Question

The client is a nullipara at 5 cm dilation, 100% effacement, 0 station, vertex presentation, LOP position, with intact membranes, Contractions are occurring every 3 minutes lasting 60 seconds with strong intensity. The healthcare provider orders continuous external electronic fetal monitoring.

How often should the nurse assess maternal vital signs and fetal well-being?

2.       Where might the client be feeling discomfort and why?

3.       What interventions should the nurse use to promote the client’s comfort at this stage and phase of labor?

4.       When the Client asks what to expect as labor progresses, how should the nurse respond?

5.       The client states she has experienced a healthy pregnancy and asks why continuous fetal monitoring is necessary. How should the nurse respond?

Answer 1

1. Maternal vital signs has to monitored every 15 minutes to half hourly as she has got 5cm dilation of cervix and the client will be very much tensed about her baby.

• Fetal well being has to be monitored continuously by connecting a CTG ( cardiac topography ) machine to the maternal abdomen and the fetal heart rate has to be monitored using a fetal doppler every 15 minutes to half hour.

2. The client will have feeling of discomfort in her abdomen and back.

• This is due to the strong and powerful contractions in the uterus occurring every 3 minutes which is lasting for 60 seconds.

3. In this stage of labour the client needs continuous psychological support as she might have tensed thinking about her baby's well being.

• The nurse can massage the client's back in order to get some relief from the pain.
• Provide water to drink if client is thirsty. Do not give a large amount of water as it may cause vomiting when the contractions becomes more stronger.
• Be with the client every time in order to prevent the feeling of loneliness.

4. The nurse should explain that,

• The contractions becomes more strong as the baby's head reaches the cervix and the cervix becomes more dilated upto 10 cm.
• So she will have more pain at that time but she dont have to worry as we all nurses are there with her to provide support.
• When the fetal head is visible then the gynecologist will tell her to use the full strength to push out her baby when gets strong contractions. This will help to deliver the baby.
• An episiotomy ( it is a cut made in the perineum to make the delivery easy) is done which is not necessary if the baby's head deliver easily. Also there will be no pain while putting an episiotomy as it will be putting only when a contraction is occurring and they will give regional anesthetic too.
• If they find any difficulty in delivery of the head then a simple vacuum or forceps will be used to deliver the baby which is not harmful to both mother and the baby.
• As soon as the baby is delivered they will start giving newborn care and keep the baby under a radiant warmer.

5. The nurse should explain that,

• It ensures that the fetus is having no complications.
• Continuous fetal monitoring is necessary in all women during delivery even though they had an uneventful pregnancy.
• Labour has different stages so they have to note whether the fetal parameters are within the limits or not.
• Some babies will pass meconium ( first stool passed by the baby after birth) within the uterus and it will be aspirated by them and cause distress after the delivery.
• In case of any decreased fetal heart rate and if the amniotic fluid is meconium stained, then an emergency caesarean will be planned.