Nursing care for pregnant women in labor proves to be a challenging task because it requires nurses to be fast in their assessment without sacrificing the quality and accuracy of rendered nursing care. Now, why should care of women in various stages of labor be taken seriously? In 2000, the United Nations Millennium Summit included the improvement of maternal health as one of the Millennium Development Goals (MDGs) to be adapted by the international community composed of over 42 countries. Promoting the health of women in labor is one active way of reducing maternal mortality and ensuring universal access to reproductive health services. Show
The progression of labor is traditionally divided into three phases, and each phase deals with different concerns and considerations. Having gained mastery of this, nurses are able to implement nursing interventions to safeguard the welfare of both the mother and the baby.
Establishing Therapeutic RelationshipTo gain patient and family’s cooperation and trust, it is important that the nurse should be able to establish a therapeutic relationship with them. The nurse should introduce himself and make them feel welcome. At this point, they are all anxious and it is best for the nurse to convey his message gently and confidently. Expectations of the family about birth should be determined and it is also the best time to ascertain cultural values. Admission AssessmentWhen a patient arrives at the labor floor, pertinent information about the pregnant woman’s health history is taken during admission. These include personal data (e.g. blood type, allergies, etc.), previous illness, pregnancy complications, preferences for labor and delivery, and childbirth preparations. Standard obstetric, medical, and social history taking is also done. In addition, the nurse assesses the following: vital signs, physical exam, contraction pattern (frequency, interval, duration, and intensity), intactness of membranes through vaginal exam, and fetal well-being through fetal heart rate, characteristic of amniotic fluid, and contractions. The nurse performs Leopold’s maneuver to determine fetal presenting part, point of maximum impulse, fetal descent and engagement. Admission into labor room is only done when the patient is in active labor. Stages of LaborThe progress of cervical effacement, cervical dilatation, and descent of fetal presenting part dictate stages of labor. Here are the stages of labor and significant events that mark their beginning and end:
First Stage of LaborAs mentioned above, the first stage of labor is divided into three sub-phases, namely: latent, active, and transitional phases. Latent PhaseLatent (Preparatory) Phase starts from the onset of true labor contractions to 3 cm cervical dilatation. Here are nursing responsibilities during this phase:
Active PhaseActive Phase starts from 4 cm cervical dilatation to 7 cm cervical dilatation. During this phase, contraction intensity is stronger, interval shortens, and duration lengthens. This is where true discomfort is first felt by the patient so she is dependent and her focus is on herself. Here are nursing responsibilities in this phase:
Transition PhaseTransition Phase starts from 8 cm cervical dilatation to 10 cm (full) cervical dilatation and full cervical effacement. During this time, patient may be exhausted and withdrawn or aggressive and restless. Patient’s urge to push is noticeable. Here are nursing responsibilities in this phase:
WHO do not recommend the following nursing interventions during labor because they have low quality of evidence:
Second Stage of LaborSecond Stage of Labor starts when cervical dilatation reaches 10 cm and ends when the baby is delivered. At this stage, the patient feels an uncontrollable urge to push. The patient may also experience temporary nausea together with increased restlessness and shaking of extremities. The nurse at this stage must coach quality pushing and support delivery. Here are nursing care tips for this stage:
WHO do not recommend the following interventions during delivery because they provide low quality of evidence:
Third Stage of LaborThird Stage of Labor or the placental stage starts from birth of infant to delivery of placenta. It is divided into two separate phases: placental separation and placental expulsion. Five minutes after delivery of baby, the uterus begins to contract again, and placenta starts to separate from the contracting wall. Blood loss of 300-500 mL occurs as a normal consequence of placental separation. Placenta sinks to the lower uterine segment or upper vagina. The placenta is then expelled using gentle traction on the cord. Here are the signs of placental separation:
At this stage, here are the nursing care tips:
For immediate postpartum, the nurse checks the vital signs and monitors for excessive bleeding. The first four hours after birth is sometimes referred to as the fourth stage of labor because this is the most critical period for the mother. The nurse is set to perform nursing interventions that would prevent the patient from infection and hemorrhage. Also, they are being reminded of the importance of breastfeeding, ambulation, and newborn care. Here are WHO recommendations for immediate postpartum:
On the other hand, here are interventions not recommended during immediate postpartum:
Nursing care for women in labor is a routine that takes a while to fall into. After all, it is overwhelming for beginner nurses to do their responsibilities in front of a woman writhing in pain. However, the opportunity to protect women and the privilege of being a part of their positive pregnancy experience is rewarding. Read and share this to your nurse friends because women’s and children’s lives deserve only the best care. References:
Which breathing technique would the nurse instruct the client to use as the head of the fetus is crowning quizlet?Which breathing technique should the nurse instruct the client to use as the head of the fetus is crowning? (Blowing forcefully through the mouth controls the strong urge to push and allows for a controlled birth of the head. A shallow breathing pattern does not help control expulsion of the fetus.
Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated?Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated? Have the client pant and blow through the contraction.
What is the best way to push during labor?5 Tips for Pushing During Childbirth. Push from Your Bottom. We know… ... . Put Your Chin to Your Chest. When your care team instructs you to push, take a deep breath and tuck your chin as you push, looking below your bellybutton. ... . Use Your Contractions as Your Guide. ... . A Mirror Can Be Helpful. ... . Follow Your Instincts.. During which stage of labor would a woman feel the urge to push?The third phase is called transition and is the last phase. During transition, the cervix dilates from 8 to 10 centimeters. Contractions are usually very strong, lasting 60 to 90 seconds and occurring every few minutes. Most women feel the urge to push during this phase.
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