Question

Essentials of Maternity, Newborn, and Women's Health Nursing

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)

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?

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?

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)

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.

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

Answer 1

1.The following questions to be asked to Emily to assess true labor

• Does she have any stronger contraction frequently less than 20 minutes
• Any cramping abdominal pain
• Is there any vaginal discharge (water,blood or mucus)
• Severe lower back pain
• Any sensation of lightening or baby drop
• Bowel movement frequently

The prenatal history has to be collected by the nurse during telephonic conversation

• EDD (Expected date of delivery )
• Any allergies
• Vaccinations
• Blood investigation
• Having sonography reports
• Any medical complication during pregnancy
• Complete father history
• Infectious disease
• Smoking, alcohol,drugs,food habits to be asked

She is in first stage of labor.If is the longest stage lasting from 13 -18 hours if first delivery, having three phases (early labour phase -cervix 3cm dilated, Active Labour phase-cervix dilated till 7cm ,Transitional labour phase-cervix dilated till 10cm

The physiological changes are

• Back pain
• Contraction
• Abdominal cramping
• Cervical changes and effacement
• Fundal dominance can be noted
• Bowel movement and micturation frequently and in a urge

The psychological changes are

• Fear and anxiety
• Emotional disturbances
• Wanting to have family members or spouse to be with them

The mother is encouraged to lie down in recumbent position in this stage.

If the pain is mild and not progresses the mother can be encouraged to walk

Teaching breathing exercise

Pain management

The following assessment has to be done by the nurse when the client sag that their pant is wet

• Vaginal examination to assess dilation and rupture of amniotic sac
• Assess foetal hear rate
• Position the mother in lying down position immediately
• Assess the vitals of mother to have baseline data.

2.The 5p's of labor are

• Passenger :The fetus in the womb is referred to passenger .It depends on its lie,presentation,position.
• Power:the force or uterine contraction exhibited by mother
• Passage:the pathway of the fetus being delivered via vaginal opening
• Position:It is the lie of the fetus
• Psychological response : The prenatal education, communication, support plays an important part here

The cardinal movement of labor are engagement, descent of fetus,flexion,internal rotation, extension, external rotation and finally delivering

She may be having malposition of fetus which has lead to back pain without progress in labor.The passenger could be the cause for it.If iy is a occipital posterior position the this will lead to back pain and a slow cervical dilation.