6/6/24, 9:03 PM Week 4 Edapt Nursing CARE Intrapartum
Week 4 Edapt- Intrapartum Care
INTRAPARTUM PERIOD
The birthing process represents a major life event for clients and their families, regardless of the
number of previous deliveries. The nurse is responsible for caring for the pregnant woman, family, and
fetus throughout labor and delivery.
Knowledge of factors that influence childbirth preparation, such as prior coping strategies, family roles,
culture, and spirituality, are essential.
Labor and Delivery Admission
When admitting a client to the labor and delivery unit, which is the priority assessment?
Contraction frequency and duration
Time of last meal
Gravida and para status
Presence of a labor partner
Induction of Labor
The nurse is caring for a client in labor who is receiving oxytocin. Which assessment finding requires
immediate action?
Contraction duration 50-60 seconds
Urine output 75 mL in 2 hours
Fetal heart rate 125 bpm with moderate variability
Six contractions in 10 minutes
Indications for Labor Induction
What are indications for labor induction? Select all that apply.
Placenta previa
Client request to select the delivery date
Post-term gestation
Prolonged rupture of membranes
History of precipitous labor
Intrapartum Terminology
Maternity nursing is a highly specialized area of nursing, which includes terminology that may
be new. It may be helpful to keep a reference guide handy for use in the clinical area as you become
familiar with maternity nursing terms.
AROM: Augmented (also called artificial) rupture of membranes.
Cephalic Presentation: Fetus positioned head down; most common fetal presentation.
Dilation: Progressive opening of cervix caused by uterine contractions; 0–10 cm.
Effacement: shortening and thinning of the cervix during the first stage of labor - the drawing up of
the internal os and the cervical canal into the uterine side walls. Measured as a percentage: 0% is
approximately 1 cm thick; 100% is paper thin.
EFM: Electronic fetal monitoring
Engagement: Fetal presenting part reaches true pelvis
FHR: Fetal heart rate
Fundus: Upper aspect of the uterus
Intrapartum: Onset of labor to birth
Lightening: Descent of fetal presenting part into the pelvic cavity, often 38 weeks gestation (or 2 wee
ks before labor onset in primiparas).
NST: Nonstress test; fetal assessment for well-being, (2) accelerations documented with 15 bpm abov
e baseline × 15 seconds in length minimum = (+) NST
PROM: Premature rupture of membranes; no contraction or no dilation noted, but SROM occurred
SROM: Spontaneous rupture of membranes
Station: Relation of the presenting part to the ischial spines of maternal pelvis
SVE: Assessment performed by RN to determine cervical dilation, station, and effacement.
Psychosocial Factors
The intrapartum period is a time of preparation and anticipation. As childbirth draws closer, the
intrapartum nursing assessment includes important psychosocial factors related to the woman, the
about:blank 1/72
,6/6/24, 9:03 PM Week 4 Edapt Nursing CARE Intrapartum
fetus, and the family. Physical preparation and health are important factors for achieving good
intrapartum outcomes, but so are emotional and psychological preparation.
The nurse must recognize cues that signal the woman’s need for further support and information, so
questions and concerns may be resolved. Below are some questions that the nurse should consider.
Is this the first pregnancy and delivery?
The primigravida client will likely experience more anxiety and fear than a multigravida client, who kno
ws what to expect. However, even a multigravida client who has had labor complications in the past m
ay experience high levels of anxiety as well.
The nurse must provide information and assist the client with coping strategies to reduce anxiety.
Is there a labor partner throughout childbirth?
The nurse must assess the coping strategies of both the client and labor partner, while caring for both
throughout the childbirth process. The nurse should keep the family informed and involved to a level a
ppropriate to the client’s wishes.
If the client does not have a support team for childbirth, the nurse may need to provide more frequent
or continual bedside support.
Is the woman a survivor of sexual abuse?
Childbirth and associated intimate medical interventions may trigger feelings of anxiety and fear in
women who are survivors of sexual abuse. Nurses should provide emotional support, helping the client
to associate uncomfortable experiences with the birth of a child, instead of past abuse. Providing
information and privacy while allowing client control may reduce anxiety and fear.
Sexual Abuse Survivors
When caring for a laboring woman who is a survivor of sexual abuse, special considerations are
needed. From the statements provided, identify which are special considerations and which are not a
special consideration.
Specical Not a Special
Consideration Consideration
The woman may be anxious and fearful when examined
X
during labor.
The woman may wish to be kept uninformed in order to cope
X
with the stress of labor.
The woman may associate childbirth with her past sexual
X
abuse.
The woman may be sensitive to privacy. X
Preparation for Childbirth
Childbirth preparation prior to labor helps the client learn self-help measures and what to expect
during pregnancy and the birthing process. Enhanced knowledge leads to heightened confidence,
increased pain tolerance, and improved satisfaction with the birth experience.
Childbirth Preparation Classes
There are many different types of childbirth preparation techniques taught to clients. Though all
methods provide instruction on pain management techniques, each has unique aspects. Some of the
common classes offered are:
Dick-Read Childbirth Education focuses on alleviating the fear of childbirth through education
and the pain through relaxation and breathing techniques.
Bradley Childbirth Education teaches abdominal breathing to increase relaxation and
emphasizes the avoidance of medications and interventions.
Lamaze Childbirth Education teaches concentration and relaxation to decrease contraction
pain.
Childbirth Education Topics
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,6/6/24, 9:03 PM Week 4 Edapt Nursing CARE Intrapartum
fetus, and the family. Physical preparation and health are important factors for achieving good
intrapartum outcomes, but so are emotional and psychological preparation.
The nurse must recognize cues that signal the woman’s need for further support and information, so
questions and concerns may be resolved. Below are some questions that the nurse should consider.
Is this the first pregnancy and delivery?
The primigravida client will likely experience more anxiety and fear than a multigravida client, who kno
ws what to expect. However, even a multigravida client who has had labor complications in the past m
ay experience high levels of anxiety as well.
The nurse must provide information and assist the client with coping strategies to reduce anxiety.
Is there a labor partner throughout childbirth?
The nurse must assess the coping strategies of both the client and labor partner, while caring for both
throughout the childbirth process. The nurse should keep the family informed and involved to a level a
ppropriate to the client’s wishes.
If the client does not have a support team for childbirth, the nurse may need to provide more frequent
or continual bedside support.
Is the woman a survivor of sexual abuse?
Childbirth and associated intimate medical interventions may trigger feelings of anxiety and fear in
women who are survivors of sexual abuse. Nurses should provide emotional support, helping the client
to associate uncomfortable experiences with the birth of a child, instead of past abuse. Providing
information and privacy while allowing client control may reduce anxiety and fear.
Sexual Abuse Survivors
When caring for a laboring woman who is a survivor of sexual abuse, special considerations are
needed. From the statements provided, identify which are special considerations and which are not a
special consideration.
Specical Not a Special
Consideration Consideration
The woman may be anxious and fearful when examined
X
during labor.
The woman may wish to be kept uninformed in order to cope
X
with the stress of labor.
The woman may associate childbirth with her past sexual
X
abuse.
The woman may be sensitive to privacy. X
Preparation for Childbirth
Childbirth preparation prior to labor helps the client learn self-help measures and what to expect
during pregnancy and the birthing process. Enhanced knowledge leads to heightened confidence,
increased pain tolerance, and improved satisfaction with the birth experience.
Childbirth Preparation Classes
There are many different types of childbirth preparation techniques taught to clients. Though all
methods provide instruction on pain management techniques, each has unique aspects. Some of the
common classes offered are:
Dick-Read Childbirth Education focuses on alleviating the fear of childbirth through education
and the pain through relaxation and breathing techniques.
Bradley Childbirth Education teaches abdominal breathing to increase relaxation and
emphasizes the avoidance of medications and interventions.
Lamaze Childbirth Education teaches concentration and relaxation to decrease contraction
pain.
Childbirth Education Topics
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, 6/6/24, 9:03 PM Week 4 Edapt Nursing CARE Intrapartum
There is often a lack of ability to provide more advanced care should an unanticipated need ari
se.
Home
Home deliveries were the only option until the shift toward hospital deliveries and the medical practice
of obstetrics as a specialty developed. Even today, some clients still choose to deliver in the home envi
ronment. The labor and birth process is often overseen by a midwife.
Benefits:
The home environment allows clients more control over childbirth, including comfort measures
that may be unachievable outside the home.
Disadvantages:
Healthcare providers do not typically attend deliveries at home. A client desiring a home delive
ry will likely seek care from a trained midwife. Limited technology is used in home births. There
fore, the ability to anticipate complications may be hindered.
In the event of complications that cannot be managed at home, the client must be transported
to a hospital for childbirth and/or recovery.
Intrapartum Triage and Assessment
In the hospital’s labor and delivery unit, nurses encounter pregnant women who will typically undergo
a period of triage to determine whether admission is necessary. Women who are medically stable and
are over 20 weeks gestation will usually be brought to the labor and delivery unit, rather than
remaining in the emergency department or being admitted to a medical-surgical unit, even if the
reason for seeking treatment is unrelated to pregnancy.
The labor and delivery nurse will assess maternal and fetal well-being, signs of potential complications,
obstetric history, current labor symptoms, and psychosocial factors including the woman’s labor
support system. These assessment components include the considerations below.
Fetal Heart Rate and Patten
The primary and most reliable way to assess the status of a fetus is to monitor the fetal heart rate and
pattern. This can be done using continuous electronic fetal monitoring (EFM) or intermittently using an
electronic doppler. Assessing the fetal heart rate and pattern is a priority during admission. The normal
range for fetal heart rate is between 110 and 160 bpm. The pattern may include accelerations and earl
y decelerations. However, variable and late decelerations are ominous and should be evaluated further
.
The frequency of fetal monitoring during labor is determined by the client’s level of risk. During active l
abor, the nurse should plan to monitor at least every 30 minutes.
When assessing the fetal heart rate and pattern, consider these questions:
What is the baseline fetal heart rate (FHR)?
What is the FHR variability?
Are accelerations in the FHR present?
Does the FHR meet reactive non-stress test criteria?
Are any decelerations present? If yes, what type of deceleration is occurring? Are interventions
needed?
NOTE:
Nurses who care for women during childbirth are legally responsible for correctly interpreting the fetal
heart rate pattern, implementing appropriate nursing actions based on that pattern, and documenting
the outcome of those actions.
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Week 4 Edapt- Intrapartum Care
INTRAPARTUM PERIOD
The birthing process represents a major life event for clients and their families, regardless of the
number of previous deliveries. The nurse is responsible for caring for the pregnant woman, family, and
fetus throughout labor and delivery.
Knowledge of factors that influence childbirth preparation, such as prior coping strategies, family roles,
culture, and spirituality, are essential.
Labor and Delivery Admission
When admitting a client to the labor and delivery unit, which is the priority assessment?
Contraction frequency and duration
Time of last meal
Gravida and para status
Presence of a labor partner
Induction of Labor
The nurse is caring for a client in labor who is receiving oxytocin. Which assessment finding requires
immediate action?
Contraction duration 50-60 seconds
Urine output 75 mL in 2 hours
Fetal heart rate 125 bpm with moderate variability
Six contractions in 10 minutes
Indications for Labor Induction
What are indications for labor induction? Select all that apply.
Placenta previa
Client request to select the delivery date
Post-term gestation
Prolonged rupture of membranes
History of precipitous labor
Intrapartum Terminology
Maternity nursing is a highly specialized area of nursing, which includes terminology that may
be new. It may be helpful to keep a reference guide handy for use in the clinical area as you become
familiar with maternity nursing terms.
AROM: Augmented (also called artificial) rupture of membranes.
Cephalic Presentation: Fetus positioned head down; most common fetal presentation.
Dilation: Progressive opening of cervix caused by uterine contractions; 0–10 cm.
Effacement: shortening and thinning of the cervix during the first stage of labor - the drawing up of
the internal os and the cervical canal into the uterine side walls. Measured as a percentage: 0% is
approximately 1 cm thick; 100% is paper thin.
EFM: Electronic fetal monitoring
Engagement: Fetal presenting part reaches true pelvis
FHR: Fetal heart rate
Fundus: Upper aspect of the uterus
Intrapartum: Onset of labor to birth
Lightening: Descent of fetal presenting part into the pelvic cavity, often 38 weeks gestation (or 2 wee
ks before labor onset in primiparas).
NST: Nonstress test; fetal assessment for well-being, (2) accelerations documented with 15 bpm abov
e baseline × 15 seconds in length minimum = (+) NST
PROM: Premature rupture of membranes; no contraction or no dilation noted, but SROM occurred
SROM: Spontaneous rupture of membranes
Station: Relation of the presenting part to the ischial spines of maternal pelvis
SVE: Assessment performed by RN to determine cervical dilation, station, and effacement.
Psychosocial Factors
The intrapartum period is a time of preparation and anticipation. As childbirth draws closer, the
intrapartum nursing assessment includes important psychosocial factors related to the woman, the
about:blank 1/72
,6/6/24, 9:03 PM Week 4 Edapt Nursing CARE Intrapartum
fetus, and the family. Physical preparation and health are important factors for achieving good
intrapartum outcomes, but so are emotional and psychological preparation.
The nurse must recognize cues that signal the woman’s need for further support and information, so
questions and concerns may be resolved. Below are some questions that the nurse should consider.
Is this the first pregnancy and delivery?
The primigravida client will likely experience more anxiety and fear than a multigravida client, who kno
ws what to expect. However, even a multigravida client who has had labor complications in the past m
ay experience high levels of anxiety as well.
The nurse must provide information and assist the client with coping strategies to reduce anxiety.
Is there a labor partner throughout childbirth?
The nurse must assess the coping strategies of both the client and labor partner, while caring for both
throughout the childbirth process. The nurse should keep the family informed and involved to a level a
ppropriate to the client’s wishes.
If the client does not have a support team for childbirth, the nurse may need to provide more frequent
or continual bedside support.
Is the woman a survivor of sexual abuse?
Childbirth and associated intimate medical interventions may trigger feelings of anxiety and fear in
women who are survivors of sexual abuse. Nurses should provide emotional support, helping the client
to associate uncomfortable experiences with the birth of a child, instead of past abuse. Providing
information and privacy while allowing client control may reduce anxiety and fear.
Sexual Abuse Survivors
When caring for a laboring woman who is a survivor of sexual abuse, special considerations are
needed. From the statements provided, identify which are special considerations and which are not a
special consideration.
Specical Not a Special
Consideration Consideration
The woman may be anxious and fearful when examined
X
during labor.
The woman may wish to be kept uninformed in order to cope
X
with the stress of labor.
The woman may associate childbirth with her past sexual
X
abuse.
The woman may be sensitive to privacy. X
Preparation for Childbirth
Childbirth preparation prior to labor helps the client learn self-help measures and what to expect
during pregnancy and the birthing process. Enhanced knowledge leads to heightened confidence,
increased pain tolerance, and improved satisfaction with the birth experience.
Childbirth Preparation Classes
There are many different types of childbirth preparation techniques taught to clients. Though all
methods provide instruction on pain management techniques, each has unique aspects. Some of the
common classes offered are:
Dick-Read Childbirth Education focuses on alleviating the fear of childbirth through education
and the pain through relaxation and breathing techniques.
Bradley Childbirth Education teaches abdominal breathing to increase relaxation and
emphasizes the avoidance of medications and interventions.
Lamaze Childbirth Education teaches concentration and relaxation to decrease contraction
pain.
Childbirth Education Topics
about:blank 2/72
,6/6/24, 9:03 PM Week 4 Edapt Nursing CARE Intrapartum
fetus, and the family. Physical preparation and health are important factors for achieving good
intrapartum outcomes, but so are emotional and psychological preparation.
The nurse must recognize cues that signal the woman’s need for further support and information, so
questions and concerns may be resolved. Below are some questions that the nurse should consider.
Is this the first pregnancy and delivery?
The primigravida client will likely experience more anxiety and fear than a multigravida client, who kno
ws what to expect. However, even a multigravida client who has had labor complications in the past m
ay experience high levels of anxiety as well.
The nurse must provide information and assist the client with coping strategies to reduce anxiety.
Is there a labor partner throughout childbirth?
The nurse must assess the coping strategies of both the client and labor partner, while caring for both
throughout the childbirth process. The nurse should keep the family informed and involved to a level a
ppropriate to the client’s wishes.
If the client does not have a support team for childbirth, the nurse may need to provide more frequent
or continual bedside support.
Is the woman a survivor of sexual abuse?
Childbirth and associated intimate medical interventions may trigger feelings of anxiety and fear in
women who are survivors of sexual abuse. Nurses should provide emotional support, helping the client
to associate uncomfortable experiences with the birth of a child, instead of past abuse. Providing
information and privacy while allowing client control may reduce anxiety and fear.
Sexual Abuse Survivors
When caring for a laboring woman who is a survivor of sexual abuse, special considerations are
needed. From the statements provided, identify which are special considerations and which are not a
special consideration.
Specical Not a Special
Consideration Consideration
The woman may be anxious and fearful when examined
X
during labor.
The woman may wish to be kept uninformed in order to cope
X
with the stress of labor.
The woman may associate childbirth with her past sexual
X
abuse.
The woman may be sensitive to privacy. X
Preparation for Childbirth
Childbirth preparation prior to labor helps the client learn self-help measures and what to expect
during pregnancy and the birthing process. Enhanced knowledge leads to heightened confidence,
increased pain tolerance, and improved satisfaction with the birth experience.
Childbirth Preparation Classes
There are many different types of childbirth preparation techniques taught to clients. Though all
methods provide instruction on pain management techniques, each has unique aspects. Some of the
common classes offered are:
Dick-Read Childbirth Education focuses on alleviating the fear of childbirth through education
and the pain through relaxation and breathing techniques.
Bradley Childbirth Education teaches abdominal breathing to increase relaxation and
emphasizes the avoidance of medications and interventions.
Lamaze Childbirth Education teaches concentration and relaxation to decrease contraction
pain.
Childbirth Education Topics
about:blank 3/72
, 6/6/24, 9:03 PM Week 4 Edapt Nursing CARE Intrapartum
There is often a lack of ability to provide more advanced care should an unanticipated need ari
se.
Home
Home deliveries were the only option until the shift toward hospital deliveries and the medical practice
of obstetrics as a specialty developed. Even today, some clients still choose to deliver in the home envi
ronment. The labor and birth process is often overseen by a midwife.
Benefits:
The home environment allows clients more control over childbirth, including comfort measures
that may be unachievable outside the home.
Disadvantages:
Healthcare providers do not typically attend deliveries at home. A client desiring a home delive
ry will likely seek care from a trained midwife. Limited technology is used in home births. There
fore, the ability to anticipate complications may be hindered.
In the event of complications that cannot be managed at home, the client must be transported
to a hospital for childbirth and/or recovery.
Intrapartum Triage and Assessment
In the hospital’s labor and delivery unit, nurses encounter pregnant women who will typically undergo
a period of triage to determine whether admission is necessary. Women who are medically stable and
are over 20 weeks gestation will usually be brought to the labor and delivery unit, rather than
remaining in the emergency department or being admitted to a medical-surgical unit, even if the
reason for seeking treatment is unrelated to pregnancy.
The labor and delivery nurse will assess maternal and fetal well-being, signs of potential complications,
obstetric history, current labor symptoms, and psychosocial factors including the woman’s labor
support system. These assessment components include the considerations below.
Fetal Heart Rate and Patten
The primary and most reliable way to assess the status of a fetus is to monitor the fetal heart rate and
pattern. This can be done using continuous electronic fetal monitoring (EFM) or intermittently using an
electronic doppler. Assessing the fetal heart rate and pattern is a priority during admission. The normal
range for fetal heart rate is between 110 and 160 bpm. The pattern may include accelerations and earl
y decelerations. However, variable and late decelerations are ominous and should be evaluated further
.
The frequency of fetal monitoring during labor is determined by the client’s level of risk. During active l
abor, the nurse should plan to monitor at least every 30 minutes.
When assessing the fetal heart rate and pattern, consider these questions:
What is the baseline fetal heart rate (FHR)?
What is the FHR variability?
Are accelerations in the FHR present?
Does the FHR meet reactive non-stress test criteria?
Are any decelerations present? If yes, what type of deceleration is occurring? Are interventions
needed?
NOTE:
Nurses who care for women during childbirth are legally responsible for correctly interpreting the fetal
heart rate pattern, implementing appropriate nursing actions based on that pattern, and documenting
the outcome of those actions.
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