Nursing Management During Labor and Birth

Key Responsibilities

• Constant assessment of the mother and baby.
• Offer emotional support and comfort measures.
• Update and instruct the mother and her support person.
• Advocate for the mother within the healthcare system.

Monitoring and Assessment

• Monitor vital signs, uterine contractions, and fetal heart tones.
• Perform vaginal exams to check progress (cervical dilation and effacement).
• Observe for rupture of membranes and perform Leopold’s maneuver.
• Use electronic fetal monitoring to assess fetal condition.

Fetal Oxygenation Requirements

• Normal maternal blood flow and volume.
• Adequate oxygen and carbon dioxide exchange in the placenta.
• An open circulatory path via the umbilical cord.

Potential Complications

• Maternal complications: hemorrhage, hypotension, hypertension.
• Placental abruption and umbilical cord compression.

Fetal Heart Monitoring

• Fetal heart rate: 110-160 bpm, with accelerations and no decelerations.
• Use of continuous fetal monitoring if necessary.
• Bradycardia (<110) or tachycardia (>160) are concerning and need immediate interventions.

Labor Interventions

• Administer oxygen, reposition the mother, increase IV fluids.
• Stop oxytocin if necessary to relax the uterus.
• Prepare for possible delivery if complications arise.

Pain Management

• Non-pharmacological methods: breathing techniques, relaxation, imagery.
• Pharmacological methods: opioids (e.g. fentanyl, new Bain) and epidurals.
• Monitor effects of medications on both mother and fetus.

Stages of Labor

First Stage

• Administer admission assessments, including maternal health history and fetal assessment.
• Monitor uterine contractions, fetal heart rate, and amniotic fluid status.

Second Stage

• Provide one-on-one support, assess pushing and fetal descent.
• Prepare for delivery in the delivery or labor room.

Third Stage

• Monitor for signs of placental separation (lengthening of cord, gush of blood).
• Assess fundus and perineum, administer oxytocin if needed.
• Clean and assess the perineum.

Fourth Stage

• Physical recovery for mother and infant (1-2 hours post-delivery).
• Perform fundal massage, monitor vital signs, and manage vaginal discharge (lochia).
• Support bonding and breastfeeding initiation.

Post-Delivery Care

• Monitor for postpartum bleeding and fundus firmness.
• Assess for potential complications like hematomas or retained clots.
• Provide comfort measures, including pain relief and ice packs.
• Facilitate newborn and parent bonding, initiate breastfeeding.

Summary

Nurses play a crucial role in managing labor and birth, focusing on the well-being of both mother and baby. Continuous monitoring, timely interventions, and providing emotional and physical support are key responsibilities to ensure safe and effective labor and delivery outcomes.