Question

Chapter 13: Labor and Birth Process

 1. 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)

      1. 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?

      2. 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? Why?

      3. 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."

 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.

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

Answer 1

1

• a. Do you have diarrhoea?

b.How do you feel about your contraction? Is it regular and becoming intense over time or subsiding with rest and hydration?

c. do you notice any bloody discharge?

d.Do you have back pain during contraction?

e. How do you feel about your baby's movement, active or inactive?

f. do you sense like something is coming down?

• prenatal history

when is your last menstrual period?

is this your first pregnancy?

how many pregnancy termination?

Were you taking birth control pills at the time you became pregnant?

Do you use any tobacco or alcohol or any other drugs?

Have you been diagnosed with type 1 or 2 diabetes or hypertension?

if yes, do you take medicines?

do you have any history of HIV or hepatitis?

2.

since Emily's cervix is 3 cm dilated and 40 % effaced, she is in the latent phase of the first stage of labour.

physiological changes

• painful uterine contractions with regular intervals and its intensity and duration increases with time.
• bloody discharge due to the release of mucous plug from the uterus.
• dilatation occurs and cervix becomes effaced.
• breakage of fluid may happen at any phase of the first stage of labour.

psychological change

*mother would be tensed about labour complications.

*because of increasing labour pain and pain on the back, she may be uncomfortable.

• upright positions and walking around may shorten the duration of the first phase of labour, and that freedom of movement to relieve pain and improve their comfort.