Essentials Of Maternity, Newborn, And Women's Health 045741

Essentials Of Maternity Newborn And Womens Health Nursingchapter 13

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: 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? The cervical exam reveals 3 cm dilation, 40% effacement, with membranes intact and presenting part engaged. These findings suggest she is in the active phase of labor, during which the cervix dilates from 4 to 7 cm and effacement continues. Physically, the active phase involves uterine contractions increasingly effective in dilating the cervix. The psychological changes include increasing fatigue, anxiety, and focus on labor progress. Appropriate activities at this stage include walking, mobility, and comfort measures like changing positions.

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 nurse should assess the amniotic fluid for color and odor to determine if rupture of membranes has occurred. Vital signs must be reassessed, and fetal heart rate monitored to evaluate fetal well-being. Cervical examination should be repeated after a suitable interval to assess dilation and effacement progress. The nurse should also record the time of rupture or leakage. Informing the healthcare provider of these findings ensures appropriate management.

d. Diane, age 22, has been in labor for 8 hours. Her cervical exam reveals she is 3 cm, 30% effaced, and at station –1. She reports feeling most of her pain in her lower back.

i. 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.

Back labor often results from fetal malposition, such as occiput posterior position, which causes the fetus to press against the mother's sacral region, causing intense back pain. Malpositioning can also impede progress because the fetal head does not flex properly to pass through the pelvis. Slow progress may relate to the size of the fetal head and the unfavorable position, which increases resistance in the birth canal.

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

Strategies include having Diane squat to improve fetal alignment, sitting on a birth ball to facilitate fetal rotation, using abdominal lifts or manual maneuvers to encourage fetal anterior position, guiding her into hands-and-knees positions, or employing the Miles circuit technique, which involves positional changes to free the fetal occiput from the sacral bone, thereby promoting descent and rotation. Encouraging relaxation techniques and providing psychological support are also vital.

iii. It is noted that Diane is only 3 cm dilated, and she should be encouraged that she is progressing but still has a way to go. Reminding her of her birth plan, providing reassurance, and supporting her efforts can improve her comfort and cooperation.

Analysis of these cases underscores the importance of accurate assessment of labor progress, understanding physiological and psychological changes, and employing appropriate nursing interventions to facilitate safe childbirth. Recognizing signs of true labor versus false labor, responding to membrane rupture, and addressing fetal malposition are crucial components of maternal and fetal care.

Paper For Above instruction

In obstetric nursing, accurately distinguishing between true and false labor is essential for optimal management and to prevent unnecessary hospitalization or interventions. Emily’s case illustrates early labor assessment, emphasizing questions about contraction patterns, pain location, and fetal movement. True labor is characterized by regular, progressively intense contractions, cervical dilation and effacement, and fetal engagement, as seen in Emily’s assessment with 3 cm dilatation and 40% effacement. The nurse's evaluation of stable vital signs and reassuring fetal heart tones supports the conclusion that Emily is in active labor, specifically in the beginning stages, with physiologic changes including cervical dilation, uterine contractions, and fetal engagement. Psychologically, the excitement and mild discomfort are common, but fatigue may develop as labor progresses. Appropriate activities such as walking or resting between contractions can facilitate labor progression, always tailored to the woman's comfort and labor status.

When Emily reports a sudden wetness, the nurse should evaluate for rupture of membranes by assessing the fluid for smell, color, and consistency. Confirming rupture prompts attention to infection prevention and fetal well-being, warranting fetal monitoring and evaluation of labor progress. Ongoing assessment facilitates timely interventions and labor management decisions.

Diane's case highlights the impact of fetal malposition—specifically occiput posterior—on labor progress and maternal discomfort. Back labor, characterized by intense lower back pain, often indicates malposition, which impedes fetal rotation and descent. Slow cervical dilation and station progression necessitate positional and behavioral interventions. The recommended strategies include encouraging Diane to assume positions like squatting or hands-and-knees to aid fetal rotation, which can shorten labor and reduce back pain. Use of the birth ball and abdominal lifts further promote optimal fetal positioning. Continuous support and reassurance are fundamental to managing back labor, as stress and pain can hinder progress. Monitoring and applying these interventions can decrease labor duration and improve maternal outcomes.

Overall, managing labor requires keen assessment skills, understanding labor physiology (the 5 P's: powers, passage, passenger, position, and psychological responses), and implementing evidence-based nursing care. Each case exemplifies challenges like subtle labor signs, malposition, and emotional responses, stressing the need for individualized care plans. Promoting mobility, comfort, and fetal well-being, along with effective communication, contributes to safe, patient-centered childbirth experiences.

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