Question

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

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

Answer 1

Traditionally childbirth has been described as consisting of various mechanisms and they can denoted as 5 Ps:

1. Powers – The forceful strength of co-ordinated contractions.
2. Passage – The birth canal anatomy, including the size and shape of the woman’s bony pelvis, and resistance of her soft tissue.
3. Passenger – The baby, particularly its lie and position of its head.
4. Psyche – it includes woman’s expectations of the birthing process, and how her anxiety can lengthen labour. It comprises empowered confidence in her own body’s ability; the positive support of caring nurses and calm, holistic labour room environment and receptive approach.
5. Preparation - To prepare oneself positively in every way feasible result in labour with surgical delivery. If we are well prepared ahead, number of complication can be tackeled smoothly. (Yes, you could “do everything right”, and it still “go all wrong” … the difference is, with preparation, it’s simply more likely, it will “go all right”.)

Out of these 5Ps, it is the Passenger that is the cause of the poor labour progress. The fetus may be malpositioned which results in poor cervical dilatation and lower back pain. The occiput of the fetus is putting pressure on mothers sacral bone during contractions which causes lower back pain.

Nursing interventions to assist Daine in labour are:

1. Ask for:
   1. How long are you contractions?
   2. How frequent are they?
   3. Do you have any low back pain?
   4. Is there any vaginal bleeding?
   5. How far along are you?
2. Position of the baby should be checked with obstetrician.
3. Encourage mother to walk if vitals are stable.
4. Ask mother to sit in squatting position.
5. Birth ball can be used by nurse to assist the mother.
6. Ask the mother to balance herself on hands and knees on the bed to adjust the foetal position.