Nursing Care of a Family Experiencing a Complication of a Labor or Birth
☺ occur during the active phase of labor and after
DYSTOCIA
Four main Components of the labor process:
☺ The power, or the force that propels the fetus
(uterine contractions)
☺ The passenger (fetus)
☺ The passage way (birth canal)
☺ The psyche (the birthing parent’s and family’s
perception of the event)
COMPLICATIONS WITH THE POWER
(the force of labor)
☺ Inertia - time-honored term to denote
sluggishness of contractions, or that the force
of labor is less than usual
☺ Dysfunctional Labor - occur at any point in
labor, but is generally classified as Primary
( occuring at the onset of labor ) or Secondary
(occuring later in labor)
INEFFECTIVE UTERINE FORCE
☺ occur bec. of the interplay of the contractile
enzyme adenosine triphosphate and;
☺ influence of major electrolytes such as;
▫ calcium, sodium, and potassium
▫ specific contractile proteins (actin and
myosin)
▫ epinephrine and norepinephrine
▫ oxytocin
▫ estrogen,progesterone, and prostaglandins
Hypotonic Contractions
☺ number of contractions is unusually infrequent
(not more than 2 or 3 occuring in a 10 minute
period)
☺ resting tone of uterus remains less than 10mm
Hg
the administration of analgesia, especially if the
cervix is not dilated to 3 - 4 cm or if bowel or
bladder distention is preventing descent or firm
engagement
☺ occur in a uterus that is overstretched by a
multiple gestation, a larger than usual single
fetus, polyhydramnios, or a uterus that is lax
from grand multiparity
☺ contractions are not exceedingly painful bec. of
their lack of intensity
☺ will increase the length of the labor bec more
of them are necessary to achieve cervical
dilatation
☺ if uterus becomes exhausted, can cause it to not
contract as effectively during the postpartal
period, thus increasing a birthing parent’s
chance for postpartal hemorrhage
☺ 1st hour after birth ff. a labor of hypotonic
contrcations
▫ palpate the uterine fundus
▫ obtain the birthing parent’s blood pressure
▫ assess the amount of lochia q 15mins for
the 1st hr
→ to ensure postpartal contractions are not
also hypotonic and to halt hemorrhage
Hypertonic Contractions
☺ increase in resting tone to more than 15 mm Hg
☺ intesity of the contractions may be not stronger
☺ occur in the latent phase of labor
☺ occur bec. more than one uterine pace maker is
stimulating contractions or bec. the muscle
♥ JOANNA
 Nursing Care of a Family Experiencing a Complication of a Labor or Birth
fibers of the myometrium do not repolarize or
relax after contractions,
→ thereby, “wiping it clean” to accept the
new pacemaker stimulus
☺ more painful than usual bec. myometrium
becomes tender from constant lack
relaxation and the anoxia of uterine cells that
results
☺ Danger of hypertonic contractions
▫ lack of relaxation between contractions
may not allow optimal uterine artery filling
→ lead to fetal anoxia early in latent phase
of labor
☺ applying a uterine and a fetal external monitor
to help identify that the resting phase between
contractions is adequate
☺ FHR is not showing late deceleration
▫ if dcelerations is present, an abnormally
long first stage of labor or lack of progress
with pushing occurs
→ CS birth may be necessary
Comparison of HYPOTONIC and
HYPERTONIC Contractions
myometrium may be acting independently of
the pacemaker
☺ occur so closely together that they can interfere
with the blood supply to the placenta
☺ occur so erratically
of ☺ applying a fetal and a uterine external monitor
and assessing the rate, pattern, resting tone, and
fetal response to contractions for 15mins
reveals the abnormal pattern
☺ oxytocin administration - helpful to
uncoordinated labor to stimulate a more
effective and consistent pattern of contractions
DYSFUNCTIONAL LABOR AND
ASSOCIATED STAGES OF LABOR
Dysfunctional the First Stage of Labor
☺ occurs with the first stage of labor involves a
prolonged latent phase, protracted active phase,
prolonged deceleration phase and secondary
arrest of dilatation
Prolonged Latent Phase
☺ contractions become ineffective during the first
stage of labor
☺ prolonged latent phase can develop

Criteria Hypertonic Hypotonic

Uncoordinated Contractions
Phase of occur. Latent Active
☺ all contractions are initiated at one pacemaker
Symptoms Painful Limited Pain
point in high in the uterus
Oxytocin Unfavorable Favorable
☺ contraction sweeps down over the organ,
Reaction Reaction
encircling it; repolarization occurs; relaxation
Sedation Helpful Little Value
or a low resting tone is achieved and another
pacemaker-activated contraction begins ☺ defined by Friedman (1978), latent phase -
☺ more than one pacemaker initiating 20hrs (nulli) and 14hrs (multi)
contractions or receptor points in the

♥ JOANNA
 Nursing Care of a Family Experiencing a Complication of a Labor or Birth
☺ may occur if the cervix is not “ripe” at the ☺ s
beginning of the labor ☺ s
☺ the uterus tends to be in hypertonic state ☺ h
☺ relaxation between contractions is inadequate
☺ contractions are only mild (< 15 mm Hg),
there, ineffective
☺ MANAGEMENT
☺ providing adequate fluid for hydration, and
administering pain relief (morphine sulfate or ☺ s
epidural)
☺ changing the linen and px gown, darkening
room lights, and decreasing noise and
stimulation

☺ these measure combine to allow labor to

become effective and begin to progress
☺ if does not, cesarean birth or amniocentesis
(artificial rupture of membranes) and oxytocin
infusion to assist labor
Protracted Active Phase
☺ associated w/ fetal malposition or CPD
☺ this phase is prolonged if cervical dilataion
does not occur at a rate of at least 1.2cm / hr
(nulli) and 6hrs (multi)
☺ if the cause of delay in dilatation is fetal
malposition or CPD --> CS birth
☺ dysfunctional labor during dilatation division
of labor tends to be hypotonic
☺ s
☺ s
☺ s
☺ s
☺ s
☺ s
☺ s
♥ JOANNA