Now that we've talked about the four stages of
labor, we want to break this down a little bit more.
We're going to look at the phases
that are within the stages of labor.
Don't panic, it's still going to be okay.
If you have an older textbook, what you
may notice is that it mentioned three phases.
Back in 2017, the nomenclature
changed, so that now there are only two.
So there are two phases within stage 1 of labor.
Feel free to rewind that and say that a
couple of times fast.
So within stage one, we have the first
phase, which is the latent early phase.
And this goes from zero centimeters to five centimeters.
So during the second phase is usually
when the client is going to come to the hospital.
And so at that point, the nurse's responsibility is
going to be to conduct an admission assessment.
So what's in an admission assessment, you ask?
Well, let's talk about it.
The first thing we want to find out is a
little bit about the client's medical history.
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.
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.
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.
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.
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.
And the patient can write all that down,
the client will put that in their birth plan,
and then we can use that.
And then what's going to be
the plan for feeding the newborn?
So that's the subjective information.
Let's look at the objective information.
So the assessments and the other
interventions that we might make as nurses
during the admission process.
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.
We're going to learn in a few lectures about
fetal heart rate tracing, so keep that in mind.
But we definitely want to make
sure the fetus is doing okay.
That's how we do sort of baby
vital signs, so think of it like that.
We're also going to check the cervix.
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.
Finally, we're going to get some labs.
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.
And then we're going to check the urine,
and we're going to look for things like infection.
We're also going to look for protein,
because that could be signs of preeclampsia.
Again, this is another lecture we're going to
get into later under hypertension, so no worries.
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.
The patient may start off really well
with blood pressure and temperature,
but that may change over the course of the labor.
So we want to make sure that that's okay.
The frequency of vital sign
testing will have something to do with
how well the patient is progressing through labor.
We're also going to check on the fetus.
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.
Again, don't worry, there's a
whole lecture about this.
We also want to make sure the client is well hydrated.
Some clients will have an IV, some
clients will take PO or liquids by mouth.
But as the nurse, we have to
make sure the patient is well hydrated
so that they can continue through labor.
We also want to monitor the bladder.
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.
So we want to make sure that
the bladder stays empty.
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.
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.
So the nurse should encourage
the client to move around.
And moving around could look different
depending on whether the client has chosen
to use medication or not.
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.
We can use a peanut ball or something
like that to sort of help the client move.
So don't think that just because they're not
up walking that we can't encourage movement,
definitely want to do that.
We also want to educate.
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.
We call that anticipatory guidance.
We want to do that continuously,
because things are always changing.
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.
Laboring patients are not sick so
they're completely aware of what's going on.
We want to make sure that we're
doing a great job with education.
And then we want to advocate for the
family, for everybody because they get a say.
And so we want to be the voice.
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.
Okay, let's see if we can remember all
of the pieces that we just talked about
and put it together.
So nursing management for first stage,
we're going to explore the patient's plan for birth.
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.
We want to encourage movement, because
that's going to help the baby navigate the pelvis.
We want to make sure that the client is
feeling comfortable as much as possible.
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.
We also want to talk to
them about the labor process.
Education is key.
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.
We also want to monitor
the well being of the fetus.
So fetal monitoring, or listening to
heart tones, checking on position,
those are going to be things that
are ongoing during that first stage.
And then we have to communicate
with the provider what's going on.
One of the things that's unique to
nurses that are in labor and delivery is
often the provider is not in the hospital.
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.