CASE STUDY 1: Woman in

first stage of labor

• Tasha is a nulliparous woman at 39
weeks’ gestation. She and her
husband George attended childbirth
education classes based on the
Lamaze method. They also prepared
a birth plan with their nurse-midwife.
Tasha calls her nurse-midwife’s office
to report that she is in labor and asks
if she should get her husband and
leave for the hospital right away.
A. How should the nurse
approach this situation?
• Ask the mother details about the contractions.
How long has it occurred, its duration, frequency
and intensity? If what the mother has reported
are parts of a true labor, allow the mother to
admit herself with her husband as the support.
Usually these contractions are painful occurring
at least every ten minutes or closer,
accompanied by at least one of the following:
bloody mucous vaginal discharge, spontaneous
rupture of the membranes or complete cervical
effacement. A woman may have regular painful
uterine contractions for many hours or even
days before meeting these criteria for labor
 B. Tasha is in labor and her
husband brings her to the hospital
for admission. Outline the process
of admission and assessment that
the nurse who will care for Tasha
and George should follow.
Initial Interview and Physical Examination
Ask about the following areas:

●Expected date of birth

●Frequency, duration, and intensity of contractions
●Amount and character of show
●Whether ruptured of membranes has occurred
●Time the woman last ate
●Any known drug allergies
●Past pregnancy and previous pregnancy history
●Her birth plan or what individualized measures
she has planned, such as no analgesia or who
will cut the umbilical cord
Assess
●Vital signs- temperature, pulse, respiration, and
blood pressure (assess between contractions)
●Contractions (frequency, duration, intensity)
●Her preparedness and readiness for labor
Detailed Assessment During
the First Stage of Labor

I.History
• review of a woman’s pregnancy
including both physical and
psychological events, past pregnancies,
general health, and family medical
information-all data necessary to plan
nursing care.
a. Current Pregnancy History-
• gravida and para status
• description of this pregnancy
• plans for labor
• future child care
b. Past Pregnancy History-
• Document prior pregnancies
-including number,dates
-types of birth
-any complications and outcomes
-sex and birth weights of children.
c. Past Health History-
• previous surgeries
• heart disease or diabetes
• anemia
• tuberculosis
• kidney disease or hypertension
• sexually transmitted
• Lifestyle
d. Family Medical Health History-
• if any family member has a condition
such as heart disease, blood dyscrasia,
diabetes, kidney disease, etc.
 II. Physical Examination
• pelvic examination
• woman’s physical appearance
• Palpate for enlargement of the lymph node
• Inspect the mucous membrane of the mouth and
the conjunctiva of the eyes for color
• Assess lung
• Listen for normal heart sounds
• Inspect and palpate her breasts
• Abdominal assessment
• inspect the lower extremities for skin turgor
III. Leopold’s Maneuvers- to determine fetal
presentation and position
IV. Assessing Rupture of Membranes
V. Vaginal Examination
VI. Assessment of Pelvic Adequacy
VII. Ultrasound
VIII. Vital Signs
a. Temperature
b. Pulse and Respiration
c. Blood Pressure
IX. Laboratory Analysis
1. Blood
2. Urine
X. Assessment of Uterine Contractions-
XI. Length of Contractions
XII. Intensity of Contraction
XIII. Frequency of Contraction
XIV. Initial Fetal Assessment
XV. Auscultation of Fetal Heart Sounds
XVI. Fetal Heart Rate and Uterine Contraction
Records
XVII. Fetal Heart Rate
• C. Tasha becomes tense and begins to cry
when the nurse prepares to perform
vaginal examination as part of the
admission process. What should this
nurse do?
•  
• Have a good talk with her and her partner,
encouraging them to express their
feelings. Acknowledge and validate their
feelings of frustration, discouragement,
fatigue, or even anger at the staff for not
doing something to correct the problem.
She may benefit from a good cry, followed
by a pep talk and perhaps a visit from a
friend or family member who is rested and
optimistic.
• D. A priority nursing diagnosis for Tasha
would be acute pain related to the
increasing frequency, duration, and
intensity of uterine contractions during
the first stage of labor. State one
expected outcome, and discuss the
nonpharmacologic measures the nurse
could use to help reduce Tasha’s pain
and discomfort.
1.Outcome:
The Client will demonstrate ability to
control situation by 30 minutes.
2.Nonpharmacologic Method:
●Relaxation
●Heat or Cold Application
●Bathing or Hydrotherapy
●Therapeutic Touch and Massage
●Focusing and Imagery
●Prayer
●Breathing Techniques
●Herbal Preparation
●Aromatherapy and Essential Oils
• Yoga and meditation
●Reflexology
●Crystal or Gemstone Therapy
●Hypnosis
●Biofeedback
●Transcutaneous Electrical Nerve
Stimulation (TENS)
●Acupressure and Acupuncture
●Intracutaneous Nerve Stimulation
• E. Tasha is very reluctant to change
her position (semi-Fowler’s). She
states that she feels just fine the way
she is. What approach could the
nurse take to help Tasha realize the
importance of changing positions
frequently throughout labor?
Promote Changes in position to the mother. Tell her the importance
of different positions and its advantages. Reassure a woman that
she may move about as she wants. Basically, educate her about
the positions:
Why movement and position changes make labor easier
• If the mother is confined in bed, this increases pain and decreases
her satisfaction with the birth experience.
• When you walk or move around in labor, your uterus works more
efficiently
• Changing position moves the bones of the pelvis to help the baby
find the best fit through your birth canal
• Upright positions use gravity to help bring the baby down
• Upright, side-lying, and forward-leaning positions allow
plenty of blood flow to your baby, so he may be less likely
to show signs of distress
• • Actively responding to labor may help you feel more
confident and less afraid
Give different ways that the mother can do to move during your
labor:
• • Plenty of space to walk around in
• • A deep tub to soak in
• • A shower
• • A birth ball (exercise physio-ball)
• • A variety of comfortable furniture, such as a rocking chair and
couch
• • A squatting bar and/or birthing stool
• • Telemetry (portable monitoring equipment that allows women
to walk around even if they need continuous fetal monitoring)
• • CD players for music, which can encourage movement
• • An active support person to help you move and change
positions
• To the labor partners, they can encourage
women to use movement and position
changes to improve their comfort and help
labor progress. They can help the mother
by taking a walk or slow-dancing with her,
by making sure she has access to props
such as a birth ball and squatting bar, and
by suggesting different positions,
especially when she seems discouraged
or uncomfortable.
• F. What measures could the nurse use
to enhance and facilitate the progress
of Tasha’s labor?
To enhance and facilitate the progress of Tasha’s labor, the
nurse could:
• ●Respect Contraction Time
• ●Promote Change of Positions
• ●Promote Voiding and Provide Bladder Care
• ●Offer Support
• ●Respect and Promote the Support Person
• ●Offer Praise not only for the Woman for the Support
Person as well
• ●Relieve the Support Person as necessary, so that he or
she can take a break and get something to eat or visit with
older children
• ●Support a Woman’s Pain Management Needs