Essentials of Maternity, Newborn, and Women’s Health Nursing

Chapter 13: Labor and Birth Process

 Emily, age 32, has an obstetrical history of G1, T0, P0, A0, L0. Emily’s week of gestation is 39.1. Emily telephones the health care provider’s office and tells the nurse she believes she is in labor. Based on her assessment, the nurse advises her to have her husband bring her to the labor and birth unit. Emily arrives and is admitted. She is talkative and excited about being in labor and describes her contractions and discomfort as mild.

The following are the assessment findings of the examining nurse: Maternal vital signs are stable. Fetal heart tones with the external fetal monitor are reassuring. Vaginal exam indicates the cervix is 3 cm dilated, 40% effaced, membranes intact with the presenting part engaged.

Ten minutes after the vaginal exam by the nurse, Emily says, “I think I just wet my pants.” (Learning Objectives 2, 6, 7, and 8)

 

a. What questions might the nurse have asked Emily to determine that she may be in true labor? What prenatal history information should the nurse have obtained during the telephone call?

The questions include asking whether she is in pain, specifically whether or not she has low back pain. The nurse might also ask whether there is vaginal bleeding. The prenatal information would be the intensity and frequency of contractions.  Other questions would be “When did the contractions begin?” “Where do you feel the pain…back or belly?” “Does rest or drinking fluid help the pain?” “Fetal movements?”

 

b. Explain the meaning of the nurse’s assessment findings. Identify the stage and phase of labor, listing the physiologic and psychological changes during this stage. What positions and activities would be appropriate for Emily based on the assessment data? 

If the cervix is 3 cm dilated, 40 % effaced, Emily is in active labor. During phase 1, the cervix begs to dilate and continues to thin for the delivery. “Vitals are stable and FHT are reassuring meaning the fetus is not in any distress” (Oktay et al, 2016). The physiological changes include the pressure on pelvis, increase in pain and regular uterine contractions with concomitant cervical dilation and effacement while the psychological changes include increase in fear, distress, and the need for hydration and food although appetite is often suppressed. The appropriate activities would be to have Emily walk around to help in moving labor. Emily can participate in activities that involve walking.

c. Describe the nursing interventions that would be appropriate for the nurse to implement based on Emily’s statement that “I think I just wet my pants.”

The nursing interventions are to assess the FHR and determine the color and odor of amniotic fluid in case the membranes ruptured. Vital signs should be assessed and nearness to birth should also be determined by evaluating cervical dilation and contractions. The time of ROM is at the onset of labor. The healthcare provider should be notified of the rupture of membranes.

2. Diane, age 22, has been in labor for 8 hours. Her cervical exam reveals she is 3 cm, 30% effaced and –1 station. Diane has been feeling most of her pain in her lower back. (Learning Objectives 3, 4, and 5)

1. Given your understanding of the 5 P’s and the cardinal movements of labor, discuss why Diane is having back labor and why her progress is slow.

The cause of slow labor progress is the Passenger. The malposition of fetus causes it. The fetal position is the cephalic posterior position.

You have to identify the fetal positon that causes back pain and slow progress.

“The fetus is the ‘passenger travelling down the birth canal” (Subramaniam et al, 2019). The low progress may be as a result of the fetal head being too large in addition to the mispositioning. There might be exertion of pressure on the mother’s sacral backbone which causes the back pain and poor cervical dilatation.

0. What strategies may the nurse implement to assist Diane in progressing in her labor?

The strategies are:

a. Telling her to squat

b. Asking her to sit on the birth ball

c. Use of the miles circuit technique

d. Conducting abdominal lift

e. Asking Diane to balance on knees and hands on a bed to help adjust fetal position.

 

It is good to encourage Diane that she will be able to bear the pain of delivery. Diane should also remind on the birth plan.

 

 

 

 

 

 

REFERENCES

Oktay, K., Bedoschi, G., Pacheco, F., Turan, V., & Emirdar, V. (2016). First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery. American journal of obstetrics and gynecology, 214(1), 94-e1.

Subramaniam, A., Tita, A. T., & Rouse, D. J. (2019). Obstetric Management of Labor and Vaginal Delivery. Chestnut’s Obstetric Anesthesia E-Book, 393.