Nursing Management of Labor and Birth at Risk
Carol, age 17, is pregnant with her first child. Her menstrual dates are accurate and her date of conception is limited to one possible day. Her physician gives her an EDC of March 28th. Carol has gone past her due date and refuses to have her labor induced. Carol states, “My grandmother says that the baby will come when it is good and ready.” It is now April 14th and Carol is at 42 3/7 weeks’ gestation. She calls the office and reports that she is having a significant lower backache and she just passed “a glob of bloody mucus” from her vagina. (Learning Objective 5)
A. Discuss the risks a prolonged pregnancy places on Carol.
B. What risks are there for Carol’s unborn baby?
C. Describe the nursing care required for women in labor with prolonged pregnancy.
Essentials of Maternity, Newborn, and Women’s Health Nursing
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Essentials of Maternity, Newborn, and Women’s Health Nursing
Nursing Management of Labor and Birth at Risk
From the initial breath of life to the joys and difficulties of motherhood, the monarchy of maternity, newborn, and women’s health nursing incorporates obligatory compassionate care, scientific expertise, and an extreme comprehension of the life-changing journey women encounter throughout their reproductive lifespan. Maternity, newborn, and women’s health nursing is a unique nursing field focusing on women’s care throughout their reproduction time. This nursing field demands a thorough comprehension of the specific physical, emotional, and social requirements for women and infants. Nurses working in the area must provide compassionate care to women during labor and delivery, handle any complications during pregnancy and childbirth, and the nurse should provide education and support to new mothers (Perry et al., 2022). Nurses in this area play a significant role in promoting women’s health by averting illness through education and preventive care; this essay will explore a case study of a 17-year-old pregnant girl with her first child. From the case study, the essay will explain the risks a prolonged pregnancy places on Carol, the risks there for Carol’s unborn baby, and finally, look at nursing care needed for women in labor with prolonged pregnancy.
The Risks of Prolonged Pregnancy and the Influence on Carol’s Health and Well-being
A prolonged pregnancy, or post-term pregnancy, can constitute numerous risks to the mother, Carol, and the baby. As the pregnancy continues beyond the estimated due date, the placenta may age and deteriorate, minimizing its ability to offer sufficient oxygen and nutrients to the baby. This can lead to fetal distress or intrauterine development restriction, where the baby’s development is restricted. Additionally, a prolonged pregnancy raises the risk of complications during labor and delivery (Stephansson et al., 2018). The amniotic fluid levels may lessen, resulting in oligohydramnios, increasing the risk of umbilical cord compression and compromising the baby’s oxygen supply. Carol’s risk of getting complications during labor, like fetal distress, meconium aspiration when the child breaths in meconium-stained amniotic fluid, and birth trauma may also increase. Moreover, Carol may encounter physical discomfort and emotional stress because of the prolonged pregnancy (Irani et al., 2019). She may have challenges sleeping, maximized fatigue, and discomfort linked with the baby’s size and position. There is also a possibility for increased anxiety and emotional strain as she waits for labor to start logically. Taking into account these risks, Carol needs to maintain effective communication with her healthcare provider and accurately observe her and her baby’s well-being during the prolonged pregnancy. Routine prenatal check-ups, non-stress tests, and ultrasounds can assist in evaluating the baby’s health, ensuring timely intervention if any compilations increase. The choice to induce labor must be accurately assessed, weighing the possible risks of progressing the pregnancy against the risk of intervention.
Disclosing the Risks to Carol’s Unborn Baby
There are possible risks for Carol’s unborn baby, given her current circumstance. Carol has passed her due date, which puts her baby at risk for numerous complications. Prolonged pregnancy raises the chances of placental inadequacy, where the placenta may not be able to sufficiently provide oxygen and nutrients to the unborn baby (Wardinger & Ambati, 2020). This can result in fetal distress, lessened development, and potential complications during labor. In addition, a crucial lower backache and the passage of a glob of bloody mucus termed the bloody show, can be signs of impending labor. Furthermore, in the case of Carol, it could also highlight a possible issue. The backache might indicate issues with the baby’s position or the onset of labor without sufficient cervical dilation, which could raise the risk of prolonged or complicated labor. The passage of bloody mucus could also suggest an issue with the placenta, like placenta abruption, where the placenta separates from the uterine wall prematurely, possibly depriving the baby of oxygen and nutrients. However, Carol’s refusal to have her labor persuade indicates its own set of risks. If the baby remains in the womb for an enlarged period beyond the due date, the risk of meconium aspiration rises. Meconium is the baby’s initial stool, and if the baby proceeds it while still in the womb and then breathes in, it can lead to respiratory issues and meconium aspiration syndrome. According to Sayed Ahmed & Hamdy (2018), prolonged pregnancy can increase the likelihood of umbilical cord complications like cord compression or prolapse, compromising the baby’s oxygen supply. Taking into account such risks, Carol needs to discuss her circumstance with her healthcare provider and accurately weigh the possible benefits and risks of involving labor or exploring alternative options, ensuring the well-being of both herself and the unborn child.
Nursing Care for Women in Labor Having Prolonged Pregnancy and the Essential Strategies and Considerations
Women in labor having a prolonged pregnancy need proper and attentive nursing care ensuring their well-being and the safe delivery of their baby. In this specific case, Carol is beyond her due date and encountering a lower backache along with the passing of bloody mucus, indicating the start of the labor procedure. As her nurse, evaluating Carol’s condition promptly and offering necessary care is essential. At first, a thorough evaluation of Carol’s crucial signs and fetal well-being must be conducted. This involves observing her blood pressure, pulse, and temperature and evaluating fetal heart rate patterns. Any signs of distress in either Carol or the baby should be promptly recognized and addressed. Additionally, to physical evaluation, emotional support is vital during this time. Prolonged pregnancy can be emotionally demanding, anxious or frustrating for the mother. The nurse must offer a calm and supportive environment, reassuring and tackling Carol’s questions or concerns. Fostering her to express her feelings and addressing her fears can assist in alleviating her anxiety and enhance an emphatic birthing encounter.
During labor, progressive observation of both Carol and the baby is appropriate. This involves frequent evaluations of fetal heart rate, uterine contractions, and cervical dilation. The nurse must offer pain management methods and options to assist Carol in coping with labor discomfort, like breathing exercises, relaxation methods, or pharmacological pain relief if craved. As labor continues, the nurse must closely monitor Carol’s progress and alert the physician or midwife of any deviations from the expected course. In this case, Carol has gone through bloody mucus, indicating the loss of the mucus plug and the onset of cervical changes. This must be documented and reported to the healthcare professional because it may indicate the beginning of active labor. Finally, the nurse must adhere to Carol’s birth plan and wishes as long as they are within safe parameters. Moreover, it is essential to progress in educating and informing her about the possible risks of prolonged pregnancy and the benefits of interventions such as labor induction. Involving in open and honest communication can assist Carol in developing informed decisions to ensure the safety of both her and the child. Comprehensively, nursing care for women in labor with a prolonged pregnancy includes watchful observation, emotional support, pain management, and successful communication. By offering inclusive care and enhancing a positive birth encounter, nurses play a critical role in helping women like Carol during this crucial time in their life.
Conclusion
The case of Carol, a 17-year-old pregnant woman, indicates the necessity of comprehending the essentials of maternity, newborn, and women’s health nursing. As Carol surpasses her estimated due date and refuses induction, the risks of a prolonged pregnancy become severe for both Carol and her unborn child. Her prolonged pregnancy maximizes the opportunities for complications like placental inadequacy, fetal distress, and meconium aspiration syndrome. In addition, the possible risks to the baby are macrosomia, hypoglycemia, and a maximized likelihood of stillbirth. To offer nessesally nursing care for women in labor with prolonged pregnancy, healthcare providers should closely observe both the mother and baby to ensure regular evaluation, manage pain, enhance fetal well-being, and prepare for possible interventions or complications. By identifying and addressing the risks linked to prolonged pregnancy, healthcare providers can assist in ensuring the safety and well-being of both mother and baby during labor.
References
Irani, M., Khadivzadeh, T., Nekah, S. M. A., Ebrahimipour, H., & Tara, F. (2019). Emotional and cognitive experiences of pregnant women following prenatal diagnosis of fetal anomalies: A qualitative study in Iran. International Journal of community-based nursing and Midwifery, 7(1), 22.
Perry, S. E., Hockenberry, M. J., Cashion, M. C., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing Care-E-Book. Elsevier Health Sciences.
Sayed Ahmed, W. A., & Hamdy, M. A. (2018). Optimal management of umbilical cord prolapse. International Journal of Women’s Health, 459-465.
Stephansson, O., Johansson, K., Söderling, J., Näslund, I., & Neovius, M. (2018). Delivery outcomes in term births after bariatric surgery: Population-based matched cohort study. PLoS medicine, 15(9), e1002656. https://doi.org/10.1371/journal.pmed.1002656
Wardinger, J. E., & Ambati, S. (2020). Placental insufficiency.
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