2. Diane, age 22, has been in labor for 8 hours. Her cervical exam reveals she is 3 cm, 30% effaced and, –1 station. Diane has been feeling most of her pain in her lower back. (Learning Objectives 3, 4, and 5)

  1. Given your understanding of the five Ps and the cardinal      movements of labor, discuss why Diane is having back labor and why her      progress is slow.
  2. What strategies may the nurse implement to assist Diane in      progressing in her labor?

Case Studies, Chapter 14, Nursing Management During Labor and Birth

1. Desiree, a 28-year-old G2P1, is admitted to the labor and birth unit. Her birth plan indicates that she is planning natural childbirth without pharmacologic interventions. She has attended childbirth education classes. Desiree is considered low risk based on her personal and family health history and physical exam. Her pregnancy has progressed without complications. She is approximately 38 weeks pregnant. Vaginal assessment reveals cervical dilation at 10 cm, 100% effaced, and +1 station. Position of the fetus is LOA. The external fetal monitor indicates a reassuring fetal heart rate at 130 bpm. Maternal status is stable. (Learning Objectives 1, 2, 5, and 8)

  1. Based on the vaginal assessment, identify the stage of      labor and appropriate nursing interventions for this stage of labor.
  2. Explain how the nurse determined that the external fetal      monitor would be appropriate for Desiree. What factors would necessitate a      change to internal fetal monitoring during labor?

Desiree says, “I’m not sure I can cope with the pain much longer.” How would you respond, considering her birth plan, stage of labor, and assessment data?

2. Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced, and +2 station. She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations. Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended. (Learning Objectives 3 and 4)

a. What is happening to Emily’s baby at this point in time? What does this mean?

b. What role do you, as the nurse, play regarding fetal assessment and what interventions do you need to implement/recommend at this point in time?

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