Question

Maternal Body System Changes During Labor

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. What are these physiologic changes, and what are the risks to the maternal-fetal unit as a result? How will the nurse modify her care of Laurie in response to these physiologic changes during labor?

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

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

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

4.         Laurie asks the nurse if she can eat the turkey sandwich that her husband bought for her in the cafeteria. Should Laurie eat a sandwich while in labor? What are the gastrointestinal physiologic changes that occur during labor?

5.         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+. Should the nurse be concerned about this finding?

6.         Laurie is now 10 cm dilated and +2 station, and she feels the urge to push. What instructions should the nurse give Laurie about pushing?

Answer 1

1) Cardiovascular physiological changes occurs during labour are increased blood volume,cardiac output and decrease in arterial blood pressure.

2) The best position for laboring women owing to this cardiovascular changes is left lateral recumbent position.In this position pulse pressure increases only 6% when compared to supine position,in supine position pulse pressure increases by 26%.

SO LEFT LATERAL RECUMBENT POSITION IS BEST POSITION.

3) Respiratory physiological changes that occur during during labor are Hyperventilation and respiratory alkalosis,a low expiratory reserve volume and respiratory volume increases by 50% to compensate the demand of fetus and increase in the metabolic rate of women and increased minute ventilation because of increased respiratory centre activity and increased O2 consumption.

4) No she shouldn't eat sandwich during labor.if she have sandwich it leads to nausea or vomiting and sometimes rarely aspiration occurs.

5)No,The Laurie's nurse should not be concerned about this finding,because +1 proteinuria is mild or normal for laboring women.

6) The nurse should ask laurie that to push with every contraction so that her body doesn't have to work hard.