🩺

Nursing Management of Labor and Birth Risks

Mar 20, 2025

Lecture Notes: Nursing Management of Labor and Birth at Risk

Introduction

  • Focus on Chapter 21: Nursing management of labor and birth at risk.
  • Expect 4 test questions from this chapter.
  • Discussion on dystocia – difficult labor leading often to C-section.

Dystocia

  • Causes: Maternal issues or fetal issues.
  • Associated Factors:
    • Problems of the powers (ineffective contractions/pushing).
    • Problems due to maternal fatigue, inactivity, fluid/electrolyte imbalance, hypoglycemia, anesthesia, stress, disproportionate pelvis, and uterine over-distension.

Types of Dysfunction

  • Hypotonic Dysfunction:
    • Weak, infrequent contractions.
    • Management involves treating the cause: IV hydration, position change, augmentation with oxytocin.
  • Hypertonic Dysfunction:
    • Uncoordinated, erratic contractions, often painful.
    • Management: Pain medication, warm showers, and potentially tocolytic drugs.

Maternal Pushing Issues

  • Caused by poor pushing position, fear, exhaustion, psychological unreadiness.

Risk Factors for Dystocia

  • Maternal age >35, high caffeine intake, gestational age >41 weeks.

Problems with Passageway

  • Pelvic Contraction: Obstruction in maternal birth canal.
  • Fetal Issues: Macrosomia, shoulder dystocia, abnormal presentations (e.g., breech).

Multi-fetal Pregnancy

  • Risk for dysfunctional labor, postpartum hemorrhage.

Psychological Stress

  • Can contribute to dystocia, coaching and reassurance are vital.

Preterm Labor

  • Defined: Labor starting between 20-37 weeks.
  • Causes: Infections, dental issues, gestational diabetes, hypertension, drug abuse.
  • Prevention: Early prenatal care, nutrition, smoking cessation.

Management of Preterm Labor

  • Identify/treat infections and other conditions.
  • Use of tocolytics and corticosteroids to manage and prepare for early delivery.

Prolonged Pregnancy and Labor

  • After 42 weeks can be detrimental to fetus.
  • Risk of placental insufficiency and fetal growth issues.

Procedures During Labor

  • Amniotomy: Artificial rupture of membranes.
  • Amnioinfusion: Used to increase fluid volume to prevent cord compression.

Cesarean Section

  • Indications: Dystocia, fetal distress, maternal health issues.
  • Procedure: Includes pre-op labs, anesthesia, fetal heart monitoring, and careful surgical practice.
  • Post-op Care: Vital signs, respiratory status, abdominal dressing, uterine firmness, and recovery monitoring.

Labor Induction and Augmentation

  • Cervical Ripening: Use of prostaglandins and other methods to soften cervix.
  • Oxytocin: Used post-ripening to stimulate labor.

Emergencies

  • Placental Abruption: Premature separation, emergency situation.
  • Uterine Rupture: Tear in uterine wall, requires immediate intervention.
  • Amniotic Fluid Embolism: Rare, high mortality, requires immediate treatment.

Nursing Roles

  • Support psychological and physical comfort for the mother.
  • Provide education and reassurance.
  • Monitor vital signs, fetal heart rate, contractions, and maternal comfort.

This summary provides an overview of key concepts and interventions related to labor and birth at risk, focusing on dystocia, preterm labor, prolonged pregnancy, and related procedures. It highlights the critical role of nursing management in these scenarios.

Full transcript