Question

Search the nursing literature for articles related to the care management of women experiencing labor and birth complications discussed in this chapter. Choose one article and complete a bibliography card that includes the following: 1. Summary of the key points of the article 2. Personal reaction to the ideas presented in the article 3. How the professional nurse can use the ideas in the article to enhance and improve the quality of health care provided to women experiencing complications of labor and birth.

Answer 1

Complications of Labor and Delivery:

Labor & delivery occur without any problems. Serious problems are relatively rare, and most can be anticipated and treated effectively. However, problems sometimes develop suddenly and unexpectedly.

- Anticipation of complications can be done through regular visits to a doctor or certified nurse midwife which will improve the chances of having a healthy baby and safe delivery.

Problems/complications may involve:

• The timing of labor—whether labor occurs earlier or later than normal

• Problems in the fetus or newborn

• Problems in the mother

• A problem with the placenta called placenta accreta

• Premature rupture of the membranes (the mother's water breaks too soon)

• Postterm pregnancy and postmaturity (a pregnancy continues longer than normal, sometimes causing problems with the baby)

• Abnormal position and presentation of the fetus (the fetus is in the wrong position for the safest delivery)

• Multiple births (such as twins or triplets)

• preeclampsia (high blood pressure with protein in the urine) may lead to premature detachment of the placenta from the uterus (placental abruption) and problems in the newborn.

• Amniotic fluid embolism (the fluid that surrounds the fetus in the uterus enters the woman’s bloodstream, sometimes causing a life-threatening reaction in the woman)

• Shoulder dystocia (the fetus's shoulder gets caught in the birth canal)

• Labor that starts too early (preterm labor) or too late (postterm pregnancy)

• Labor that progresses too slowly

• Prolapsed umbilical cord (the umbilical cord comes out of the birth canal before the baby) or nuchal cord (the umbilical cord is wrapped around the baby's neck)

• A fetus that is too large to pass through the birth canal (pelvis and vagina)—called fetopelvic disproportion

• Artificial starting of labor (induction of labor)

• Augmentation or slowing down of labor

• Forceps or a vacuum extractor (called operative vaginal delivery) to deliver the baby

• Cesarean delivery

• Excessive uterine bleeding at delivery

• A uterus that is turned inside out (inverted uterus)

• Uterine rupture

To Improve the quality of health care provided to women experiencing complications of labor and birth:

Professional Nurse would:

In Preterm labor:

• Promote rest, hydration, circulation
• Monitor FHR & uterine activity
• Support
• Administer medical therapy as per Dr's order

In intrapartum labor:

• Never leave patient alone
• Partograph to be maintained
• Encourage patient to rest between contractions and to push with contractions
• Position the patient's legs in stirrups for the lithotomy position
• Prepare the patient's perineum
• Monitor Patient's vital signs, FHR

Postpartum care:

• As Active management of third-stage labor is beneficial and recommended. So,Women should be educated before labor on their options for third-stage management and the risks and benefits of uterotonics.
• Some women request that the cord clamping be delayed until pulsations have ceased. This may benefit the newborn without significantly increasing the woman’s risk for PPH.
• Nurses carefully assess the fundus and bleeding while recovering the immediate postpartum woman and are frequently the first to notice PPH.
• A protocol for PPH should be made clear to all staff. All staff should be able to identify when bleeding is too heavy and the correct steps of emptying the bladder, pad inspection, uterine massage, and whom to call immediately.
• Easily accessed kits of necessary medications should be available, along with training in their use.