Stage I of Labor (Nursing)

00:01 Now that we've talked about the four stages of labor, we want to break this down a little bit more.

00:06 We're going to look at the phases that are within the stages of labor.

00:10 Don't panic, it's still going to be okay.

00:13 If you have an older textbook, what you may notice is that it mentioned three phases.

00:18 Back in 2017, the nomenclature changed, so that now there are only two.

00:23 So there are two phases within stage 1 of labor.

00:28 Feel free to rewind that and say that a couple of times fast.

00:31 So within stage one, we have the first phase, which is the latent early phase.

00:39 And this goes from zero centimeters to five centimeters.

00:43 So during the second phase is usually when the client is going to come to the hospital.

00:49 And so at that point, the nurse's responsibility is going to be to conduct an admission assessment.

00:55 So what's in an admission assessment, you ask? Well, let's talk about it.

00:59 The first thing we want to find out is a little bit about the client's medical history.

01:04 Have they had diabetes, cardiovascular disease, or some other kind of condition that may affect their labor? What about their social history, are they married? Are they not married? Are they divorced? Whom do they live with? Who is in their support circle? We want to talk about drivers of health, because we know that social drivers and other types of drivers really can determine someone's experience in labor, and definitely what happens afterwards so we want to ask those questions.

01:32 Now, in another lecture called antepartum care, we're going to really get into what information might be included in a prenatal record so that you know how to read that when you go to the hospital.

01:42 But you definitely want to make sure as a nurse that you're reviewing that record so you know what happened during their antepartum course.

01:50 Clients also have a lot of say in what happens in labor - who's in the room, whether a photographer comes because I think that's the big thing now, to take pictures in labor.

01:59 So if a photographer is going to be there, are they going to have a doula, do they have in laws that maybe they want or not want in the room? Those are going to be things we want to ask about.

02:09 And the patient can write all that down, the client will put that in their birth plan, and then we can use that.

02:15 And then what's going to be the plan for feeding the newborn? So that's the subjective information.

02:21 Let's look at the objective information.

02:23 So the assessments and the other interventions that we might make as nurses during the admission process.

02:28 So of course, we're going to take maternal vital signs, we want to know if the patient is stable, blood pressure, temperature, that lets us know if there's signs of infection or any other types of problems.

02:40 We're going to learn in a few lectures about fetal heart rate tracing, so keep that in mind.

02:44 But we definitely want to make sure the fetus is doing okay.

02:47 That's how we do sort of baby vital signs, so think of it like that.

02:51 We're also going to check the cervix.

02:53 So we're going to use our fingers and do an internal exam and figure out how dilated the cervix might be, because that helps us determine where the patient is in labor.

03:03 Finally, we're going to get some labs.

03:05 So we want to know if the patient is stable in terms of their hemoglobin, hematocrit, platelets, white count, that gives, again, gives us some information on how well the patient is right now.

03:16 And then we're going to check the urine, and we're going to look for things like infection.

03:20 We're also going to look for protein, because that could be signs of preeclampsia.

03:25 Again, this is another lecture we're going to get into later under hypertension, so no worries.

03:30 So we've talked about assessment during admission, what about the ongoing assessments that the nurse will make during labor? We're going to continue to check vital signs.

03:41 The patient may start off really well with blood pressure and temperature, but that may change over the course of the labor.

03:47 So we want to make sure that that's okay.

03:49 The frequency of vital sign testing will have something to do with how well the patient is progressing through labor.

03:56 We're also going to check on the fetus.

03:58 So remember, we have two clients, not just one, so we have to monitor the vital signs of the fetus and we'll do that using the fetal monitor, or we'll auscultate the fetal heart rate.

04:09 Again, don't worry, there's a whole lecture about this.

04:13 We also want to make sure the client is well hydrated.

04:15 Some clients will have an IV, some clients will take PO or liquids by mouth.

04:21 But as the nurse, we have to make sure the patient is well hydrated so that they can continue through labor.

04:26 We also want to monitor the bladder.

04:29 So why do we monitor the bladder? Well, remember, the bladder is a big balloon, and the fetus is sitting kind of on top of that balloon, and if the balloon is full, the fetus can't come down.

04:40 So we want to make sure that the bladder stays empty.

04:43 So we're going to be checking in with the client fairly often at least every two hours to make sure that the bladder is not full and the fetus is not up here.

04:52 What about other activities? What else can the nurse do to help this labor progress? First, lying on your back and not moving around is not very effective for progressing labor.

05:03 So the nurse should encourage the client to move around.

05:07 And moving around could look different depending on whether the client has chosen to use medication or not.

05:13 So of course, if the client has an epidural and they can't move their legs, getting up and walking around is not going to to be an option, but we can still change position in the bed.

05:23 We can use a peanut ball or something like that to sort of help the client move.

05:28 So don't think that just because they're not up walking that we can't encourage movement, definitely want to do that.

05:34 We also want to educate.

05:36 So as nurses, this is something we do naturally, but don't get caught up in labor and forget to talk to the client about what's coming next.

05:44 We call that anticipatory guidance.

05:46 We want to do that continuously, because things are always changing.

05:50 And think about how scary it would be to be in a new situation and you don't know what's going on, all the lights and the noises and the beeps, and people coming in and out of the room, and you don't know what's going on.

06:01 Laboring patients are not sick so they're completely aware of what's going on.

06:05 We want to make sure that we're doing a great job with education.

06:09 And then we want to advocate for the family, for everybody because they get a say.

06:15 And so we want to be the voice.

06:16 That's one of the things we do as nurses that make us the most trusted profession, is that we can advocate for clients, and we do.

06:24 Okay, let's see if we can remember all of the pieces that we just talked about and put it together.

06:29 So nursing management for first stage, we're going to explore the patient's plan for birth.

06:35 We're going to offer support because we know that if someone feels support in labor, they're going to have a better experience and they're going to be less likely to have a caesarean delivery because of an emergency.

06:47 We want to encourage movement, because that's going to help the baby navigate the pelvis.

06:53 We want to make sure that the client is feeling comfortable as much as possible.

06:57 And if they choose to have medication or not, is totally up to them, but we want to make sure that we have that information well down.

07:04 We also want to talk to them about the labor process.

07:07 Education is key.

07:09 And so we're going to do that often to make sure the client and the other support people in the room know how the labor is progressing, and what to expect.

07:18 We also want to monitor the well being of the fetus.

07:21 So fetal monitoring, or listening to heart tones, checking on position, those are going to be things that are ongoing during that first stage.

07:29 And then we have to communicate with the provider what's going on.

07:33 One of the things that's unique to nurses that are in labor and delivery is often the provider is not in the hospital.

07:39 So part of what the nurse has to do is make sure they're keeping the provider abreast of how things are going and when the baby might come or if complications come up, what they might need in order to have those addressed.