Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 14
Caring for the Woman
Experiencing Complications
During Labor and Birth
Catherine Marin, MSN/Ed(c), WHCNP, RN
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Dystocia
 Long, difficult, or abnormal labor
 May arise from
 Powers
 Passenger
 Passageway
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Dysfunctional Labor Pattern:
Hypertonic
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Strong, painful, ineffective contractions
Contributing factor—maternal anxiety
Occiput-posterior malposition of fetus
Management
 Rest, hydration, sedation
 Facilitate rotation of the fetal head
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Dysfunctional Labor
Pattern: Hypotonic
 Contractions decrease in frequency and
intensity
 Maternal and fetal factors that produce
excessive uterine stretching
 Management
 Walking, position changes
 Augmentation of labor
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Precipitate Labor and Birth
 Rapid intense contractions
 Nursing considerations
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Careful examination for dilation and effacement
Reassure woman and support person
Breathing to avoid pushing and prevent tearing
Careful examination of maternal soft tissue and
placenta
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Pelvic Structure Alterations
 Pelvic dystocia
 Soft tissue dystocia
 Trial of labor
 To assess safety of vaginal birth
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Obstetric Interventions—
Amnioinfusion
 Risks: infection, overdistention of uterus,
increased uterine tone
 Nursing
 Careful monitoring of infusion, intensity and frequency
of contractions, and maternal vital signs
 Educate
 Pharmacological induction of labor
 Nonpharmacological stimulants of labor
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Obstetric Interventions—
Amniotomy
 Artificial rupture of membranes
 Augment or induce labor
 Nursing
 Careful monitoring of vital signs, cervical
effacement/dilation, station, FHR, contractions
 Document regarding amniotic fluid
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Induction of Labor
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Indications for induction
Bishop score
Cervical ripening agents
Mechanical methods
Oxytocin
Augmentation of labor
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Induction—Nursing
Considerations
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Informed consent
Careful monitoring of labor
Discuss pain relief measures
Position changes
Keep patient and support person informed
of progress
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Instrumentation
Assistance of Birth
 Forceps
 Vacuum extraction
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Maternal Complications—
Hypertensive Disorders
 Preeclampsia-eclampsia, HELLP syndrome
 Nursing
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Careful assessments
Monitor lab values
Administer platelets as appropriate
Ongoing education
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Maternal
Complications—Diabetes
 Fetal lung maturity
 Intrapartum management—maternal hydration and blood
glucose levels
 Labor: normal progression of labor
 Upright or side-lying position
 Encourage breastfeeding
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Preterm Labor and Birth
 Careful maternal monitoring
 FHR monitoring ***
 Identify and report symptoms suggestive of
fetal hypoxia
 Assess psychological status
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Labor and Birth
Complications—Fetal
 Fetal malpresentation
 Version: external or internal
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Shoulder dystocia- McRoberts Maneuver
Cephalopelvic disproportion
Multiple gestation
Non-reassuring FHR patterns
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Amniotic Fluid Complications
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Oligohydramnios
Hydramnios
Meconium
Nuchal cord
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Complications—Placental
Problems
 Placenta previa
 Placental abruption
 Disseminated intravascular coagulation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Other Complications
 Uterine rupture
 Obstetric emergency
 Uterine inversion
 Umbilical cord prolapse
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Variations—Umbilical
Cord and Placenta
 Velamentous cord insertion
 Fetal vessels separate at distal end and insert into
placenta away from the margin
 Vasa previa
 fetal blood vessels, unsupported by either the
umbilical cord or placental tissue, traverse the fetal
membranes (bag of waters) across the lower segment
of the uterus between the baby and the cervical
opening
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Placental Variations
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Circumvallate placenta
Succenturiate placenta
Battledore placenta
Placenta accreta
Placenta increta
Placenta percreta
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Amniotic Fluid Embolism
 Rapidly deteriorating maternal condition
 Acute dyspnea, severe hypotension
 Rapid delivery after stabilizing mother
 Ethical conflict
 Save mother versus fetus
Collaboration in Perinatal
Emergencies
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Perinatal Fetal Loss
 Nursing considerations
 What to say
 What not to say
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Cesarean Birth
 Indications
 Health of mother or fetus is jeopardized
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Ethical considerations
Surgical procedures
Surgical and postoperative care
Vaginal birth after cesarean
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Postterm/Prolonged Pregnancy
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Postterm—extends beyond 42 weeks
Risk for fetal/neonatal problems
Increased maternal risk
Management—labor induction
Nursing implications