Precipitous Labor (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    00:01 Let's talk about the next complication, a precipitous labor.

    00:05 So a precipitous labor is one that lasts less than three hours from the onset of contractions to delivery.

    00:12 Now, that might actually sound like a great plan.

    00:15 What's wrong with a precipitous labor? It's actually a complication. It's not what we want.

    00:19 And we'll talk about why in just a minute.

    00:22 So let's first talk about risk factors.

    00:24 The first one is an abruption of the placenta.

    00:27 So if the placenta breaks away from the uterine wall before the baby comes out, then we might have a uterus that tries really hard to push the baby out really quick.

    00:36 So not only is the placental abruption a bad thing, then we have a fetus that's coming through really quick, and that's not good either.

    00:44 The next risk factor is uterine tachysystole Tachysystole, if you remember from tachycardia means fast.

    00:53 And so if we have a uterus that is contracting really quickly, then we may push the baby out really fast.

    01:01 One of the things that can cause uterine tachysystole is drug use, specifically, cocaine use.

    01:07 So if we have a patient that's done cocaine prior to coming to the hospital, or they come in the hospital, and they're experiencing a precipitous labor, one of the things that might be done is a drug screen to make sure that there are no drugs in the system, because that might be the cause.

    01:25 So how will the nurse know that the patient might be experiencing a precipitous labor? Well, the most obvious way is that they tell you.

    01:34 So if a client comes in and says, "I'm feeling pressure." Maybe you let them go to the restroom to collect a urine sample, and while they're in there, they'll say, "Oh, I'm feeling something coming." Hmm, believe them, because it might be a baby.

    01:47 Might be pop, out comes the baby right in the toilet.

    01:50 So if they tell you that, listen.

    01:52 The next thing that you might notice, once you get them on the monitor is that you see a contraction pattern that looks like this.

    01:59 Take a look at what's going on at the bottom of this graph.

    02:02 You can see that these contractions are really close together.

    02:06 And that will let you know this baby is moving out quick, fast in a hurry.

    02:11 So pay attention to that.

    02:12 So what do we need to do? we're going to separate this into in the hospital experiences and out of the hospital experience, because that can happen.

    02:22 If you're in the hospital, the first thing you're going to do is call for a precipitous birth kit.

    02:27 One of the really cool things on units, all units in the emergency room, in labor and delivery in the ICU, anywhere in the hospital where a patient might actually deliver a baby there are what we call precipitous labor kits that have all the things you need in order to safely deliver the baby right then call for one, you will need it.

    02:47 The next thing you want to do is there's not really a lot of fancy things to help prepare the baby, or prepare the mom, or do any of those things, you want to make sure that you support the baby because it will come flying out.

    03:00 And you want to make sure that you protect the fetus from any sort of emergency or trauma that might happen as they move out of the uterus and protect the skin of the labia, and the vaginal vault, because a baby coming out really fast is not good for either one of them.

    03:18 Also thinking about the transition of the fetus as they make their way out, we depend on that squeeze through the uterus to help clear the fluid that might be there for the fetus.

    03:28 And if the baby comes out really fast, there's not an opportunity for that.

    03:33 So the possibility of aspiration is really high.

    03:35 So we want to slow that delivery down as much as possible.

    03:41 Now, let's think about what we would do if we're not in the hospital.

    03:45 So actually, this is like one of my dreams in life is to be on an airplane and someone say, "Is there someone who can deliver a baby?" and I will say, "Yes." and I will go up, and I will deliver the baby and get free airline tickets forever.

    04:00 But anyway, first thing we need to do is call 911.

    04:04 Because we want emergency services coming so that whatever is going to happen and whatever could happen, we have backup, because you're likely not to have a precipitous kit anywhere with you.

    04:16 The next thing we want to do is to keep the client calm and warm.

    04:21 So let's say you're in a car, then this is a time when you might want to move to the backseat and turn the heat way up.

    04:28 Now, nobody's usually going to be particularly excited except for me on the airplane if a baby's coming out, and you're not where you're supposed to be.

    04:35 So keeping everybody calm is going to be really important.

    04:38 Maybe even yourself.

    04:41 We still want to support the delivery of the baby.

    04:43 So we're trying to prevent injury to the fetus and to the vaginal tract.

    04:48 So we want to support the baby as it emerges really slow.

    04:51 We don't need to check the patient.

    04:53 We don't need to do any of that because it doesn't matter.

    04:56 If she's 10 centimeters or tensimeters and + 2, or 3, or 4 station, it's not going to change anything.

    05:03 There's no need to introduce the fingers into the vagina, just make sure that everything is clear.

    05:09 And you can see. And that's all you need to do.

    05:12 After delivery, you want to place the baby on the mother's chest.

    05:16 And that's a good way to keep them warm.

    05:19 Think about skin to skin.

    05:20 If we have other articles of clothing, then we can wrap that around both of them.

    05:25 But don't wrap the baby up and then put them on the chest.

    05:28 Take the baby out of any sort of wrappings, put them straight on the chest, and then wrap the patient and the baby together.

    05:35 And again, if you're in the car, crank up that heat and keep them both as warm as possible.

    05:40 The next thing we want to think about is the cord.

    05:43 Now, we don't need to cut the cord because that could introduce infection, and a lot of blood and all kinds of things that we don't need.

    05:50 You can however, tie it off.

    05:52 So a shoestring or some kind of hair tie, or whatever you have a torn piece of clothing, you can tie off the cord.

    05:59 And that will make it easier to move the fetus around or actually now the baby because it's outside.

    06:05 Then once you do that, you can consider whether you need to deliver the placenta or not.

    06:11 The placenta can really stay in for maybe up to 30 minutes without any problem.

    06:16 Now, if you call 911, they're on their way, they can deliver the placenta and all is good.

    06:22 If it's going to be a long time, or if you find that the client has actually started to bleed, then we need to deliver the placenta.

    06:30 So that requires just some gentle traction, a couple of pushes from the client, and hopefully, the placenta will just slide right out.

    06:38 The next thing we can do is we can go ahead and encourage the client to breastfeed.

    06:43 Once we start breastfeeding the body naturally releases oxytocin, which causes contractions of the uterus, which will help stop any of that postpartum bleeding.

    06:54 There we go.

    About the Lecture

    The lecture Precipitous Labor (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Complications in Labor (Nursing).

    Included Quiz Questions

    1. Cocaine use
    2. Multiple gestations
    3. Intrauterine growth restriction
    4. Preeclampsia
    1. Fetal aspiration
    2. Fetal head trauma
    3. Maternal vaginal tears
    4. Maternal bleeding
    1. Keep the client warm and calm
    2. Place the baby on the mother's chest skin-to-skin
    3. Begin breastfeeding as soon as possible
    4. Find a tool or object to cut the umbilical cord
    5. If the client is bleeding, do not deliver the placenta

    Author of lecture Precipitous Labor (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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