Nursing Case Study: Labour and Birth Process
Chapter 13, Labor and Birth Process
1. Emily, age 32, has an obstetrical history of G1, T0, P0, A0, and L0. Emily’s week of gestation is 39.1. Emily telephones the health care provider’s office and tells the nurse she believes she is in labor. Based on her assessment, the nurse advises her to have her husband bring her to the labor and birth unit. Emily arrives and is admitted. She is talkative and excited about being in labor and describes her contractions and discomfort as mild.
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The following are the assessment findings of the examining nurse: Maternal vital signs are stable. Fetal heart tones with the external fetal monitor are reassuring. Vaginal exam indicates the cervix is 3 cm dilated, 40% effaced, membranes intact with the presenting part engaged.
Ten minutes after the vaginal examination by the nurse, Emily says, “I think I just wet my pants.” (Learning Objectives 2, 6, 7, and 8)
What questions might the nurse have asked Emily to determine that she may be in true labor? What prenatal history information should the nurse have obtained during the telephone call?
Explain the meaning of the nurse’s assessment findings. Identify the stage and phase of labor, listing the physiologic and psychological changes during this stage. What positions and activities would be appropriate for Emily based on the assessment data? Why?
What are the nursing interventions that would be appropriate for the nurse to implement based on Emily’s statement that “I think I just wet my pants”?
2. Diane, age 22, has been in labor for 8 hours. Her cervical examination reveals she is 3 cm, 30% effaced, and –1 station. Diane has been feeling most of her pain in her lower back. (Learning Objectives 3, 4, and 5)
Given your understanding of the 5 P’s and the cardinal movements of labor, discuss why Diane is having back labor and why her progress is slow.
What strategies may the nurse implement to Help Diane in progressing in her labor?
Case Studies,
Chapter 14, Nursing Management During Labor and Birth Nursing Case Study: Labour and Birth Process
1.Desiree, a 28-year-old G2P1, is admitted to the labor and birth unit. Her birth plan indicates that she is planning natural childbirth without pharmacological interventions. She has attended childbirth education classes. Desiree is considered low risk based on her personal and family health history and physical examination. Her pregnancy has progressed without complications. She is approximately 38 weeks pregnant. Vaginal assessment reveals cervical dilation at 10 cm, 100% effaced, and +1 station. Position of the fetus is LOA. The external fetal monitor indicates a reassuring fetal heart rate at 130 beats per minute. Maternal status is stable. (Learning Objectives 1, 5, and 8)
Based on the vaginal assessment, what is the stage of labor and what are the appropriate nursing interventions for this stage of labor?
Explain how the nurse determined that the external fetal monitor would be appropriate for Desiree. What factors would necessitate a change to internal fetal monitoring during labor?
Desiree says, “I’m not sure I can cope with the pain much longer.” How would you respond, considering her birth plan, stage of labor, and assessment data?
2.Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced, and +2 station.She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations. Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended.(Learning Objectives 3 and 4) Nursing Case Study: Labour and Birth Process
A.What is happening to Emily’s baby at this point in time?What does this mean?
B.What role do you, as the nurse, play regarding fetal assessment and what interventions do you need to implement/recommend at this point in time?
Chapter 21, Nursing Management of Labor and Birth at Risk
1.Laura is a 26-year-old G2P1 who had a caesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat caesarean delivery or attempting a VBAC.(Learning Objective 9)
In order to ensure that Laura has the facts to Help her in her decision, explain the risks of a repeat caesarean delivery.
Laura can’t understand why more women don’t want to try a VBAC delivery.Discuss the possible reasons for this.
Describe the management of care for a woman attempting a VBAC delivery.
2.Carol, age 17, is pregnant with her first child.Her menstrual dates are accurate and her date of conception is limited to one possible day.Her physician gives her an EDC of March 28. Carol has gone past her due date and refuses to have her labor induced.Carol states, “My grandmother says that the baby will come when it is good and ready.”It is now April 14 and Carol is at 42 3/7 weeks’ gestation. She calls the office and reports that she is having a significant lower backache and she just passed “a glob of bloody mucus” from her vagina.(Learning Objective 5)
A.Discuss the risks a prolonged pregnancy places on Carol.
B.What risks are there for Carol’s unborn baby?
C.Describe the nursing care required for women in labor with a prolonged pregnancy. Nursing Case Study: Labour and Birth Process
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Case Study: Labor and Birth
Case Study: Labor and Birth
Chapter 13: Birth and Labor
Emily, 32, has a G1, T0, P0, A0, and L0 obstetric history. Emily is 39.1 weeks pregnant. Emily calls the doctor’s office and tells the nurse she thinks she’s in labor. The nurse recommends her husband to take her to the labor and delivery unit. Emily is admitted. She is chatty and delighted to be in labor, and her contractions and pain are mild.
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The examining nurse’s findings are as follows: Her vital signs are steady. The external fetal monitor’s heart tones are comforting. The cervix is 3 cm dilated, 40% effaced, membranes intact, and the presenting part engaged.
Emily comments ten minutes later, “I think I just wet my pants.” 2.6.6.7.8
If Emily was in labor, what questions would the nurse ask her? What prenatal history should the nurse have gotten over the phone?
Describe the nurse’s assessment results. Describe the physiological and psychological changes that occur throughout each stage of labor. Based on the assessment results, what jobs and hobbies would Emily enjoy? Why?
What nursing treatments might be acceptable based on Emily’s comment “I think I just wet my pants”?
2. Diane, 22, is 8 hours pregnant. Her cervical exam shows 3 cm, 30% effaced, and –1 station. Diane’s pain is mostly in her lower back. (3, 4, and 5)
Discuss why Diane is having back labor and why her progress is slow.
What tactics may the nurse use to help Diane proceed in labor?
Studies,
Case Study: Nursing Management During Labor and Birth
Desiree, 28, is admitted to the labor and delivery unit. Her birth plan calls for a drug-free natural birth. She’s taken prenatal classes. Desiree has a low risk profile based on her medical history and physical test. Her pregnancy has gone smoothly. She is 38 weeks pregnant. Cervical dilatation 10 cm, 100% effaced, and +1 station. The fetus is LOA. The external fetal monitor shows a comforting 130 bpm fetal heart rate. Stable maternal status (Learning Goals 1, 5, 8)
What is the stage of labor based on the vaginal assessment and what are the necessary nursing interventions?
Explain how the nurse decided Desiree needed an external fetal monitor. Factors that can warrant changing fetal monitoring during labor
“I’m not sure I can take much more pain,” Desiree admits. What would you say given her birth plan, labor stage, and assessment data?
2.Emily, a 26-year-old G3P2, is 7 cm, 90% effaced, and +2 station.
Currently, her fetal heart rate is 120 bpm, with minimal variability and occasional varied decelerations. After a contraction, the fetal heart rate dips to 80 bpm and slowly returns to baseline 1 minute later. (Learning Goals 3 and 4) Case Study: Labor and Birth
A.What is Emily’s kid doing now?
So, what?
B.As a nurse, what role do you play in fetal assessment and what interventions do you need to implement/recommend now?
Managing Risky Labor and Birth
Caesarean birth for fetal distress: Laura, 26-year-old G2P1, had her first pregnancy. Laura is now torn between a repeat caesarean and a VBAC. (Learning Goal 9)
Explain the dangers of a repeat caesarean delivery to Laura so she is fully informed.
Laura doesn’t understand why more ladies don’t try VBAC.
Examine the causes for this.
Describe the care management for a woman attempting a VBAC.
2.Carol, 17, is expecting her first baby.
Her menstrual periods are exact, and her conception date is one day.
Her doctor gives her EDC March 28. Carol is overdue and refuses to be induced. “My grandmother thinks the baby will arrive when it is ready,” Carol explains. Carol is 42 3/7 weeks pregnant as of April 14. She phones the office with a severe lower backache and “a glob of crimson mucus” from her vagina. (Learning Goal 5)
A. Discuss Carol’s dangers of a longer pregnancy.
B.How risky is Carol’s unborn child?
What nursing care is needed for women in labor with a long pregnancy? Case Study: Labor and Birth
