Question

Laurie is a 32-year-old primigravida at 40 weeks of gestation who is admitted to the Labor and Delivery unit in early labor. She has no known risk factors. Her bag of waters is intact, and she is 3 cm dilated, 90% effaced, and –1 station. The fetal heart rate is 120 with moderate variability, and she is contracting 3 to 4 minutes apart for 60 seconds.

As a woman progresses through the stages of labor, various body system adaptations will occur.

1. What are these physiologic changes, and what are the risks to the maternal-fetal unit as a result?

2. How will the nurse modify her care of Laurie in response to these physiologic changes during labor?

3. What are the cardiovascular physiologic changes that occur during labor?

4. What position is beneficial for the laboring woman owing to these cardiovascular changes?

5. What are the respiratory physiologic changes that occur during labor?

Laurie asks the nurse if she can eat the turkey sandwich that her husband bought for her in the cafeteria.

6. Should Laurie eat a sandwich while in labor?

7. What are the gastrointestinal physiologic changes that occur during labor?

Laurie’s labor progresses. Her bag of waters ruptures spontaneously for clear fluid. She is 5 cm dilated on examination. Laurie wants an epidural for pain management. She is preloaded with IV fluid. Her bladder is distended 1 hour after the epidural is placed, and the nurse obtains an order from the physician for an in and out catheterization. The nurse dipsticks Laurie’s urine for protein, and it is 1+.

8. Should the nurse be concerned about this finding?

Laurie is now 10 cm dilated and +2 station, and she feels the urge to push.

9. What instructions should the nurse give Laurie about pushing?

Answer 1

1. As per the physiological status , Ms. laurie is stable and shows that she is in the second stage of labour helping baby move down the birth canal as it is observed with 90% effacement, -1 station , 3cm dilation and she has a good contraction of 3 to 4 minutes apart for 60 second.The main risk that can happen in second stage of labour is cephalo pelvic disproportion, fetal distress, malposition , shoulder dystocia etc.

2. The nurses role during 2nd stage of labour for Ms. Laurie involve:

• Constant supervision
• vaginal examination
• provide sip of water using a cotton ball just to wet the dry mouth and lips
• provide a supporting care and provide a quiet environment which help her to concentrate on bearing down.
• Administer analgesic as adviced by the gynecologist, and repeat the advices and on how to push towards labour.

3. The cardiovascular changes during labour include:

• increased cardiac output
• heart rate increases during contraction and returns to normal as baby moves.
• decreased blood pressure
• increased extra cellular volume
• increased arterial compliance
• increased mean arterial pressure

4. We can prefer both upright position(sitting, squatting, kneeling) or horizontal position(lithotomy, lateral or supine ) the upright position help the patient to reduce the pain , decrease the duration of labour and ease labour by gravitational force . horizontal position provides easy access for the midwife and doctor for examining the mothe and fetus during labour.So, in these context , for a labouring women a semi sitting position is more favourable in the aspect of reducing pain, reducing duration of labour and to reduce cardio vascular risk.

5.The respiratory changes during labour include increased metabolic rate, increased oxygen consumption due to increased muscular work, compensated respiratory alkalosis and low expiratory reserve volume .

6.It is not safe to eat a sandwitch during labour as a precaution to prevent nausea if the patient is posted for emergency caesarean.

7. Due to the pressure of enlarging uterus on the lower GI system, risk of constipation is very high. to prevent dehydration patient will be on IV fluid.

8.On vaginal examination, as 10 cm dilation and +2 station, the nurse should patiently stay back with patient and assist her in pushing and giving instruction during contraction and pain and look forward for the stages of labour like crowning and descend.

9. instruction for pushing during labour:

• Advice to push as if you have a bowel movement
• Ask to tuck chin to your chest during pushing
• Ask to push with all energy to bring the baby soon.
• Help patient to change position if she feel comfortable
• Advice to rest during contraction
• Ask her to patiently listen to her doctor on when to stop pushing.
• Inspire her to push by showing the head of the baby on a mirror during crowning stage.