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?
To determine if Emily is in true labor, the nurse might ask her the following questions:
1. When did you first notice your contractions?
2. How far apart are your contractions?
3. How long do your contractions last?
4. Are your contractions getting stronger or more intense over time?
5. Have you noticed any bloody show?
6. Are you experiencing any lower back pain or pressure?
7. Are you feeling any urge to push?
8. Have you experienced any rupture of membranes or fluid leakage?
These questions can help the nurse assess the nature and progression of Emily's labor and determine if
she is in true labor or not.
b. What action should the nurse take in response to Emily's statement?
Emily's statement, "I think I just wet my pants," may indicate that her membranes have ruptured, which
is also known as her water breaking. The nurse should take the following actions:
Confirm that Emily's membranes have ruptured by checking for fluid pooling or testing the fluid for pH
levels.
Check the fetal heart rate to ensure that the baby is tolerating the rupture of membranes.
Assess the color, odor, and amount of the fluid to determine if there are any signs of infection.
Document the time and characteristics of the rupture of membranes.
Inform the healthcare provider of the rupture of membranes and obtain further orders for management
of labor.
If the rupture of membranes has occurred, the nurse will need to monitor Emily and her baby closely for
signs of infection or other complications. The nurse may also need to encourage Emily to change into a
clean gown or provide her with incontinence pads to manage the fluid leakage.
c. What is the significance of Emily's obstetrical history and gestational age in relation to her current
labor?
Emily's obstetrical history and gestational age provide important context for understanding her current
labor.
Her obstetrical history of G1, T0, P0, A0, L0 means that this is her first pregnancy, she has not had any
previous term deliveries, preterm deliveries, abortions, or living children. This information can help the
healthcare provider anticipate the course of Emily's labor and delivery and prepare for any potential
complications that may arise.
Her gestational age of 39.1 weeks indicates that she is at term and nearing the end of her pregnancy.
This information is important because it means that her baby is fully developed and has a high likelihood
of being born healthy. However, it also means that the baby may be larger and more difficult to deliver,
and there may be an increased risk of certain complications, such as meconium aspiration or shoulder
dystocia.
Overall, Emily's obstetrical history and gestational age provide important information that can help the
healthcare team make decisions about her care and anticipate any potential risks or complications
during labor and delivery.
d. What does the cervical exam tell the nurse about Emily's labor progress?
The cervical exam provides the nurse with information about the progress of Emily's labor. The findings
from the cervical exam indicate that Emily's cervix is 3 cm dilated, 40% effaced, and the membranes are
still intact with the presenting part engaged.
Cervical dilation refers to the opening of the cervix and is measured in centimeters. At 3 cm dilation,
Emily's cervix has begun to open and is making progress towards the full dilation of 10 cm that is needed
for delivery.
Effacement refers to the thinning and shortening of the cervix, and is also measured as a percentage. At
40% effaced, Emily's cervix is beginning to thin out, which is another important aspect of cervical
preparation for delivery.
The fact that the membranes are intact with the presenting part engaged means that the baby's head
has descended into the pelvis and is pressing on the cervix. This is a good sign that Emily's labor is
progressing and that she may be closer to delivery.
Overall, the cervical exam provides important information about the progress of Emily's labor and helps
the healthcare team determine the next steps in her care.
e. What nursing interventions might the nurse implement to support Emily's labor progress and manage
her discomfort?
The nurse can implement several nursing interventions to support Emily's labor progress and manage
her discomfort, including:
Encouraging Emily to change positions frequently, such as walking, rocking in a chair, or using a birthing
ball. This can help promote cervical dilation and fetal descent, as well as provide comfort and pain relief.
Providing emotional support and reassurance to Emily, including praise and encouragement during
contractions.
Offering relaxation techniques, such as deep breathing, visualization, or massage, to help manage pain
and promote relaxation.
Monitoring Emily's vital signs and fetal heart rate to ensure both she and the baby are tolerating labor
well.
Providing ice chips or clear fluids to keep Emily hydrated and energized.
Administering pain medications or epidural anesthesia as ordered by the healthcare provider, if
requested by Emily and appropriate for her individual situation.
Documenting labor progress, including cervical dilation, effacement, and descent of the fetal presenting
part, as well as the timing, duration, and intensity of contractions.
These nursing interventions can help support Emily's labor progress and provide comfort and pain relief
during the labor process.
f. What actions should the nurse take in response to Emily's statement, “I think I just wet my pants?”
Emily's statement that she may have just wet her pants could be an indication that her amniotic sac has
ruptured and that her water has broken. The nurse should take the following actions:
Ask Emily to describe what she is feeling and to note any odor or color associated with the fluid.
Assess the amount of fluid present, which may involve performing a speculum exam to visualize the
cervix and check for pooling of fluid in the vagina.
Test the fluid for pH to confirm whether it is amniotic fluid or urine. Amniotic fluid has a pH of 7.0 to 7.5,
whereas urine has a pH of less than 7.0.
Monitor fetal heart rate and maternal vital signs to ensure both are stable and that there are no signs of
distress.
Document findings, including the time of rupture, color and odor of the fluid, and any other relevant
information.
If the fluid is confirmed to be amniotic fluid, the nurse should inform the healthcare provider and
prepare for delivery. If the fluid is urine, the nurse should reassure Emily that this is a common
occurrence during labor and provide appropriate hygiene measures. Regardless of the type of fluid, the
nurse should continue to monitor Emily closely and provide appropriate support and interventions to
facilitate labor progress and ensure maternal and fetal well-being.
g. What is the significance of the obstetrical history "G1, T0, P0, A0, L0" and how does it relate to Emily's
current labor experience?
Emily's obstetrical history is often abbreviated as GTPAL, which stands for Gravida, Term births, Preterm
births, Abortions, and Living children. In Emily's case, G1 indicates that she is a primigravida, meaning
this is her first pregnancy. T0, P0, A0, and L0 indicate that she has had no term births, preterm births,
abortions, or living children.
The significance of Emily's GTPAL is that it provides important information about her risk for
complications during labor and delivery. For example, primigravidas may experience a longer labor or
have a higher risk for certain complications, such as fetal distress or perineal trauma. Additionally, the
absence of prior term births or living children may indicate a higher risk for certain complications, such
as preterm labor or fetal distress.
In terms of Emily's current labor experience, her GTPAL indicates that she is a first-time mother, which
may impact the progress and duration of her labor. However, the absence of prior pregnancies, term
births, or preterm births may also indicate a lower risk for certain complications. Ultimately, the
healthcare team will use a combination of Emily's obstetrical history, labor assessment findings, and
clinical judgment to provide appropriate care and support during labor and delivery.
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?”
During the telephone call, the nurse should have obtained several pieces of prenatal history information
from Emily, including:
Gestational age: The nurse should have asked Emily how far along she is in her pregnancy to determine
if she is at term or preterm.
Prenatal care: The nurse should have asked if Emily has received regular prenatal care throughout her
pregnancy, including any recent appointments or tests.
Maternal health: The nurse should have asked about any medical conditions or complications that Emily
has experienced during her pregnancy, such as hypertension, gestational diabetes, or pre-eclampsia.
Fetal well-being: The nurse should have asked about any changes in fetal movement or other concerns
related to fetal well-being.
Birth plan: The nurse should have asked about Emily's birth plan, including any preferences for pain
management or delivery, and any special considerations or requests.
Obtaining this information can help the nurse determine the appropriate course of action and level of
urgency for Emily's current situation, as well as ensure that the healthcare team is prepared to provide
safe and effective care during labor and delivery.
Additionally, the nurse may also want to ask about any previous surgeries or medical conditions that
could impact labor and delivery, such as a history of prior cesarean sections or uterine surgery. It is also
important to ask about any medications or supplements that Emily is taking, as well as any allergies or
adverse reactions to medications.
The nurse should also ask about any history of complications or issues during previous pregnancies or
deliveries, such as preterm labor, premature rupture of membranes, or the need for interventions such
as induction of labor or instrumental delivery.
By obtaining a comprehensive prenatal history, the nurse can help identify any potential risks or
complications that may impact Emily's current labor and delivery experience. This information can also
help guide the healthcare team in developing an appropriate plan of care and interventions to support a
safe and positive delivery outcome for both Emily and her baby.
Furthermore, the nurse should also ask about any lifestyle factors that may affect the pregnancy, such as
smoking, alcohol or drug use, and exposure to toxins or infectious diseases. This information can help
the healthcare team provide appropriate care and interventions to manage any potential risks or
complications related to these factors.
The nurse should also inquire about any recent symptoms that Emily may be experiencing, such as
contractions, vaginal bleeding, or fluid leakage, which can indicate the onset of labor or potential
complications.
Overall, obtaining a thorough prenatal history during the telephone call can help the healthcare team
prepare for Emily's arrival and ensure that appropriate measures are taken to promote a safe and
positive labor and delivery experience for both Emily and her baby.
In addition to the above information, the nurse should also ask about Emily's social support system,
including her partner, family, and friends. Understanding her support system can help the healthcare
team provide appropriate emotional and psychological support during labor and delivery.
The nurse should also ask about Emily's cultural and religious beliefs, preferences, and values related to
childbirth. This information can help the healthcare team provide culturally sensitive care and respect
her values and preferences.
It is also important for the nurse to assess Emily's level of knowledge and understanding about the
process of labor and delivery, as well as her expectations and concerns related to childbirth. This
information can help the healthcare team provide appropriate education, support, and reassurance to
promote a positive childbirth experience.
Overall, obtaining a comprehensive prenatal history during the telephone call can help the nurse assess
the current situation and determine the appropriate course of action to support a safe and positive
childbirth experience for Emily and her baby.
Finally, the nurse should also inquire about any specific concerns or questions that Emily may have
about labor and delivery, such as pain management options, birthing positions, or interventions such as
episiotomy or forceps delivery. Addressing Emily's concerns and providing appropriate education can
help reduce anxiety and promote a positive childbirth experience.
In summary, obtaining a thorough prenatal history during the telephone call can help the nurse assess
the current situation, identify any potential risks or complications, and develop an appropriate plan of
care to support a safe and positive childbirth experience for Emily and her baby. It is important for the
nurse to ask a range of questions to gather as much information as possible, while also being sensitive to
Emily's needs, preferences, and cultural and religious beliefs.
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 nurse's assessment findings indicate that Emily is in the first stage of labor, specifically in the early
phase. The dilation of her cervix to 3 cm, the effacement of 40%, and the engagement of the presenting
part are all consistent with the early stage of labor. The intact membranes indicate that Emily has not
yet experienced rupture of the membranes, which typically occurs later in the first stage of labor.
Physiologically, the first stage of labor is characterized by regular contractions that become increasingly
stronger and longer over time. As the cervix begins to dilate and efface, the baby's head engages in the
pelvis, putting pressure on the cervix and causing it to thin and stretch. During this stage, there is a
gradual onset of maternal pain and discomfort, as well as an increase in adrenaline and stress hormones
that can affect the mother's emotional state.
Psychologically, the first stage of labor can be a time of excitement, anticipation, and anxiety for the
mother. It is important for the healthcare team to provide emotional support, reassurance, and
education to help the mother cope with the physical and emotional changes that occur during this stage.
Based on the assessment data, appropriate positions and activities for Emily during this stage of labor
would include changing positions frequently, walking, using a birthing ball or other aids, and utilizing
relaxation and breathing techniques. These activities can help promote optimal fetal positioning,
increase maternal comfort, and facilitate progress in labor. Emily may also benefit from emotional
support and encouragement from her partner or other support person during this stage.
In terms of pain management, non-pharmacological interventions such as massage, heat/cold therapy,
and relaxation techniques may be appropriate for Emily at this stage of labor. However, given that Emily
describes her contractions and discomfort as mild, pharmacological pain management may not be
necessary at this time. The healthcare team should continue to monitor Emily's pain and assess her need
for pain relief as labor progresses.
It is important to note that the first stage of labor can last for several hours, and progress can vary
widely between individual women. The nurse should continue to monitor Emily's vital signs, fetal heart
rate, and progress in labor to determine whether further interventions or monitoring are needed.
In summary, the nurse's assessment findings indicate that Emily is in the early stage of the first stage of
labor. Based on this information, appropriate positions and activities for Emily would include changing
positions frequently, walking, using a birthing ball or other aids, and utilizing relaxation and breathing
techniques. The healthcare team should continue to monitor Emily's pain, progress in labor, and vital
signs to determine whether further interventions or monitoring are needed.
As Emily progresses further into the first stage of labor, the contractions will become more intense and
frequent. This is the active phase of the first stage of labor, during which the cervix continues to dilate
from 4 cm to 10 cm. During this stage, Emily may experience a stronger urge to push, and the baby's
head will descend further into the pelvis. This stage can last several hours, and Emily may begin to feel
fatigued and overwhelmed.
Appropriate positions and activities during the active phase of the first stage of labor would include
continuing to change positions frequently, utilizing breathing and relaxation techniques, and utilizing
pain management strategies as needed. The healthcare team may also suggest specific positions, such
as squatting or kneeling, to help facilitate the descent of the baby's head and promote optimal fetal
positioning.
As the first stage of labor progresses, the healthcare team will continue to monitor Emily's vital signs,
fetal heart rate, and progress in labor. If Emily's labor stalls or if there are concerns about the baby's
wellbeing, interventions such as augmentation of labor or a cesarean birth may be necessary.
In summary, the first stage of labor is a complex process that involves a range of physical and emotional
changes for the mother. By providing appropriate support, education, and interventions, the healthcare
team can help promote a safe and positive childbirth experience for both Emily and her baby.
The second stage of labor begins when the cervix is fully dilated and ends with the birth of the baby.
During this stage, Emily will experience strong and frequent contractions that will help her to push the
baby down the birth canal. The urge to push will become stronger as the baby's head descends further
into the pelvis, and Emily may feel a burning sensation as the baby's head stretches the perineum.
In terms of position and activity, Emily may be encouraged to find a position that feels comfortable and
effective for pushing. This may include squatting, sitting upright, or lying on her side. The healthcare
team may also suggest certain pushing techniques, such as breathing through the contractions or
bearing down during the urge to push.
As the baby's head emerges, the healthcare team will suction the baby's mouth and nose to help clear
any mucus or fluids. The shoulders will then rotate and be delivered, followed by the rest of the baby's
body.
Once the baby is born, the healthcare team will assess the baby's Apgar score and provide any necessary
interventions, such as suctioning or oxygen administration. Emily will then deliver the placenta, and the
healthcare team will assess for any signs of excessive bleeding or other complications.
In summary, the second stage of labor is the final stage of childbirth and involves the delivery of the
baby. By providing appropriate support, education, and interventions, the healthcare team can help
ensure a safe and positive childbirth experience for both Emily and her baby.
The third stage of labor begins after the baby is born and ends with the delivery of the placenta. During
this stage, Emily will continue to experience contractions as her uterus works to expel the placenta and
any remaining fetal membranes.
The healthcare team will monitor Emily's vital signs and assess for any signs of excessive bleeding or
other complications. Emily may be encouraged to push during this stage to help deliver the placenta.
The healthcare team may also administer medications such as oxytocin to help stimulate uterine
contractions and facilitate placental delivery.
Once the placenta is delivered, the healthcare team will examine it to ensure that it is intact and that no
pieces remain in the uterus. Emily will continue to be monitored for any signs of excessive bleeding or
other complications.
In terms of position and activity, Emily may be encouraged to rest and recover in a comfortable position,
such as lying on her side. The healthcare team may also offer pain management strategies, such as
medication or ice packs, to help manage any discomfort.
In summary, the third stage of labor is the final stage of childbirth and involves the delivery of the
placenta. By providing appropriate support, education, and interventions, the healthcare team can help
ensure a safe and positive childbirth experience for both Emily and her baby.
After the delivery of the placenta, the fourth stage of labor begins, which is the immediate postpartum
period. This stage lasts for the first 1-2 hours after delivery and is a critical time for both Emily and her
baby.
During this stage, Emily's uterus will continue to contract, helping to control bleeding and shrink back to
its pre-pregnancy size. The healthcare team will monitor Emily's vital signs and assess for any signs of
excessive bleeding or other complications. Emily may also receive medication to help manage any pain
or discomfort.
The healthcare team will also assess the baby's vital signs, perform a physical examination, and
administer any necessary medications or interventions. Emily will have the opportunity to breastfeed
her baby, which can help promote bonding and stimulate milk production.
In terms of position and activity, Emily may be encouraged to rest and recover in a comfortable position,
such as lying on her side. The healthcare team may also offer support and education on postpartum
care, including proper hygiene, nutrition, and exercise.
In summary, the fourth stage of labor is the immediate postpartum period and is a critical time for both
Emily and her baby. By providing appropriate support, education, and interventions, the healthcare
team can help ensure a safe and positive postpartum experience for both Emily and her baby.
During the immediate postpartum period, Emily may experience a range of emotions, including joy,
relief, and exhaustion. The healthcare team can provide emotional support and education to help Emily
and her partner navigate this transition period.
In addition to emotional support, the healthcare team will also monitor Emily's physical recovery,
including her vaginal bleeding, perineal healing, and breast engorgement. Emily may also receive
medication to help manage any pain or discomfort.
The healthcare team will also assess the baby's feeding and elimination patterns, as well as provide
education and support on newborn care and breastfeeding.
As Emily continues to recover in the postpartum period, she will have follow-up appointments with her
healthcare provider to monitor her physical and emotional health, as well as her baby's growth and
development.
Overall, the postpartum period can be a challenging but rewarding time for new mothers and their
families. By providing appropriate support, education, and interventions, the healthcare team can help
ensure a safe and positive postpartum experience for both Emily and her baby.
During the postpartum period, Emily will experience a range of physical and emotional changes as her
body recovers from childbirth and adjusts to caring for a new baby. Here are some of the common
physical and emotional changes that may occur during the postpartum period:
Physical Changes:
Vaginal bleeding: Emily will experience vaginal bleeding, also known as lochia, for several weeks after
delivery. This bleeding is normal and gradually decreases in volume over time.
Perineal healing: If Emily had a vaginal delivery, she may experience discomfort and soreness in the
perineal area. The healthcare team can provide education and support on perineal care and pain
management.
Breast engorgement: Emily's breasts will become engorged with milk as her body prepares to breastfeed
her baby. The healthcare team can provide education and support on breastfeeding and managing
breast engorgement.
Urinary and bowel changes: Emily may experience urinary or bowel incontinence or difficulty with
urination or bowel movements.
Fatigue and sleep disturbances: Emily may experience significant fatigue and disrupted sleep patterns as
she adjusts to caring for a new baby.
Emotional Changes:
"Baby blues": Many new mothers experience "baby blues" in the first few days after delivery, which may
include mood swings, crying, and feelings of sadness or anxiety. These symptoms typically resolve on
their own within a few weeks.
Postpartum depression: Some new mothers may experience more severe symptoms of depression, such
as persistent feelings of sadness, hopelessness, or guilt. The healthcare team can provide education and
support on postpartum depression and refer Emily to a mental health professional if needed.
Adjustment to parenting: Emily may experience a range of emotions as she adjusts to the demands of
caring for a new baby, including feelings of overwhelm, self-doubt, and joy.
Overall, the postpartum period is a time of significant physical and emotional changes for new mothers.
By providing appropriate support, education, and interventions, the healthcare team can help ensure a
safe and positive postpartum experience for both Emily and her baby.
In addition to the physical and emotional changes, there are also important considerations for
postpartum care, including:
Follow-up appointments: Emily will need to attend postpartum follow-up appointments with her
healthcare provider to monitor her physical and emotional recovery and address any concerns or
complications.
Nutrition and hydration: Adequate nutrition and hydration are important for postpartum recovery and
breastfeeding. The healthcare team can provide education and support on healthy eating and hydration
habits.
Pain management: Emily may need pain management interventions, such as medication or non-
pharmacologic methods, to manage postpartum pain and discomfort.
Breastfeeding support: The healthcare team can provide education and support on breastfeeding
techniques, positioning, and addressing common challenges such as engorgement or nipple soreness.
Family planning: The postpartum period is a good time for Emily to discuss family planning options with
her healthcare provider to ensure she is using a method of contraception that is safe and effective for
her.
Overall, the postpartum period is a critical time for maternal and infant health. By providing
comprehensive postpartum care that addresses both physical and emotional needs, the healthcare team
can help promote optimal outcomes for both Emily and her baby.
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.”
If Emily has indeed experienced rupture of membranes (also known as "water breaking"), the nurse's
interventions would include:
1. Assessing the color, amount, and odor of the amniotic fluid. This can provide important
information about the baby's health and the risk of infection.
2. Monitoring fetal heart rate and maternal vital signs to assess for any signs of distress or
infection.
3. Encouraging Emily to rest and avoid activities that could increase the risk of infection, such as
sexual activity or using tampons.
4. Providing education on signs and symptoms of infection, such as fever, abdominal pain, or foul-
smelling discharge, and encouraging Emily to report any concerns or changes in her condition.
5. Documenting the time and nature of the rupture of membranes, as well as any interventions
and assessments performed.
6. Preparing for delivery, as ruptured membranes increase the risk of infection and may indicate
that labor is imminent. The nurse should ensure that Emily has a plan for transportation to the
hospital and that she understands when to return to the hospital if labor begins.
7. Continuing to monitor Emily's progress through labor and delivery, providing support and
comfort measures, and facilitating communication with the healthcare provider.
It's important to note that if the amniotic fluid is meconium-stained (contains fetal stool), additional
interventions may be needed to prevent complications and ensure the baby's health. The healthcare
provider may also order additional tests or interventions depending on the specific circumstances.
If the healthcare provider confirms that Emily's water has indeed broken and she is in labor, the nurse's
interventions would also include:
Monitoring the frequency, duration, and intensity of contractions to assess labor progress and ensure
that Emily is progressing safely.
Encouraging Emily to change positions, such as walking or rocking in a chair, to help manage pain and
promote labor progress.
Providing comfort measures, such as massage, heat therapy, or breathing techniques, to help manage
pain and discomfort during labor.
Monitoring fetal heart rate and maternal vital signs to ensure that both Emily and the baby are
tolerating labor well.
Providing emotional support and reassurance to Emily and her partner, helping them cope with the
stress and uncertainty of labor.
Facilitating communication between Emily and her healthcare provider, ensuring that questions and
concerns are addressed promptly and that informed decisions are made about interventions and pain
management options.
Ensuring that appropriate documentation is completed, including records of interventions, assessments,
and communication with the healthcare team.
Throughout the labor and delivery process, the nurse's role is to provide skilled and compassionate care
that supports Emily's physical, emotional, and informational needs. By using a patient-centered and
evidence-based approach, the nurse can help promote a safe and positive birth experience for Emily and
her family.
If Emily's water has broken, the nurse would also assess the color and odor of the amniotic fluid to
detect any signs of infection or fetal distress. If the fluid is cloudy or has a foul odor, it may indicate an
infection, and the healthcare provider should be notified immediately.
The nurse would also ensure that Emily's perineal area is kept clean and dry to reduce the risk of
infection. If Emily is uncomfortable or in pain, the nurse may provide perineal care, such as applying ice
or a warm compress, or administering pain medication as ordered by the healthcare provider.
Additionally, the nurse would assess Emily's progress and readiness for pushing. If the healthcare
provider determines that Emily is fully dilated and effaced and the baby is in the appropriate position,
the nurse may coach Emily through the pushing phase of labor.
Overall, the nurse's interventions would be focused on ensuring the safety and well-being of both Emily
and the baby, while providing support and comfort during the labor and delivery process.
If Emily's water has broken and she is in active labor, the nurse may also implement the following
interventions:
Preparing the delivery room, ensuring that all necessary equipment and supplies are available and ready
for use.
Monitoring Emily's vital signs and fetal heart rate continuously, to detect any changes that may require
intervention.
Administering antibiotics if prescribed by the healthcare provider, to prevent infection in case of
prolonged rupture of membranes.
Administering pain medication as ordered by the healthcare provider, if Emily requests it.
Encouraging Emily to push during the second stage of labor, and coaching her on effective pushing
techniques.
Assisting with the delivery of the baby, including monitoring the baby's condition and ensuring that the
delivery is progressing safely.
Providing immediate postpartum care to both Emily and the baby, including assessing for any
complications and providing appropriate interventions as needed.
Throughout the labor and delivery process, the nurse should also communicate effectively with Emily
and her partner, providing information about what to expect during each stage of labor and answering
any questions they may have. By providing skilled and compassionate care, the nurse can help ensure a
safe and positive birth experience for Emily and her family.
If Emily's water has broken, the nurse would also need to assess for any signs of infection, such as fever,
foul-smelling amniotic fluid, or increased maternal heart rate. The nurse would also need to ensure that
Emily is not having contractions too frequently or for too long, as this can increase the risk of infection
and fetal distress.
If the nurse suspects that Emily is developing an infection or that the baby is experiencing distress, the
healthcare provider may order an induction of labor or a cesarean section delivery to ensure the safety
of both Emily and the baby.
Overall, the nurse's interventions would be focused on ensuring that Emily and the baby are safe and
healthy, and that the labor and delivery progress smoothly. By providing skilled and compassionate care,
the nurse can help facilitate a positive birth experience for Emily and her family.
If Emily's water has broken, the nurse should also encourage her to maintain good hygiene, such as
changing into a clean gown and keeping the perineal area clean and dry, to reduce the risk of infection.
The nurse should also advise Emily to avoid inserting anything into the vagina, such as tampons or
douches, which can increase the risk of infection.
If Emily is not yet in active labor, the nurse may advise her to rest and conserve her energy until
contractions become more frequent and intense. The nurse may also suggest that Emily walk or change
positions frequently to help encourage labor progression and alleviate discomfort.
If Emily is in active labor, the nurse may advise her to avoid lying on her back and instead try more
upright positions, such as sitting or standing, which can help increase the strength and frequency of
contractions and facilitate the descent of the baby through the birth canal.
The nurse should also continue to monitor Emily's vital signs and fetal heart rate, and provide emotional
support and encouragement throughout the labor and delivery process. By providing comprehensive
care and support, the nurse can help ensure a safe and positive birth experience for Emily and her
family.
Additionally, if Emily's water has broken and she is not yet in active labor, the nurse may advise her to
come into the hospital for further evaluation and monitoring. Depending on the hospital policy, Emily
may need to be admitted to the labor and delivery unit and placed on continuous fetal monitoring to
ensure that the baby is not experiencing any distress.
If Emily is already in active labor, the nurse should continue to monitor her contractions and cervical
dilation to assess the progress of labor. If labor is progressing slowly or if there are concerns about the
baby's well-being, the nurse may collaborate with the healthcare provider to develop a plan of care to
help facilitate a safe and effective delivery.
The nurse may also need to provide additional education to Emily and her support person about the
signs and symptoms of labor, such as when to come to the hospital and what to expect during labor and
delivery. The nurse can also provide information about pain management options, such as breathing
techniques, relaxation techniques, and medication options, to help manage discomfort during labor.
Ultimately, the nurse's interventions will depend on Emily's individual needs and the progress of her
labor. By providing individualized care and support, the nurse can help ensure a safe and positive birth
experience for Emily and her family.
If Emily's water has indeed broken, the nurse should assess the color, odor, and amount of amniotic
fluid to ensure that it is clear and not malodorous, as these could indicate an infection. If the fluid is
meconium-stained (greenish in color), this may indicate that the baby has passed its first stool and is at
risk for aspiration. In this case, the nurse may need to collaborate with the healthcare provider to
develop a plan for appropriate interventions, such as suctioning the baby's airway at delivery.
The nurse may also need to monitor Emily's vital signs and fetal heart rate more frequently to ensure
that both she and the baby are stable. Depending on the hospital policy, Emily may need to be placed on
continuous fetal monitoring to ensure that the baby is not experiencing any distress.
The nurse should also assess Emily's cervical dilation and effacement to determine if labor is
progressing. If Emily is not yet in active labor, the nurse may advise her to rest, avoid strenuous activity,
and stay hydrated to help facilitate the onset of labor. If Emily is already in active labor, the nurse may
collaborate with the healthcare provider to develop a plan of care to help facilitate a safe and effective
delivery.
Finally, the nurse should provide emotional support and reassurance to Emily and her support person
during this potentially stressful time. The nurse can help to promote a positive birth experience by
acknowledging and validating the couple's feelings, providing information and education, and being a
calming presence throughout the labor and delivery process.
Additionally, if Emily's water has broken and she is experiencing leaking of amniotic fluid, the nurse may
need to provide her with a peri-pad and encourage her to change it frequently to help prevent infection.
The nurse may also advise Emily to avoid vaginal exams unless medically necessary to reduce the risk of
infection.
If Emily is not yet in active labor, the nurse may also provide her with information about signs and
symptoms of labor to monitor for, such as increasing frequency and intensity of contractions, and advise
her to contact the healthcare provider if any concerns arise.
Overall, the nursing interventions in this situation will depend on the individual circumstances and
assessment findings, and will require ongoing assessment and collaboration with the healthcare
provider to ensure the safety and well-being of both Emily and her baby.
If Emily's water has broken, the nurse will also need to monitor her closely for signs of infection and
notify the healthcare provider immediately if she develops a fever or other signs of infection, such as
chills or foul-smelling discharge.
In addition, the nurse may need to discuss pain management options with Emily and provide comfort
measures such as back rubs, warm blankets, and encouraging her to change positions frequently to help
manage discomfort and promote progress in labor.
As Emily progresses into active labor, the nurse may also need to provide support and guidance with
pushing and encourage her to try different positions, such as squatting or using a birthing ball, to
facilitate the descent of the baby and promote optimal fetal positioning.
Overall, the nurse's role in this situation is to monitor Emily closely for signs of progress and any
potential complications, provide ongoing support and education, and collaborate with the healthcare
provider to ensure the best possible outcomes for both Emily and her baby.
Once Emily's water has broken, the nurse will also need to monitor the amount, color, and odor of the
amniotic fluid, as well as the fetal heart rate and contractions. If there are any abnormalities, the nurse
will need to notify the healthcare provider immediately and provide appropriate interventions.
If Emily is still in early labor, the nurse may encourage her to walk or change positions to help promote
the progression of labor. The nurse may also encourage her to continue to hydrate and provide her with
ice chips or clear liquids as appropriate.
If Emily is in active labor, the nurse will need to assess the frequency, duration, and intensity of
contractions and provide appropriate pain management interventions, such as breathing techniques or
pharmacological pain relief as ordered by the healthcare provider.
The nurse will also need to monitor Emily's vital signs, such as blood pressure, pulse, and respiratory
rate, and provide emotional support and encouragement throughout the labor and delivery process.
Once Emily reaches the second stage of labor, the nurse will need to assist with pushing and provide
guidance on effective pushing techniques. The nurse may also need to provide perineal support to
prevent tearing or episiotomy, and prepare for delivery by gathering necessary equipment and notifying
the healthcare provider.
Overall, the nursing interventions during labor and delivery will depend on Emily's individual needs and
preferences, as well as the assessment findings and guidance from the healthcare provider. The nurse's
role is to provide safe, compassionate, and effective care to ensure the best possible outcomes for both
Emily and her baby.
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.
Back labor is a term used to describe the pain and discomfort experienced by some women during labor,
which is primarily felt in the lower back instead of the front of the abdomen. In Diane's case, the back
pain she is experiencing may be due to the position of the baby in her uterus. If the baby is in a posterior
position, meaning its back is facing the mother's back, the pressure of the baby's head on the mother's
sacrum can cause significant discomfort in the lower back.
Diane's slow progress may also be due to the position of the baby. The cardinal movements of labor
involve a series of maneuvers that the baby must undergo in order to be born. If the baby is not in the
optimal position for these movements, labor can progress more slowly. For example, if the baby is in a
posterior position, it may be more difficult for it to navigate the pelvis and engage in the cardinal
movements.
The 5 P's of labor are also important factors in the progress of labor. The 5 P's include: Passageway (the
birth canal), Passenger (the baby), Powers (contractions), Position (of the mother), and Psyche
(emotional state of the mother). In Diane's case, the baby's position is affecting the Passageway and
causing her slow progress.
To address Diane's back labor, the nurse may suggest different positions for labor such as hands and
knees or the use of a birthing ball to help relieve pressure on the lower back. Massage, warm
compresses, and other comfort measures may also be helpful. The nurse may also suggest that Diane
change her position frequently during labor to help the baby move into a better position. If progress
continues to be slow, the healthcare provider may consider interventions such as oxytocin
augmentation or assisted delivery.
In Diane's case, her back labor is likely due to the baby's position, which can cause pressure on the
sacrum and lower back. This position can also slow down the progress of labor as the baby may not be
able to descend as easily. Additionally, the baby's position may cause the cardinal movements of labor
to be less effective, making it harder for Diane to progress. In order for the baby to be born, it is
important for the baby to navigate through the mother's pelvis in a certain order: descent, flexion,
internal rotation, extension, and finally external rotation and expulsion. The baby's position can affect
the ability to complete these movements, causing a slower labor.
Furthermore, the 5 P's of labor - Passageway, Passenger, Powers, Position, and Psychological response -
can also impact the progress of labor. In Diane's case, her passageway (her pelvis) and her powers (the
strength and frequency of her contractions) may be adequate for labor to progress, but the position of
the passenger (the baby) is causing difficulties. Additionally, her psychological response to the pain and
discomfort of back labor may also be a factor in the slow progress of labor.
In summary, Diane's back labor is likely caused by the baby's position, which is also slowing down the
progress of labor by making the cardinal movements less effective. The 5 P's of labor can also impact
labor progress, with the passenger's position being a key factor in Diane's case. Addressing these factors
may be necessary to help Diane progress through labor and ultimately give birth to her baby.
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.
2. What strategies may the nurse implement to assist Diane in
progressing in her labor?
The strategies are:
Telling her to squat
Asking her to sit on the birth ball
Use of the miles circuit technique
Conducting abdominal lift
Asking Diane to balance on knees and hands on a bed to help adjust fetal position.
These are all great strategies to assist Diane in progressing in her labor. In addition to these, the nurse
can also encourage Diane to change positions frequently to help facilitate fetal descent and rotation.
Walking, standing, and side-lying positions can also be helpful for relieving pressure on the back and
facilitating descent. The nurse can also provide comfort measures such as massage, warm compresses,
and relaxation techniques to help manage pain and anxiety. If Diane is experiencing intense back pain,
the nurse can suggest using counterpressure on the lower back during contractions, either with the
nurse's hands or with a partner's hands or a rolled-up towel. Lastly, if progress is slow, the nurse can
communicate with the healthcare provider to discuss potential interventions such as augmentation of
labor or use of pain medication.
Additionally, the nurse can encourage Diane to change positions frequently and use different positions
during contractions, such as kneeling or standing while leaning on a wall or a partner. The nurse can also
provide emotional support, reassurance, and positive feedback to help Diane feel empowered and in
control of her labor.
It is important for the nurse to monitor Diane's progress, assess fetal well-being, and communicate
effectively with the healthcare provider to ensure safe and effective management of the labor. Pain
management options, such as relaxation techniques, breathing exercises, and pharmacologic
interventions, can also be discussed and offered to Diane as needed.
Overall, the nurse's role is to provide individualized care and support to Diane during her labor and
delivery, while promoting a safe and positive birth experience for both Diane and her baby.
here are some additional strategies that the nurse may implement to assist Diane in progressing in her
labor:
f. Provide continuous emotional support: The nurse can provide continuous emotional support to Diane,
which can help reduce her anxiety and stress levels. The nurse can encourage her and remind her that
she is doing great and making progress in her labor.
g. Use of hydrotherapy: Hydrotherapy can help alleviate back pain and promote relaxation during labor.
The nurse can suggest that Diane takes a warm shower or bath to help her cope with the pain.
h. Administer pain medication: If Diane's pain becomes too intense and she is unable to cope, the nurse
can suggest pain medication such as epidural anesthesia or other pain-relieving drugs as per the
physician's order.
i. Position changes: The nurse can encourage Diane to change positions regularly, which can help to
relieve pressure on her back and promote fetal descent.
j. Provide a supportive environment: The nurse can create a supportive environment for Diane, including
dimming the lights, playing soothing music, and providing a comfortable atmosphere.
k. Encourage Diane to engage in relaxation techniques: The nurse can teach Diane relaxation techniques
such as deep breathing, guided imagery, or progressive muscle relaxation. These techniques can help
her to manage her pain and stay relaxed during labor.
l. Use of a TENS machine: The nurse can suggest the use of a transcutaneous electrical nerve stimulation
(TENS) machine, which can help to reduce back pain during labor.
It is important to note that these interventions should be implemented based on Diane's preferences,
medical history, and physician's orders.
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.
There are several strategies that the nurse can implement to assist Diane in progressing in her labor:
1. Encouraging Diane to change positions frequently - this can help the baby move into a more
favorable position and help relieve some of the pressure on Diane's lower back.
2. Providing support and encouragement during contractions - this can help Diane manage the
pain of back labor and feel more in control of the situation.
3. Providing pain relief measures such as warm compresses, massage, or TENS unit - this can help
alleviate some of the discomfort and allow Diane to focus on the progress of labor.
4. Suggesting the use of a birthing ball or a squat bar - these can be useful for helping the baby
move into a more favorable position and allowing gravity to assist in labor progress.
5. Monitoring fetal well-being closely - if the baby's heart rate shows signs of distress,
interventions such as changing positions, administering oxygen, or in some cases, a cesarean
delivery may be necessary.
6. Providing emotional support - this can be especially important for women experiencing back
labor, as it can be a particularly challenging and intense experience. Encouragement,
reassurance, and empathy can help Diane feel more comfortable and confident in her ability to
give birth.
Overall, the nurse should work with Diane to develop a plan of care that addresses her unique needs
and goals for labor and birth.
Some strategies the nurse may implement to assist Diane in progressing in her labor include:
Encouraging position changes: Changing positions frequently can help relieve pressure on the back and
encourage fetal descent. The nurse can suggest different positions such as side-lying, sitting, kneeling, or
using a birthing ball.
Providing comfort measures: The nurse can offer non-pharmacological pain relief measures such as
massage, hot or cold compresses, or hydrotherapy.
Administering pharmacological pain relief: If non-pharmacological measures are insufficient, the nurse
may discuss pharmacological options with the healthcare provider and administer pain medications as
ordered.
Providing emotional support: The nurse can provide emotional support and encouragement to Diane, as
labor can be a challenging and emotional experience.
Encouraging hydration and nutrition: Keeping well hydrated and nourished can help maintain energy
levels during labor, and may facilitate cervical dilation.
Monitoring fetal well-being: The nurse can monitor fetal heart rate and uterine contractions regularly to
ensure the baby is tolerating labor well.
Promoting relaxation: Encouraging deep breathing, visualization, and other relaxation techniques may
help alleviate tension and promote relaxation, which can assist with labor progress.
Some additional strategies the nurse may implement to assist Diane in progressing in her labor include:
Encouraging position changes: The nurse can encourage Diane to change positions frequently during
labor to help the baby move down and encourage cervical dilation. Positions that may be helpful include
squatting, sitting upright, and hands-and-knees position.
Providing comfort measures: The nurse can provide comfort measures such as massage, back rubs,
warm compresses, and relaxation techniques to help Diane manage her pain and decrease stress.
Administering pain medication: The nurse can discuss with Diane and her healthcare provider the option
of pain medication to help her manage her pain and potentially increase relaxation, which can aid in
cervical dilation and descent of the baby.
Using the peanut ball: The nurse can utilize a peanut ball, a peanut-shaped exercise ball, to help position
Diane's legs and pelvis during labor. This can help the baby move down into the birth canal and aid in
cervical dilation.
Providing emotional support: The nurse can provide emotional support to Diane and her support
person, helping them stay positive and motivated throughout labor. This can help decrease stress and
encourage progress in labor.
In addition to the interventions already mentioned, the nurse may consider using non-pharmacologic
pain management techniques such as breathing techniques, relaxation techniques, and visualization to
help Diane cope with her pain. The nurse can also encourage Diane to change positions frequently to
help relieve her back pain and encourage fetal descent. Walking, rocking on a birthing ball, and knee-
chest position are some positions that can help relieve back pain and promote fetal descent. The nurse
can also provide emotional support and encouragement to help Diane stay focused and motivated
during labor. It is important for the nurse to continue to monitor Diane's progress and fetal well-being
and communicate any concerns with the healthcare provider.
The nurse can also provide education to Diane and her support person about the process of labor and
birth, including the stages of labor, coping techniques, and the potential need for interventions such as
an epidural or augmentation of labor. Education on the benefits of upright positions during labor and
how it can help with fetal descent can also be helpful. The nurse should also ensure that Diane is staying
well hydrated and nourished during labor, providing water and light snacks as appropriate.
If Diane's progress continues to be slow, the healthcare provider may consider interventions such as
artificial rupture of membranes or administration of oxytocin to augment labor. The nurse should closely
monitor Diane's response to these interventions and communicate any concerns to the healthcare
provider. If necessary, the nurse may also advocate for Diane's preferences and ensure that her birth
plan is being followed as closely as possible.
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.2American
journal of obstetrics and gynecology,2214(1), 94-e1.
Subramaniam, A., Tita, A. T., & Rouse, D. J. (2019). Obstetric Management of
Labor and Vaginal Delivery.2Chestnut's Obstetric Anesthesia E-Book,2393.
