Unit 2 (Lesson 3): Care of the Woman during First Stage of Labor - PDF

Unit 2 (Lesson 3): Care of the Woman during First stage of Labor Maternal and Child Course Nursing Notebook MCN Care of the Woman...

Unit 2 (Lesson 3): Care of the Woman during First stage of Labor Maternal and Child Course Nursing Notebook MCN Care of the Woman During the First Stage of Labor: Comprehensive Notes The first stage of labor is critical for both the mother and the fetus, requiring attentive nursing care to ensure a safe and supportive experience. This stage is divided into three phases, each characterized by different contractions and levels of support needed. Phases of the First Stage of Labor: Latent Phase (0-3 cm cervical dilation) Mild, irregular contractions. The woman can be relatively independent, needing little assistance. Active Phase (4-7 cm cervical dilation) More intense, regular contractions. Increased need for support and pain management. Transition Phase (8-10 cm cervical dilation) Strong, frequent contractions. Unit 2 (Lesson 3): Care of the Woman during First stage of Labor 1  Women may feel overwhelmed and require continuous support. Key Nursing Care Goals: The primary objective of nursing care during this stage is to ensure the woman feels supported, safe, and in control of her experience. Key goals include: Monitoring maternal and fetal well-being continuously. Managing pain through pharmacological and non-pharmacological methods. Respecting the woman's birth preferences and providing culturally sensitive care. Advocating for the woman's needs and collaborating with the healthcare team. Maternal Monitoring: During labor, careful assessment of the mother's condition is essential: Vital Signs: Monitor blood pressure, pulse, and temperature every 4 hours. Contraction Patterns: Assess frequency, duration, and intensity of contractions. Cervical Changes: Conduct vaginal exams every 4 hours to check for dilation and effacement. Fetal Monitoring: Fetal assessment is primarily done through the fetal heart rate (FHR): Normal FHR: Ranges from 120-160 bpm, checked every 30 minutes. Continuous Monitoring: May be necessary in high-risk situations. Report any signs of fetal distress, such as abnormal heart rate patterns or meconium-stained fluid. Managing Pain and Discomfort: Effective pain management is central during this stage: Non-pharmacological methods: Unit 2 (Lesson 3): Care of the Woman during First stage of Labor 2  Encourage position changes to promote comfort and fetal descent. Utilize breathing exercises to help manage pain. Apply massage and touch for comfort, especially on the lower back. Consider hydrotherapy through warm showers or baths for relaxation. Use aromatherapy with essential oils to aid in relaxation. Pharmacological options: Epidurals can provide significant pain relief during labor. Analgesics may be given to relieve pain and anxiety in early labor. Avoid sedatives in active labor to prevent neonatal respiratory depression. Emotional Support: Labor is not only physically demanding but emotionally challenging. Nurses should provide: Reassurance: Encourage the woman, affirming that pain is a normal part of labor. Support Persons: Involve labor companions for additional emotional and physical support. Cultural Sensitivity: Ensure care aligns with the woman's cultural beliefs and practices. Positioning and Mobility: Frequent changes in position during labor can help with pain management and fetal descent: Encourage positions like standing, walking, squatting, or leaning over the bed. Avoid lying supine to prevent pressure on the vena cava, which can reduce blood flow to the placenta. Hydration and Bladder Care: Preventing dehydration is important for effective labor: Unit 2 (Lesson 3): Care of the Woman during First stage of Labor 3  Hydration: Encourage the woman to drink fluids like water or fruit juice and offer ice chips. Bladder Care: A full bladder can obstruct fetal descent; encourage urination every 2 hours. Companionship and Support: The presence of a supportive person can positively affect labor outcomes: A labor companion can provide comfort, potentially shortening labor. Ensure the companion is informed about the woman's progress and included in the process. Documentation: Accurate documentation of key information is vital: Record maternal vital signs and contraction patterns. Document fetal heart rate and any significant changes in condition. Note any pain relief methods used and their effectiveness. Use of Partograph: The partograph is essential for monitoring labor progress: Plot cervical dilation, fetal descent, and contraction patterns. Identify if labor progresses normally or if interventions are necessary. Nursing Diagnoses: 1. Powerlessness related to the duration of labor Goal: Client expresses preferences for positions and techniques to control pain. Interventions: Encourage position changes, promote independence during latent phase. 2. Anxiety related to stress of labor Goal: Client states she feels in control of her situation. Unit 2 (Lesson 3): Care of the Woman during First stage of Labor 4  Interventions: Provide emotional support, educate about labor progress, involve support persons. 3. Risk for fluid volume deficit related to prolonged lack of oral intake Goal: Client states she does not feel thirsty; voids at least 30 mL per hour. Interventions: Encourage fluid intake, offer ice chips, monitor hydration status. 4. Altered comfort: Pain related to progress of labor Goal: Client states labor pains are tolerable. Interventions: Utilize non-pharmacological pain relief methods, assess effectiveness regularly. 5. Risk for self-care deficit related to exhaustion from labor efforts Goal: Client states a sense of cleanliness and well-being. Interventions: Assist with personal hygiene, provide frequent mouth care. Complications to Watch For: Fetal distress: Monitor for abnormal FHR patterns or meconium-stained fluid. Delayed labor progress: Evaluate if cervical dilation is slower than expected. Maternal exhaustion or dehydration: Encourage rest and hydration to prevent complications. Unit 2 (Lesson 3): Care of the Woman during First stage of Labor 5