gestates until childbirth. If the egg does not embed in the wall of the uterus, a woman gets her period and the egg is flushed away.
Oviducts
The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus.
On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when it reaches the uterus, which signals the beginning of pregnancy.
Ovaries
The ovaries are the place inside the female body where ova or eggs are produced. The process by which the ovum is released is called ovulation. The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle.
After ovulation, the ovum is captured by the oviduct, after traveling down the oviduct to the uterus, occasionally being fertilized on its way by an incoming sperm, leading to pregnancy and the eventual birth of a new human being.
The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to help the egg cell travel.
Parts and Its Function
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female mammals, or to the cloaca in female birds and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the oviduct.
The vagina is the place where semen from the male is deposited into the female's body at the climax of sexual intercourse, commonly known as ejaculation. Around the vagina, pubic hair protects the vagina from infection and is a sign of puberty.
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible; the remainder lies above the vagina beyond view.
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female mammals, or to the cloaca in female birds and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the oviduct.
The vagina is the place where semen from the male is deposited into the female's body at the climax of sexual intercourse, commonly known as ejaculation. Around the vagina, pubic hair protects the vagina from infection and is a sign of puberty.
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible; the remainder lies above the vagina beyond view.
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