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4 main components of the labor process
- power
- passenger
- passageway
- psyche
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one of the main components of the labor process: the force that propels the fetus (uterine contractions)
power
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one of the main component of the labor process: the fetus
passenger
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one of the main component of the labor process: birth canal
passageway
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one of the main component of the labor process: the birthing parent's and family's perception of the event
psyche
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what should a nurse prioritize if a patient develops a complication of labor or birth?
to increase the FHR or to strengthen uterine contractions
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this refers to the sluggishness of contractions or that the force of labor is less than usual
inertia/dysfunctional labor
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most common causes of prolonged labor
- fetal macrosomia
- hypotonic, hypertonic, or uncoordinated contractions
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common causes of dysfunctional labor
- primigravida
- cephalopelvic disproportion
- posterior fetal position/extension of fetal head
- failure of the uterine muscle to contract/overdistention of the uterus
- polyhydramnios
- fetal macrosomia
- multiple pregnancy
- nonripe cervix
- full rectum or urinary bladder
- patient becoming exhausted from labor
- inappropriate use of analgesia
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the basic force that moves the fetus thru the birth canal
uterine contractions
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characteristics of hypotonic uterine contractions
- no. of contractions are unusually infrequent (not more than 2 or 3 occurring in a 10-min period)
- resting tone of uterus is <10mm Hg
- strength of contractions does not rise above 25mm Hg
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this type of contractions occur during the active phase of labor and tend to occur after administration of analgesia, especially if the cervix is not dilated to 3-4 cm
hypotonic contractions
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risk factors of hypotonic contractions
- multiple gestation
- fetal macrosomia
- polyhydramnios
- grand multiparity
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this type of contractions are not exceedingly painful because of their lack of intensity (keep in mind that pain is subjective)
hypotonic ocntractions
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in hypotonic contractions, the labor may be prolonged since more of these contractions are needed to achieve cervical dilatation. if the uterus becomes exhausted, this may cause it to contract ineffectively during the postpartal period which increases the laboring parent's risk for what?
risk for postpartal hemorrhage
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nursing management in the 1st hour after birth following a labor of hypotonic contractions
- palpate uterine fundus
- obtain BP
- assess amount of lochia q15min to ensure postpartal contractions are not also hypotonic
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hypertonic contractions
most common phase of occurrence : latent/active
symptoms: painful/limited pain
medication used (oxytocin): unfavorable/favorable reaction
medication used (sedation): helpful/little value
- most common phase of occurrence : latent
- symptoms: painful
- medication used (oxytocin): unfavorable reaction
- medication used (sedation): helpful
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hypotonic contractions
most common phase of occurrence : latent/active
symptoms: painful/limited pain
medication used (oxytocin): unfavorable/favorable reaction
medication used (sedation): helpful/little value
- most common phase of occurrence : active
- symptoms: limited pain
- medication used (oxytocin): favorable reaction
- medication used (sedation): little value
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this type of contractions are marked by an increase in resting tone to more than 15mm Hg
hypertonic contractions
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pathophysiology of hypertonic contractions
hypertonic contraction may occur because more than one uterine pacemaker is stimulating contractions or because the muscle fibers of the myometrium don't repolarize or relax after a contraction thereby "wiping it clean" to accept a new pacemaker stimulus
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possible complication of hypertonic contraction
the lack of relaxation between contractions ay not allow opyimal uterine artery filling which may lead to fetal anoxia
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nursing management for labor with hypertonic contractions
apply a uterine and a fetal external monitor to identify if the resting phase between contractions is adequate and to see if FHR is no showing late deceleration
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in hypertonic contractions, if deceleration of FHR occurs, what is done?
a c-section may be necessary
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with this type of contractions, more than one pacemaker may be initiating contractions or receptor points in the myometrium may be acting independently of the pacemaker
uncoordinated contractions
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management for uncoordinated contractions
- apply fetal and uterine external monitor to assess the rate , pattern, resting tone and fetal response to contractions for 15 mins
- administer oxytocin to stimulate a more effective and consistent pattern of contractions
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dysfunctions occuring at the first stage of labor
- prolonged latent phase
- protracted active phase
- prolonged descent phase
- secondary arrest of dilatation
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this is a latent phase that lasts longer than 20 hours in a nullipara or 14 hours in a multipara; may occur if the cervix is not ripe at the early stage of labor ; contractions are <15mm Hg; uterus tends to be in a hypertonic state
prolonged latent phase
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management of a prolonged latent phase in labor that has been caused by hypertonic contractions
- help the uterus to rest, provide adequate fluid for hydration,
- and pain relief with a drug such as morphine sulfate
- Changing the linen and the woman’s gown, darkening room lights, and decreasing noise and stimulation can also be helpful
if the interventions above aren't effective, a cesarean birth or amniotomy and oxytocin infusion may be necessary
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