Nursing Management of Pregnancy at Risk

Nursing management of labor and birth at risk

1. Laura is a 26-year-old G2P1 who had a cesarean delivery for fetal distress with her first pregnancy. Laura is now struggling with deciding between a repeat cesarean delivery or attempting a VBAC. (Learning Objective 9)

a. In order to ensure that Laura has the facts to assist her in her decision, explain the risks of a repeat cesarean delivers

b. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this.

c. Describe the management of care for a woman attempting a VBAC delivery.




Nursing Management of Pregnancy at Risk




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Nursing Management of Pregnancy at Risk

Nursing Management of Labor and Birth at Risk

Pregnancy is an actual occurrence in a woman’s life requiring careful consideration and management to ensure a healthy outcome for both the mother and the baby. Various risk factors are increasing the likelihood of complications during pregnancy. The risk factors range from pre-existing medical conditions, including diabetes or hypertension, and lifestyle factors, like smoking or substance abuse (Ramlakhan et al., 2020). The healthcare team, such as the nurses, is responsible for identifying the risk factors early and managing them appropriately to improve outcomes. Nursing management of the risks during pregnancy involves a multidisciplinary approach, including careful monitoring, education, and intervention to prevent potential complications. The essay explores the risk of a repeat cesarean delivery, why women do not want to try a VBAC delivery and the management of care for a woman attempting a VBAC delivery.

The Risks of a Repeat Cesarean Delivers

A repeat cesarean delivery is also termed a C-section, where it involves a surgery where a baby is delivered through an opening that is performed in the mother’s abdomen and the uterus. This is a secure process in many cases, but it is accompanied by many risks, including infection, bleeding, the nearing organs being injured, clotting of the blood, and reaction to anesthesia (De Mucio et al., 2019). In addition, there are some risk complications brought about by consequent cesarean delivery, including uterine rupture, which is rare but a grave complication occurring when a scar of a past cesarean delivery during labor tears leads to excessive bleeding, maternal and fetal bleeding death, and fetal distress. Another complication as a result of a consequent cesarean delivery is placenta previa, where the placenta embeds low in the uterus and partially covers the cervix hence causing bleeding during pregnancy and delivery, and it is brought about by low implanitation of the fertirized egg, fibriods, and scaring of the uterine lining (Jung et al., 2018). In addition, consequent cesarean delivery can lead to placenta accreta, where the placenta develops too deeply into the uterus walls, where during delivery, one can heavily bleed and requires a hysterectomy, which can lead to premature delivery and subsequent complications are the primary concerns for the baby. It is essential for healthcare providers and patients undergoing the process to understand its dangers and benefits.

Why Women do not Want to Try a VBAC Delivery

Vaginal birth after cesarean is an option of giving birth through the vagina after one had previously delivered through cesarean. This process is safe and successful for many women, but some women do not prefer it, and Some of the reasons as to why some women fear vaginal birth after cesarean is the fear of uterine rupture, a life-threatening complication occurring during the process, although it rarely occurs (Mujezinović & Anzeljc, 2021) Women may also fear vaginal birth after cesarean process due to the inclination for a planned cesarean birth and worries about the readiness of an emergency resources when a complication occurs during the process. A traumatic experience from a past cesarean delivery can make women have the fear of trying vaginal birth after cesarean. The determination on whether to perform a vaginal birth after cesarean is personal, and it is vital for women to acquire the appropriate information, resource, and support in decision-making on childbirth experience.

The Management of Care for a Woman Attempting a VBAC Delivery

Vaginal birth after cesarean delivery is a secure option for women having a past cesarean section and requires prudent care management. The management of care for a woman who wishes to try VBAC delivery begins with an evaluation of the history of her medication, including the reason that made her to deliver throuhg cesarean in the past, and the possible risk factor for the rupturing of the uterine and it is vital to ensure that the patient gets a supportive healthcare team involving an obstetrician who is experienced in managing vaginal birth after cesarean delivery (Familiari et al., 2020).  The patient should be informed of the risk and benefits of vaginal birth after cesarean delivery compared to a repeat cesarean process, including the perspective of natural vaginal birth. Continuous fetal monitoring is vital during labor times, where the obstetrician is always available to respond quickly in case of signs of rupturing the uterus or in case of fetal distress. In order to promote progress and reduce the risk of complications, the patient should be advised to move and change positions during labor, where pain management options are discussed and offered. The healthcare provider team must give close monitoring of the progression of labor to ensure the patient makes adequate progress in identifying any possible problems (Daminger, 2019). If a vaginal birth after a cesarean fail, a timely decision is made to continue with a repeat cesarean section ensuring the safety of both the mother and the baby. Managing care for a patient who wishes to try vaginal birth after cesarean delivery recommends a multidisciplinary approach and cautious attention to an individual’s care, communication, and clinical expertise.


The nursing management of pregnancy at risk is a vital aspect of offering safe and effective care for the mother and baby. Repeated cesarean delivery can lead to complications like infection, bleeding, and the patient taking a long time before recovering. Despite vaginal birth after cesarean being safe and effective, many women fear trying it due to fear and concerns, but with accurate management of care, which includes a thorough assessment, a healthcare team that is supportive, fetal monitoring, managing pain, close monitoring of the patient progression, an effective vaginal birth after cesarean can be achieved. Nursing staff plays a crucial role as they provide education, counseling, and supporting women who want to try vaginal birth after cesarean delivery ensuring the safety of the mother and the baby.


















Daminger, A. (2019). The cognitive dimension of household labor. American Sociological Review84(4), 609-633.

De Mucio, B., Serruya, S., Aleman, A., Castellano, G., & Sosa, C. G. (2019). A systematic review and meta‐analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. International Journal of Gynecology & Obstetrics147(3), 281-291.

Familiari, A., Neri, C., Caruso, A., Airoldi, C., Barone-Adesi, F., Zanconato, G., … & Presti, F. (2020). Vaginal birth after caesarean section: a multicentre study on prognostic factors and feasibility. Archives of Gynecology and Obstetrics301, 509-515.

Jung, E. J., Cho, H. J., Byun, J. M., Jeong, D. H., Lee, K. B., Sung, M. S., … & Kim, Y. N. (2018). Placental pathologic changes and perinatal outcomes in placenta previa. Placenta63, 15-20.

Mujezinović, F., & Anzeljc, V. (2021). Do women in Slovenia prefer vaginal birth after prior caesarean and what hinders its successful outcome? A single institution retrospective analysis.

Ramlakhan, K. P., Johnson, M. R., & Roos-Hesselink, J. W. (2020). Pregnancy and cardiovascular disease. Nature Reviews Cardiology17(11), 718-731.

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