During the early first stage of labor, which nursing intervention is most appropriate to assist the patient in managing mild contraction discomfort?

C) Instruct the patient to perform deep breathing exercises

A) Encourage the patient to take a warm shower

B) Advise the patient to lie flat on her back

C) Instruct the patient to perform deep breathing exercises

D) Suggest the patient refrain from any movement

What is the most appropriate initial action for the nurse to take when the patient in labor reports increased discomfort from frequent contractions?

B) Encourage relaxation techniques and breathing exercises

A) Administer prescribed analgesics

B) Encourage relaxation techniques and breathing exercises

C) Increase the rate of IV fluids

D) Notify the obstetrician immediately

A nurse is assessing a patient in active labor whose contractions are occurring every 6 to 7 minutes and lasting about 45 seconds. The cervix is 3 cm dilated and 60% effaced. Which of the following interventions should the nurse prioritize to support labor progression?

C) Encourage ambulation and position changes

A) Encourage the patient to rest in bed and conserve energy

B) Administer oxytocin to increase contraction frequency

C) Encourage ambulation and position changes

D) Provide the patient with a full meal to increase energy levels

What is the primary purpose of encouraging position changes during labor?

C) To facilitate optimal fetal positioning

A) To increase maternal fatigue

B) To decrease fetal heart rate variability

C) To facilitate optimal fetal positioning

What is the most appropriate nursing action to support the patient's comfort during labor based on the current assessment?

C) Recommend gentle pelvic tilts and walking

A) Encourage the patient to maintain a supine position

B) Suggest the patient stay in bed to conserve energy

C) Recommend gentle pelvic tilts and walking

D) Advise against partner involvement to focus on clinical interventions

A patient in the active phase of the first stage of labor reports increased pelvic pressure and has regular contractions every 3-4 minutes lasting 60 seconds. The cervix is dilated to 5 cm and is 80% effaced. Which intervention should the nursing team prioritize to support the patient's labor progression?

B) Encouraging the use of a birthing ball

C) Initiating continuous fetal monitoring

D) Providing a warm blanket for comfort

1st stage of labour - Nursing Case Study

Pathophysiology

• Primary mechanism: The first stage of labor involves the onset of regular uterine contractions leading to the gradual effacement (thinning) and dilation (opening) of the cervix. These contractions are driven by hormonal changes, particularly the increase in oxytocin and prostaglandins, which stimulate the uterine muscles.

• Secondary mechanism: Fetal descent into the pelvis occurs as the cervix dilates. The pressure of the fetal head on the cervix further stimulates oxytocin release, enhancing contractions and aiding in cervical changes.

• Key complication: Inefficient uterine contractions, known as uterine inertia, can lead to prolonged labor, increasing the risk of maternal fatigue and fetal distress. Early recognition and intervention, such as administering oxytocin, can help manage this complication effectively.

Patient Profile

Demographics:

28 years old, female, schoolteacher

History:

• Key past medical history: No significant past medical history

• Current medications: Prenatal vitamins

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Onset of labor

• Key symptoms: Mild contractions occurring every 10 minutes, no rupture of membranes

• Vital signs: Blood pressure 118/76 mmHg, heart rate 82 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon admission to the labor and delivery unit, the patient, a 28-year-old schoolteacher, is in the early first stage of labor. During the initial assessment, the nurse notes that the patient is calm but slightly anxious about the labor process. She expresses mild discomfort from the contractions, which are currently occurring every 10 minutes and lasting about 30 seconds. On physical examination, the cervix is found to be 2 cm dilated and 50% effaced, indicating the very early phase of labor. The fetal heart rate is monitored and shows a steady rate of 140 beats per minute, which is within the normal range. The nurse reassures the patient and provides education about the natural progression of labor, emphasizing the importance of staying hydrated and managing pain through deep breathing exercises.

As the nurse continues the assessment, she evaluates the patient's vital signs, which remain stable with a blood pressure of 118/76 mmHg, a heart rate of 82 bpm, and a temperature of 98.6°F. The patient denies any leakage of fluid or vaginal bleeding, and fetal movement is reported as normal. The nurse also assesses the patient's psychosocial status, noting that the patient has a strong support system, with her partner present and actively involved in the labor process. The nursing team plans to monitor the progression of labor closely, watching for any signs of uterine inertia due to the inefficient contractions. They consider the possibility of administering oxytocin if contractions do not become more regular and effective over the next few hours.

This initial assessment underscores the importance of continuous monitoring and patient education to facilitate a smooth progression through the first stage of labor while remaining vigilant for any signs of complications. As the labor continues, the nursing team will adjust the care plan based on the patient's needs and the labor's progression, ensuring that both the mother and baby remain safe and comfortable.

Section 2

A few hours into the labor process, the nurse conducts a follow-up assessment to evaluate the progression of the patient's labor and identify any new developments. The patient reports increased discomfort as contractions have become more frequent, now occurring every 6 to 7 minutes and lasting about 45 seconds. The nurse performs a vaginal examination and finds that the cervix is now 3 cm dilated and 60% effaced, indicating some progress in cervical change. The fetal heart rate remains stable at 138 beats per minute, reassuring the team of fetal well-being.

The nurse also checks the patient's vital signs, which continue to be stable: blood pressure is 116/74 mmHg, heart rate is 84 bpm, and temperature is unchanged at 98.6°F. However, the patient expresses a growing sense of fatigue and anxiety, which prompts the nurse to address her emotional needs. The nurse encourages the use of relaxation techniques, such as guided imagery and breathing exercises, and suggests that the partner assist by providing supportive words and gentle massage to help alleviate tension.

As the labor progresses, the nurse remains vigilant for any signs of delayed labor progression or complications, such as uterine inertia. The nursing team discusses the potential need for intervention with oxytocin if the contractions do not continue to increase in frequency and intensity. The patient is encouraged to ambulate and change positions, which can enhance the effectiveness of contractions and aid in the baby's descent. By fostering an environment of support and education, the nurse aims to empower the patient through this phase of labor, maintaining a focus on safety and comfort for both mother and baby as they prepare for the next stage of labor.

Section 3

As the labor progresses into the early afternoon, the nurse notes a change in the patient's status. The patient reports increased intensity in her contractions, which are now occurring every 5 minutes and lasting approximately 60 seconds. This change suggests a positive progression toward active labor. The nurse performs another vaginal examination, revealing that the cervix is now 4 cm dilated and 80% effaced. These findings indicate steady cervical dilation, which aligns with the expected progression in the first stage of labor. The fetal heart rate remains stable at 140 beats per minute, providing reassurance of the baby's continued well-being.

The patient's vital signs remain stable with a slight increase in heart rate to 88 bpm, likely due to the increased physical exertion and anxiety associated with labor. Blood pressure and temperature remain consistent at 118/76 mmHg and 98.7°F, respectively. While the patient continues to show signs of fatigue, she expresses feeling more in control after practicing the relaxation techniques previously suggested. Her partner's involvement in providing massage and encouragement has visibly improved her mood and reduced her anxiety levels.

Despite the overall stable progression, the patient experiences a new complication: mild back pain, often associated with the baby's position. The nurse assesses the baby's position through Leopold's maneuvers and suspects occiput posterior positioning, which can contribute to back labor. To address this, the nurse encourages the patient to try different positions, such as hands-and-knees or side-lying, which may help the baby rotate to a more favorable position. The nursing team continues to monitor for any changes and supports the patient with comfort measures, ensuring a smooth transition through the first stage of labor.

Section 4

As the afternoon progresses, the patient's response to the interventions becomes evident. The positional changes suggested by the nurse have started to alleviate some of the back discomfort, indicating a possible shift in the baby's position. The patient reports a decrease in the intensity of the back pain, and her contractions, while still regular and strong, are now more manageable. Her partner continues to provide support and encouragement, using massage techniques that further enhance her comfort.

The nursing team conducts another assessment to evaluate the effectiveness of the interventions. The fetal heart rate remains stable at 140 beats per minute, and the baby's movements are consistent, reinforcing the well-being of the fetus. The patient's vital signs display a slight increase in heart rate to 92 bpm, suggesting increased exertion, but her blood pressure remains stable at 120/78 mmHg, and her temperature holds at 98.8°F. These findings indicate that the patient is coping well with the demands of labor, and there are no signs of distress for either the mother or the baby.

Given the positive response to positional changes and comfort measures, the nursing team continues to encourage movement and flexibility. They suggest the patient try gentle pelvic tilts and walking if she feels up to it, which may further assist in optimal fetal positioning and labor progression. The patient's mood remains positive, aided by her partner's active involvement and the support of the nursing staff. With the interventions showing favorable outcomes, the team remains vigilant for any new developments, prepared to adjust the care plan as necessary to ensure a smooth transition into active labor.

Section 5

As the evening progresses, the nursing team notices a slight change in the patient's status, which warrants further evaluation. The patient begins to report increased pressure in her pelvic area, a common sensation as labor advances. While her contractions remain regular, they have intensified slightly, occurring every 3-4 minutes and lasting around 60 seconds each. This change suggests she may be transitioning into the more active phase of the first stage of labor, where cervical dilation accelerates.

The team performs another cervical assessment to evaluate labor progression. The patient's cervix is now dilated to 5 cm, up from the previous 3 cm, and is 80% effaced. These findings confirm that her labor is progressing as expected, indicating a favorable response to the interventions and her body's natural labor process. The fetal head is observed to be descending, and the baby's position is optimal, occiput anterior, which is ideal for a vaginal delivery. The fetal heart rate remains stable at 140 bpm, reassuring the team of the baby's well-being.

While the patient's vital signs show a slight increase in heart rate to 96 bpm, her blood pressure remains stable at 122/80 mmHg, and her temperature is steady at 98.9°F. The increase in heart rate is consistent with exertion and the natural progression of labor. Encouraged by these developments, the nursing staff continues to support the patient with comfort measures, including assisting her with slow, deep breathing techniques and encouraging her to use a birthing ball to ease discomfort and promote further descent of the baby. They remain attentive, ready to provide additional support as she transitions into the next phase of her labor journey.