19.12: Summary
19.1 Labor Dystocia
Labor dystocia can be caused by multiple factors. These factors are associated with power, passage, passenger, psyche, or position. The uterine contraction pattern controls the power. The pelvis is considered the passage. The fetus is the passenger. Position of the laboring person influences both the power and the passenger’s descent. When one or more of these factors are abnormal, labor dystocia occurs. The nurse is aware of the causes of labor dystocia and the most common treatments to resolve those causes.
19.2 Medical Interventions During Labor
The physiologic influence of oxytocin on uterine contractions is well documented. It has been shown to increase strength, frequency, and duration. Use of oxytocin can overcome some causes of inadequate contraction patterns, such as maternal exhaustion. Other causes of inadequate contractions, such as fetal malposition or chorioamnionitis, do not respond as well. Additionally, overstimulation of the uterine muscle using oxytocin and prostaglandins can cause tachysystole and fetal hypoxia. If overstimulation is not corrected, uterine rupture, hemorrhage, and fetal death can occur. The nurse is aware of the risks and benefits of oxytocin use and should monitor the fetal heart rate (FHR) and uterine contractions to maintain maternal and fetal safety
Amnioinfusion is used to replace lost amniotic fluid. Amnioinfusion can also help resolve variable decelerations. Use of amnioinfusion has been shown to decrease the incidence of cesarean birth. The nurse is aware of the benefits of and contraindications to amnioinfusion.
19.3 Obstetrical Conditions Affecting Labor and Birth
Complications can occur during labor. These complications can be due to pregnancy-related issues or issues beginning in labor. Meconium-stained fluid can appear during labor. Problems with the amniotic fluid amount occur and at times require induction of labor. Infection can also be a complication during labor. Fetal complications can arise during labor of multiple gestation, IUFD, and fetal malpresentation. Preterm and postdate deliveries each have complications. Preeclampsia and gestational diabetes cause disruptions in the placenta, putting the fetus at risk for uteroplacental insufficiency during labor.
Complications during labor affect the laboring person and the fetus. The nurse assesses for these complications and is prepared for appropriate interventions. Complications during labor lead to parental anxiety, and the nurse can help relieve this anxiety by educating the laboring person and support persons regarding the interventions being performed. Preparation is key to addressing labor complications.
19.4 Preexisting Conditions of the Pregnant Person Placing the Delivery at Risk
Preexisting conditions of the pregnant person can cause complications during labor that affect the laboring person and the fetus. Cardiovascular disorders and hypertension can lead to maternal morbidity and mortality. Preexisting diabetes mellitus affects the blood glucose of both the laboring person and the fetus. Musculoskeletal disabilities not only increase fetal risk but also make labor more difficult for persons who requires special equipment for mobility. Alterations in nutrition increase the risk of fetal complications. Nursing interventions revolve around knowledge of these conditions and individual plans of care.
19.5 Interventions During Birth
Operative delivery can be lifesaving for the fetus. These births can also cause complications to the laboring person and fetus. Precautions are taken by the health-care provider, and nurses are prepared for emergencies. The nurse is aware of the consequences of an operative delivery and is prepared for complications to the birthing person and newborn.
19.6 Cesarean Section
Some pregnancy and labor complications can lead to a cesarean birth. These complications can be caused by conditions of the fetus or the pregnant or laboring person. Fetal complications can be multiple gestation, malpresentation, fetal distress, or placental abnormalities. Conditions related to the pregnant or laboring person can be labor dystocia, preeclampsia, diabetes, and other chronic conditions. Cesarean births can be planned or caused by emergency complications. The nurse plays a vital role in preparing the laboring person for the cesarean birth. The nurse ensures that bonding with the newborn occurs in the operating room if possible. For the person with a previous cesarean birth, options are available for subsequent births, such as a trial of labor for vaginal birth after a cesarean or repeat cesarean birth. The nurse can encourage the person to discuss the options with their health-care provider.
19.7 Obstetrical Emergencies
The nurse is prepared for obstetric emergencies. Understanding risk factors leading to emergencies is critical. The health-care team works together to resolve the emergency as quickly as possible. Most hospitals use emergency drills to stay prepared for emergency situations.
19.8 Complications of the Second Stage of Labor
Second stage labor complications can include prolonged pushing, infection, decelerations, and exhaustion. Nurses who assist laboring persons in the second stage can prevent exhaustion by coaching the laboring person. The nurse’s recognition of fetal distress is essential during the second stage of labor.
19.9 Complications in the Third Stage of Labor
Complications can arise during the third stage of labor. The placenta can be implanted abnormally. Retained placenta or placental fragments can lead to postpartum hemorrhage. Postpartum hemorrhage can be a life-threatening complication. Emergencies arising in the third stage are managed by the health-care team. The nurse plays an important role in ensuring the safety of the birthing person.
19.10 Monitoring the Person in Labor for Complications Developing During the Process of Labor and Birth
Monitoring the laboring and birthing person for complications is done by the nurse and health-care team. Complications can arise that alter the perfusion, oxygenation, and neurologic status of the person. The nurse is aware of the risk factors for these complications. The nurse also provides care during and after these complications. The nurse monitors the person for progression of the problem or resolution of the complications. The safety of the laboring person and fetus is of highest priority to the nurse.