TOWLMC08_0131136275.

QXD 11/16/06 10:31 PM Page 238

238 Unit II Maternal-Newborn Care

BOX 8-6 NURSING CARE CHECKLIST

Assisting a Woman in Precipitous Labor

If the client says “the baby is coming,”the nurse should check to see loose enough, slip the cord over the baby’s head. If it is too tight,
if the fetus is crowning. If the baby is crowning, the nurse should: place two clamps on the cord and cut the cord between the
✓ Stay with the mother.
 clamps.Then, unwind the umbilical cord from the baby’s neck.
✓ Call for assistance by putting on the emergency call light. If

✓ Suction the baby’s nose, mouth, and throat.

outside the hospital, have someone call emergency medical ✓ Gently apply downward pressure to the baby’s head to deliver

services (EMS). the anterior shoulder.Then, gently lift the baby’s head to
✓ Remain calm and reassure the mother; instruct her to pant.
 deliver the posterior shoulder.
✓ If time permits, open emergency equipment, wash hands, and

✓ Deliver the rest of the body, being careful not to drop the

put on sterile gloves. If outside the hospital, provide a clean slippery wet baby.
environment and as much privacy as possible. ✓ Suction the airway, and dry the baby.

✓ Provide a sterile or clean area for delivery.
 ✓ Clamp the umbilical cord in two places and cut it between the

✓ If membranes are intact, tear membranes allowing the amni-
 clamps, leaving at least 1 inch (2.5 cm) between the baby and
otic fluid to drain. the clamp (Figure 8-15 ■). If outside the hospital, the cord does
not need to be clamped and cut until emergency medical
✓ Apply gentle pressure to the head with one hand to allow it
 personnel arrive.The cord should only be cut using sterile
to be delivered gradually. Do not apply firm pressure or try to technique.
stop the head from being delivered.
✓ Deliver the placenta, keeping all tissue for the physician to

✓ Check the baby’s neck for a wrapped umbilical cord, called a
 examine.
nuchal cord (Figure 8-14 ■). If there is a nuchal cord and it is

Figure 8-15. ■ Clamp and cut cord, leaving about 1 inch (2.5 cm)
Figure 8-14. ■ Nuchal cord. between the baby and the first clamp. (Photo Researchers, Inc.)

the vagina, it should be covered with wet towels to prevent
shrinking of the Wharton’s jelly and further compression of
the umbilical vessels. The physician is notified, and an emer-
gency cesarean section delivery is performed.
DYSTOCIA
Dystocia is defined as a long, difficult, or abnormal labor
pattern. It can be caused by a variety of conditions, includ-
ing ineffective uterine contractions, abnormal fetal presen-
tation or position, a large fetus, or a small maternal pelvic
outlet. When labor does not progress in the usual time
frame, the nurse should anticipate that further evaluation,
tess, and intervention may be necessary.
Electronic fetal monitoring (EFM) involves a continuous
tracing of the fetal heart rate (FHR) and uterine contractions.
The FHR can be obtained externally by an ultrasound trans-
ducer held in place on the abdomen by a belt (see Figure 7-31).
However, external monitoring of the FHR may not be accu-
rate due to fetal movement or the amount of maternal tissue
through which the sound must travel. Contractions are