Chapter 14: Nursing Management During Labor And Birth

Chapter 14 Nursing Management During Labor And Birth1 Desiree A 28

Describe the stage of labor based on vaginal assessment, including cervical dilation, effacement, station, and fetal position. Explain appropriate nursing interventions for this stage of labor. Discuss how the nurse determines that external fetal monitoring is suitable for Desiree and what factors would warrant a switch to internal fetal monitoring. Address how to respond to Desiree’s expressed pain, considering her birth plan, the current stage of labor, and assessment data.

Evaluate what is happening to Emily’s baby as indicated by the fetal heart rate deceleration pattern and explain its implications. Describe the nurse’s role in fetal assessment and specify interventions to implement or recommend in response to the fetal heart rate changes.

Paper For Above instruction

Introduction

Labor and birth are complex physiological processes that require vigilant monitoring and nursing interventions to ensure maternal and fetal well-being. Appropriate assessment and timely interventions are crucial in managing labor effectively. This paper discusses the identification of labor stages, fetal monitoring criteria, pain management responses aligned with patient preferences, and the interpretation of fetal heart rate disturbances, providing a comprehensive overview based on the given scenarios.

Stage of Labor and Nursing Interventions for Desiree

Desiree's vaginal assessment reveals cervical dilation at 10 cm, complete effacement, and a station of +1, indicating she is in the second stage of labor, which begins when the cervix is fully dilated and ends with the delivery of the baby (Cunningham et al., 2021). In this stage, the primary nursing focus is to promote effective pushing, maintain hydration, and monitor maternal and fetal status. Encouraging her to bear down during contractions, providing pain management support aligning with her natural childbirth plan, and ensuring comfort are essential. Assessing her fatigue levels and offering encouragement can help her cope better during this intense phase (Lindsey & Stapleton, 2017).

The choice of external fetal monitoring is appropriate at this stage because Desiree's pregnancy is low risk, and her fetal heart rate is reassuring at 130 bpm with no signs of distress. External monitors—electronic fetal monitors—are non-invasive and suitable when the fetus is in a vertex position, and the conduction pathways are intact (Moore et al., 2018). Continuous monitoring ensures ongoing assessment without subjecting the mother to invasive procedures (Harcourt & Roberts, 2019).

The decision to escalate to internal fetal monitoring would be based on specific indications, such as non-reassuring fetal heart rate patterns that cannot be adequately assessed externally, or if there is a need for more continuous, accurate readings to guide interventions. Additionally, if the membranes rupture and the fetal position shifts or there’s a concern about fetal compromise, internal monitoring may be necessary (Rosenfeld et al., 2020). Consequently, the nurse must assess for contraindications such as placental abnormalities or maternal bleeding that could preclude internal monitoring.

Regarding Desiree's expression of pain, the nurse should acknowledge her concerns empathetically, reinforcing her birth plan for a natural, minimally medicated birth. Since Desiree is in the second stage and close to delivery, pain during this phase is intense due to progressive cervical dilation and uterine contractions (O’Brien et al., 2017). The nurse can offer non-pharmacologic comfort measures such as deep breathing, labor support, cool washcloths, and visualization techniques. If Desiree feels overwhelmed, and her pain exceeds her coping ability, gentle offering of pharmacologic options aligned with her plan, such as epidural or IV opioids, may be discussed, ensuring informed consent and respecting her wishes (Simpson & Carter, 2019).

Fetal Heart Rate Deceleration in Emily’s Case

In Emily’s scenario, a sudden drop in fetal heart rate to 80 bpm accompanied by minimal variability and decelerations signifies a potential fetal distress—possibly indicating cord compression, placental insufficiency, or hypoxia. The low baseline heart rate and variability decline are concerning signs, and the variability decrease suggests worsening fetal oxygenation status (Avery et al., 2020). The bradycardia observed during a contraction’s termination points to a non-reassuring pattern requiring immediate attention.

The nurse's role involves continuous fetal assessment, interpreting the cardiotocography (CTG) strip, and promptly communicating findings to the healthcare team. Interventions include repositioning the mother to optimize uteroplacental perfusion, administering supplemental oxygen via face mask, and ensuring adequate maternal hydration (Alfirevic et al., 2017). Discontinuing any problematic monitors or interventions that could contribute to cord compression, like excessive uterine activity, is also crucial. Preparing for potential interventions such as labor augmentation or cesarean section is vital if fetal status does not improve, emphasizing rapid decision-making based on ongoing assessments (Macdonald et al., 2018).

Conclusion

Effective management during labor hinges on precise assessment and tailored nursing interventions. Recognizing the stage of labor directs appropriate care focus, and understanding fetal monitor patterns guides timely actions to prevent adverse outcomes. Attentiveness to maternal pain and emotional needs, plus swift responses to fetal distress, are essential to promote safe and positive birth experiences. Continued education and adherence to evidence-based practices empower nurses to optimize outcomes for mothers and babies during labor and birth.

References

• Alfirevic, Z., Devane, D., & Gyte, G. M. (2017). Continuous cardiotocography (CTG) as a form of fetal monitoring for fetal compromise. The Cochrane Database of Systematic Reviews, (2), CD006152.
• Avery, M. D., McClenathan, J. H., & Saunders, K. W. (2020). Recognizing abnormal fetal heart patterns: A guide to interpreting cardiotocography. Journal of Maternal-Fetal & Neonatal Medicine, 33(12), 2008–2014.
• Cunningham, F. G., Leveno, K. J., Bloom, S. L., et al. (2021). Williams Obstetrics (26th ed.). McGraw-Hill Education.
• Harcourt, S., & Roberts, J. (2019). Fetal monitoring in high-risk pregnancies. OB-GYN Nursing, 46(2), 82–89.
• Lindsey, J. A., & Stapleton, S. V. (2017). Nursing management of the third stage of labor. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(2), S9–S15.
• Macdonald, E. E., et al. (2018). Fetal monitoring and intervention strategies in labor. Obstetrics & Gynecology Clinics, 45(2), 331–348.
• Moore, T., et al. (2018). Fetal Heart Rate Monitoring: Principles and Practice. Elsevier.
• O’Brien, B., et al. (2017). Pain management during labor: A comprehensive review. Journal of Clinical Nursing, 26(11-12), 1479–1489.
• Rosenfeld, C., et al. (2020). Monitoring fetal well-being during labor: Techniques and indications. Journal of Maternal-Fetal & Neonatal Medicine, 33(20), 3401–3408.
• Simpson, K. R., & Carter, B. S. (2019). Pharmacologic and nonpharmacologic pain relief during labor. The Journal of Perinatal Education, 28(3), 144–152.