Which is the initial nursing action when a multipara requests something for pain

TABLE 16-1

EXPECTED MATERNAL PROGRESS DURING FIRST STAGE OF LABOR

*In the nullipara effacement is often complete before dilation begins; in the multipara it occurs simultaneously with dilation.

†Duration of each phase is influenced by such factors as parity; maternal emotions; position; level of activity; and fetal size, presentation, and position. For example, the labor of a nullipara tends to last longer, on average, than the labor of a multipara. Women who ambulate and assume upright positions or change positions frequently during labor tend to experience a shorter first stage. Descent is often prolonged in breech presentations and occiput posterior positions.

‡Women who have epidural analgesia for pain relief may not demonstrate some of these behaviors.

Labor is defined as a series of rhythmic, involuntary, progressive uterine contraction that causes effacement and dilation of the uterine cervix. It is a physiologic process during which the fetus, membranes, umbilical cord, and placenta are expelled from the uterus (Milton & Isaacs, 2019). The process of labor and birth is divided into three stages.

The first stage of dilatation begins with the initiation of true labor contractions and ends when the cervix is fully dilated. The first stage may take about 12 hours to complete and is divided into three phases: latent, active, and transition. The latent or early phase begins with regular uterine contractions until cervical dilatation. Contractions during this phase are mild and short, lasting 20 to 40 seconds. Cervical effacement occurs, and the cervix dilates minimally.

The active phase occurs when cervical dilatation is at 6 to 7 cm and contractions last from 40 to 60 seconds with 3 to 5 minutes intervals. Bloody show or increased vaginal secretions and perhaps spontaneous rupture of membranes may occur at this time. 

The last phase, the transition phase, occurs when contractions peak at 2 to 3-minute intervals and dilatation of 8 to 10 cm. If it has not previously occurred, the show will occur as the last mucus plug from the cervix is released. By the end of this phase, full dilatation (10 cm) and complete cervical effacement have occurred.

The second stage of labor starts when cervical dilatation reaches 10 cm and ends when the baby is delivered. The fetus begins the descent, and as the fetal head touches the internal perineum to begin internal rotation, the client’s perineum begins to bulge and appear tense. As the fetal head pushes against the vaginal introitus, crowning begins, and the fetal scalp appears at the opening to the vagina.

Lastly, the third stage, or the placental stage, begins right after the baby’s birth and ends with the delivery of the placenta. Two separate phases are involved: placental separation and placental expulsion. Active bleeding on the maternal surface of the placenta begins with separation, which helps to separate the placenta further by pushing it away from its attachment site. Once separation has occurred, the placenta delivers either by natural bearing down the client’s effort or gentle pressure on the contracted uterine fundus.

There are instances where labor does not start on its own, so when the risks of waiting for labor to start are higher than the risks of having a procedure to get labor going, inducing labor may be necessary to keep the client and the newborn healthy. This may be the case when certain situations such as premature rupture of the membranes, post-term pregnancy, hypertension, preeclampsia, heart disease, gestational diabetes, or bleeding during pregnancy are present.

The nursing care plan for a client in labor includes providing information regarding labor and birth, providing comfort and pain relief measures, monitoring the client’s vital signs and fetal heart rate, facilitating postpartum care, and preventing complications after birth.

Here are 45 nursing care plans (NCP) and nursing diagnoses for the different stages of labor, including care plans for labor induction, labor augmentation, and dysfunctional labor:

Precipitous Labor

Precipitous labor is a form of labor in which all three stages of labor are completed within less than three hours (Awe et al., 2021). Such rapid labor is likely to occur with grand multiparity, or it may occur after induction of labor by oxytocin. Contractions can be so forceful they lead to premature separation of the placenta or lacerations of the perineum, placing the client at risk for bleeding. It also poses a risk to the fetus because subdural hemorrhage may result from the rapid release of pressure on the head. Precipitous labor can be predicted from a labor graph if, during the active phase of dilatation, the rate is greater than 5 cm/hr (1 cm every 12 minutes) in a nullipara or 10 cm/hr (1 cm every 6 minutes) in a multipara.

Nursing care plans for precipitous labor

The nursing care for clients with precipitous labor revolves around promoting maternal and fetal well-being, preventing complications, and providing a safe delivery. Here are four nursing care plans and nursing diagnosis for precipitous labor:

1. Risk for Deficient Fluid Volume
2. Anxiety
3. Risk for Infection
4. Risk for Injury

Risk for Deficient Fluid Volume

Trauma-related bleeding can be due to lacerations. If the client’s tissues do not yield easily to powerful contractions, she may have a uterine rupture, cervical lacerations, or hematomas. Cervical and vaginal tears may develop as a result of the natural processes of delivery or the forceful contractions during precipitous labor. They may not be noted until excessive postpartum vaginal bleeding prompts lower genital tract examination, including examination for vaginal and vulvar hematomas (Voros & Pappa, 2020).

Nursing Diagnosis

• Risk for Deficient Fluid Volume

Risk factors

• Loss of fluids through normal routes
• Forceful contractions
• Premature separation of the placenta

Possibly evidenced by

• Not applicable; the presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes

• The client will identify individual risk factors and appropriate interventions.
• The client will demonstrate behaviors or lifestyle changes to prevent the development of fluid volume deficits.

Nursing Assessment and Rationales

1. Note the client’s level of consciousness and mentation.
Blood flow to the nonessential organs gradually stops to make more blood available for vital organs, specifically the heart and brain. As blood loss continues, flow to the brain decreases, resulting in mental changes, such as anxiety, confusion, restlessness, and lethargy.

2. Measure and record the intake and output balance.
Accurate documentation helps identify fluid losses and replacement needs and influences the choice of interventions. With slow bleeding, the client develops these symptoms over a period of hours; the end result of continued seepage, however, can be as life-threatening as a sudden profuse loss of blood. As blood flow to the kidneys decreases, they respond by conserving fluid. Urine output decreases and eventually stops.

3. Monitor vital signs.
Assess vital signs every 15 minutes until stable. Blood loss from a laceration or hematoma can be significant, even though it is less obvious. The body initially responds to a reduction in blood volume with increased heart and respiratory rate. Tachycardia is usually the first sign of inadequate blood volume. The first blood pressure change is a narrow pulse pressure. The blood pressure continues falling and eventually cannot be detected. 

4. Assess for the presence of lacerations or hematomas. Inspect characteristics of blood.
When the amount and character of the lochia are normal and the uterus is firm, but signs of hypovolemia are still evident, the cause may be a large hematoma. Excessive bright red bleeding despite a firm fundus may indicate cervical or vaginal laceration.

5. Monitor skin temperature and palpate peripheral pulses.
Cool or clammy skin and/or weak pulses indicate decreased peripheral circulation and the need for additional fluid replacement.

6. Observe the client for early symptoms of shock.
The client should be observed for early signs of shock, such as tachycardia, pallor, cold and clammy hands, and decreased urine output. Reduced blood pressure may be a late sign of hypovolemic shock.

Nursing Interventions and Rationales

1. Encourage the client to resume oral intake gradually.
Increased intake of oral fluids within the provider’s advice helps replenish fluid losses. If the client underwent cesarean birth due to precipitous labor, provide clear liquids in small amounts to reduce the risk of gastric irritation and vomiting to minimize fluid loss.

2. Weigh the client’s perineal pads to measure blood loss.
It is difficult to estimate the amount of blood a postpartal client is losing because it is difficult to estimate the amount of blood it takes to saturate a perineal pad. Be certain that when you are counting perineal pads, you differentiate between saturated and used. Weighing perineal pads before and after use and then subtracting the difference is an accurate technique to measure vaginal discharge; 1 g of weight is comparable to 1 ml of blood volume.

3. Apply an ice pack to the perineal area for hematomas.
Applying an ice pack (covered with a towel to prevent thermal injury to the skin) may prevent further bleeding. Usually, a hematoma is absorbed over the next three or four days.

4. Be calm and advise the client to remain calm, too, and assure her of the baby’s condition.
The client is not always aware of what is happening at this point, but she quickly senses something is seriously wrong. Try to maintain an air of calm and assure her of the baby’s condition and inform her about the need to stay in the birthing room a little longer than expected while the healthcare provider places sutures or packs.

5. Administer blood and blood products as indicated.
Hypovolemic shock is treated with packed red blood cells and other appropriate blood products. Transfusion should keep up with blood loss, with early activation of a protocol for large volume transfusion in clients with heavy bleeding (Awe et al., 2021).

6. Administer IV fluids as prescribed.
Provide intravenous fluids to maintain the circulating volume and to replace fluids. Intravenous infusions of crystalloids and colloids should be obligatory apart from previously mentioned drugs (Feduniw et al., 2020).

7. Administer medications and anesthetics as indicated.
Tranexamic acid, a clot-stabilizing medication, may be used to reduce bleeding and blood transfusions in low-risk women. Tranexamic acid was effective in reducing the rate of hemorrhage, especially if administered within three hours after labor (Feduniw et al., 2020). If the cervical laceration appears to be extensive or difficult to repair, it may be necessary for the client to be given a regional anesthetic to relax the uterine muscle and prevent pain. Administer a mild analgesic as prescribed for pain relief if hematomas are present.

8. Insert an indwelling Foley catheter, as indicated.
Place an indwelling Foley catheter to assess urine output, which reflects kidney function. An indwelling catheter may also be placed following the repair because the packing causes such pressure on the urethra that it can interfere with voiding.

9. Assist in the surgical repair of lacerations.
Perineal lacerations are sutured and treated the same as an episiotomy repair. Unfortunately, vaginal tissue is friable, making vaginal lacerations difficult to suture. A balloon tapenade similar to the type used with uterine bleeding may be effective if suturing does not achieve hemostasis. The repair of a cervical laceration usually requires sutures and can be difficult because if the bleeding is intense, this obstructs visualization of the area.

10. Prepare the client for the incision of a hematoma.
If the hematoma is large when discovered or continues to increase in size, the client may have to be returned to the birthing room to have the site incised and the bleeding vessel ligated under local anesthesia.

Anxiety

Women who experience precipitous labor may have panic responses about the possibility of not getting to the hospital in time or not having their healthcare provider present. Although they are relieved after birth, they may require continued support and reassurance concerning the deviation from their expected experience.

Nursing Diagnosis

• Anxiety

• Situational crisis
• Threat to self and/or fetus
• Interpersonal tranmission

Possibly evidenced by

• Increased tension
• Fearful
• Restless, jittery
• Sympathetic stimulation

Desired Outcomes

• The client will use breathing and relaxation techniques effectively
• The client will cooperate with necessary preparations for a rapid delivery
• The client will follow directions and/or actively participate in the delivery process

Nursing Assessment and Rationales

1. Assess the client’s level of anxiety.
Anxiety levels of pregnant women increase during labor and make it difficult to relax. Additionally, anxiety can cause tension in pelvic floor muscles, which play a key role in labor, and this muscle tension increases pain. Excessive pain may lead to increased fear, making the client more sensitive to pain. This is when the concept of fear-tension-pain arises. The State Anxiety Inventory (SAI) can be used to measure the anxiety levels of the client during precipitous labor (Cicek & Basar, 2017).

2. Monitor physiological responses and vital signs.
Physical responses such as dizziness, headache, nausea, irritability, or restlessness may indicate the degree of fear the client is experiencing. Tachypnea and palpitations may be evident during the measurement of vital signs. The client may feel out of control of the situation or reach a state of panic. However, these symptoms may also be related to a state of hypovolemic shock, therefore, the client should be observed carefully.

Nursing Interventions and Rationales

1. Maintain a calm, deliberate manner. Offer clear and concise instructions. Provide explanations.
An emergency or extremely rapid delivery occurring out of the hospital or in a hospital setting without the presence of a clinician can be extremely anxiety-provoking for the client or couple, who had anticipated an orderly progression through labor and delivery. When the actual birth event is not in keeping with their expectations, reactions may include hostility, fear, and disappointment. The composure of the nurse and her reassurance help prevent or alleviate anxiety.

2. Acknowledge that this is a fearful situation and that others have expressed similar fears.
When the client is expressing her own fear, the validation that these feelings are normal can help the client feel less isolated and understood. This may help relieve the panic that occurs with a precipitous birth and help the client cope through forceful contractions.

3. Provide a quiet environment and privacy within the parameters of the situation—position the client for optimal comfort.
This reduces distractions and discomfort, allowing the client to focus and helps reduce “contagious” anxiety of onlookers in or out of hospital delivery, and supports modesty. Removing the client from outside stressors may also promote relaxation and enhance her coping skills. Assist the client to lie on her left side until it is established that the FHR is stable.

4. Encourage partner or SO to remain with the client, and provide support and assistance as needed.
Allowing full participation by an SO enhances self-esteem, furthers cohesion of the family unit, reduces anxiety, and provides assistance for the professional. Be certain to admit the client’s support person to the birthing area along with the client and encourage them to remain throughout the birth as appropriate because having someone familiar with her during labor helps counteract the sensation that everything is new and unexpected.

5. Remain with the client. Provide ongoing information regarding labor progression and anticipated delivery.
Effective support can make a difference in helping the client feel in control. There is no substitute for personal touch and contact as a way to provide support during labor (unless the client does not want to be touched). Patting an arm while telling the client about her progress in labor or wiping her forehead with a cool cloth are required methods of conveying support and producing several benefits. Additionally, frequent updates about the client’s progress help to alleviate anxiety.

6. Respect and promote the support person.
Acquaint the support person with the physical layout of the birthing room. Offer praise not only to the client but also to the support person as well because watching a birth is often as totally a new experience for this person as for the client. Relieve the support person as necessary so they can take a break or get something to eat or visit with older children.

7. Encourage appropriate coping or relaxation techniques.
Relaxation keeps the abdominal wall from becoming tense, allowing the uterus to rise with contractions without pressing against the hard abdominal wall. Asking the client to bring her favorite music or aromatherapy with her can help with relaxation. The favorable, but not conclusive, effects of inhalation aromatherapy on stress management in healthy adults have been proven. A systematic review indicated the positive anxiolytic effects of aromatherapy in people with anxiety symptoms (Tabatabaeichehr & Mortazavi, 2020).

8. Support the client’s pain management needs.
Many women plan on using nonpharmacologic measures such as hydrotherapy, position changes, or acupuncture during labor. Other women want pharmacologic help in labor. Support whichever decision the client has made coming into labor and any change she decides on as labor progresses. Part of being in control is knowing your options and feeling free to elect the one most appropriate at that time.

9. Arrange for services of medical or nursing staff as soon as possible. Inform the client that help has been requested.
The arrival of assistance helps the client or couple feel less anxious and more secure. Support needs to come from healthcare personnel as well as the client’s individual support person.

10. Conduct delivery in a calm manner; provide an ongoing explanation.
This helps the client remain calm and cooperate with instructions. If the fetus is visibly emerging (crowning), there is no time to transfer and the client should be delivered there and then. If the client is fully dilated and effaced, delivery should probably occur immediately unless the labor and delivery unit is close by. Any scenario requires clinical judgment and consideration, which also requires the healthcare personnel to remain calm and in control (Borhart & Voss, 2019).

11. Place newborn on maternal abdomen once newborn respirations are established. Allow the partner to hold the infant.
It helps promote bonding and establishes a positive feeling about the experience. Dry the infant well with a warmed towel, wrap him or her in a sterile blanket, and cover the head with a wrapped towel or cap.

12. Administer sedation as appropriate.
Sedation may help slow labor progress and allow the client to regain control. Narcotics may be given during labor because of their potent effect, but they may cause maternal respiratory depression as well as fetal CNS depression and should be used cautiously. Narcotics may be given early to slow the labor progress.

Risk for Infection

Precipitous labor may cause accidental out-of-hospital deliveries, which constitute <1% of all live births in most developed countries. These emergency births differ from planned home births and in-hospital births because they usually happen accidentally at home or en route to the hospital. The unpredictable characteristics of out-of-hospital deliveries mean that neonates are born in inappropriate locations without medical professionals on standby. Being born in contaminated places and suboptimal cord practices may increase the risk of infection (Chang et al., 2022). Additionally, the force of a sudden birth may leave the client with perineal and cervical lacerations that are also breeding grounds for infection if not managed properly.

Nursing Diagnosis

• Risk for Infection

Risk factors

• Inadequate primary defense (e.g. skin)
• Inadequate secondary defense (e.g. decreased hemoglobin)
• Premature rupture of membranes

Possibly evidenced by                                                   

• Not applicable; the presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes

• The client will be afebrile and free from leukopenia.
• The client will verbalize understanding of individual risk factors.
• The client will identify interventions to prevent or reduce infection.
• The client will achieve timely wound healing.

Nursing Assessment and Rationales

1. Observe for localized signs of infection at the wound.
Inspect incision and dressings and note characteristics of drainage from wound and presence of erythema. This provides for early detection of developing infectious processes and timely intervention.

2. Monitor the client’s vital signs.
Precipitous labor predisposes the client to hemorrhage. The blood pressure, pulse rate, and respirations are checked to identify a rising pulse rate or falling blood pressure, and an oral temperature is taken and reported if it is 38℃ (100.4℉) or higher or if the client has a higher risk for infection. Take the client’s temperature every two to four hours or more if it is elevated.

3. Assess the infant for signs and symptoms of infection.
Some signs of sepsis include a low temperature, lethargy or irritability, poor feeding, and respiratory distress. Maternal infection and complications during labor can predispose the neonate to sepsis.

Nursing Interventions and Rationales

1. Stress proper hand hygiene by all caregivers between therapies and clients.
Hand hygiene practices reduce the risk of endogenous organism transmission from the client and exogenous organism transmission from other clients, the health care team, and the environment (Bashaw & Keister, 2018). 

2. Recommend routine or preoperative scrubs or showers when indicated
Current evidence supports surgical hand scrubs (preferably brushless) and double-gloving. Brushless hand scrubbing techniques reduce the instance of microscopic cuts on the dermis and the excessive defoliation of skin cells while cleansing the skin surface of pathogens (Bashaw & Keister, 2018).

3. Maintain sterile technique for all invasive procedures.
To help prevent infection, any articles such as gloves or instruments that are introduced into the birth canal or cutting the umbilical cord should be sterile. In addition, adherence to standard infection precautions is essential.

4. Assist the client in maintaining good perineal hygiene.
Good hygiene reduces the possibility of introducing bacteria into the birth canal. Instruct the client to wipe from front to back to avoid bringing bacteria from the rectal area to the perineal area.

5. Insert an indwelling (Foley) catheter as indicated.
Vaginal lacerations are difficult to suture because of the friable vaginal tissue. Some oozing often occurs after a vaginal repair, so the vagina may be packed to maintain pressure on the suture line. An indwelling catheter may be placed following the repair because the packing causes such pressure on the urethra that it can interfere with voiding and predispose the client to urinary tract infection. However, an aseptic technique should be ensured during insertion to avoid introducing the cervical canal to infection.

6. Review laboratory studies for systemic infections.
Increased WBC count may indicate an ongoing infection. The presence of local or systemic infection may contraindicate or adversely affect any planned surgical procedure and/or anesthesia.

7. Obtain specimens for cultures and Gram stain.
Immediate identification of the infective organism type by Gram stain allows prompt treatment, whereas more specific identification by cultures can be obtained in hours or days.

8. Administer antibiotics and note the client’s response.
In the United States and Canada, the current approach to treating early-onset neonatal sepsis includes the administration of combined IV aminoglycoside and expanded-spectrum penicillin antibiotic therapy. The specific antibiotics to be used are chosen on the basis of maternal history and prevalent trends of organism colonization and antibiotic susceptibility in individual hospitals (Gollehon & Aslam, 2019).

9. Emphasize the necessity of taking antibiotics as directed.
Premature discontinuation of treatment when the client begins to feel well may result in the return of infection and the potentiation of drug-resistant strains. Antibiotic resistance is increasing in the general population worldwide, and infections are rising in neonatal units due to multi-drug and extensively multidrug-resistant bacteriuria, posing a significant treatment dilemma (Gollehon & Aslam, 2019). 

10. Discuss the importance of not taking antibiotics or using leftover drugs unless specifically instructed by the healthcare provider.
Inappropriate use can lead to the development of drug-resistant strains or secondary infections. Antibiotics are normally continued until the septic process and surgical interventions have controlled the source of infection. Ordinarily, clients are treated for approximately two weeks, although the duration may vary according to the infection’s source, site, and severity (Bokhari & Stuart, 2019).

Risk for Injury

Precipitous labor is defined as the expulsion of the fetus within three hours of the start of contractions. Few studies have found that precipitous labor is harmful to both the mother and the newborn. Precipitous labor, which is most commonly associated with placental abruption and induction of labor, is a significant risk factor for maternal complications. Maternal morbidities reported included extensive birth canal laceration, uterine rupture, placental retention, the need for revision of the uterine cavity, postpartum hemorrhage, and blood transfusions (Ghasemi et al., 2021). Uterine rupture, which is a ripping of the uterine wall, commonly occurs in the lower segment of the uterus and would not only have short-term complications but ends in long-term complications, maternal mortality, and perinatal mortality (Getahun et al., 2018).

Nursing Diagnosis

• Risk for Injury

Risk factors

• Maternal age
• Multiparity
• Placental abruption
• Forceful contractions
• Spontaneous vaginal delivery

Possibly evidenced by                                                   

• Not applicable; the presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes

• The client will be free of complications associated with precipitous labor.
• The client will identify individual risk factors.
• The client will be able to enhance safety and use resources appropriately.

Nursing Assessment and Rationales

1. Assess the client’s progress in labor.
Precipitous labor is an extremely rapid process of labor and delivery. It is generally caused by low resistance to the birth canal, strong, frequent contractions, unawareness of uterine contractions, and possibly a combination of these (Najam et al., 2021). Labor often begins abruptly and intensifies quickly, rather than having a more subtle onset and gradual progression. Contractions may be frequent and intense, often from the onset.

2. Monitor the client’s vital signs.
The initial assessment is for hemodynamic stability for clients with suspected uterine rupture. Blood pressure and heart rate should be obtained to assess for hypotension and tachycardia. Common symptoms of hypotension include lightheadedness, dizziness, nausea, vomiting, and anxiety (Togioka & Tonismae, 2020).

3. Monitor for hematuria and oliguria.
Oliguria and hematuria after traumatic childbirth increase the likelihood of bladder rupture. The lower urinary tract’s anatomic proximity to the reproductive tract predisposes it to an iatrogenic injury (Ghasemi et al., 2021).

4. Assess for signs and symptoms of uterine rupture.
The client may have no symptoms, or she may have sudden onset of severe signs and symptoms such as shock, abdominal pain, pain in the chest between the scapulae during inspiration, cessation of contractions, abnormal or absent fetal heart tones, and palpation of the fetus outside of the uterus.

5. Monitor the fetal heart rate closely.
When uterine rupture occurs, fetal death will follow unless immediate cesarean birth can be accomplished. With complete uterine rupture, fetal heart sounds may start to fade initially and then are absent. If the rupture is incomplete, fetal heart sounds may reveal fetal distress.

Nursing Interventions and Rationales

1. Avoid applying pressure when during the delivery.
As soon as the head of the fetus is prominent at the vaginal opening, one technique to help the fetus achieve extension and allow the smallest head diameter to present is for the care provider to place a sterile towel over the rectum and press forward on the fetal chin while the other hand presses down on the occiput, called Ritgen maneuver. However, pressure should never be applied to the fundus of the uterus to affect birth because uterine rupture could occur. This practice has not been shown to shorten the second stage of labor, and it increases the risk of uterine rupture (Togioka & Tonismae, 2020).

2. Alleviate the client’s and her partner’s anxiety.
Measures to alleviate anxiety in the client and her partner are necessary as emergency measures are being initiated. Stay calm while preparing the client for an emergency cesarean birth and teach her breathing techniques that would help calm her down. Allow the partner to sit and breathe with the client while preparations are being made.

3. Administer intravenous fluids as indicated.
Administer emergency fluid replacement therapy as prescribed. A large-bore intravenous line should be in place. If large-bore intravenous access cannot be obtained, central venous access with a large bore sheath introducer should be considered. Initial resuscitation is often provided by infusing Lactated Ringer’s electrolyte solution (Togioka & Tonismae, 2020).

4. Administer blood and blood products as prescribed.
Brisk and large volume blood loss should prompt early blood transfusion. A second large-bore intravenous line should also be in place, and blood should be ordered (Togioka & Tonismae, 2020). The client’s prognosis depends on the extent of the rupture and the blood loss.

5. Prepare the client for a possible laparotomy or cesarean birth.
Prepare the client for a possible laparotomy as an emergency measure to control bleeding and birth the fetus. The viability of the fetus depends on the extent of the rupture and the time elapsed between rupture and abdominal extraction. The initial treatment step can also be an emergent cesarean birth- with or without an exploratory laparotomy. A delay n delivery, resuscitation, or surgery increases the maternal and fetal risk  (Togioka & Tonismae, 2020). Hysterectomy or the removal of the uterus is likely to be required for an extensive tear. Smaller tears may be surgically repaired.

6. Provide emotional support for the client and her partner.
Most women are advised not to conceive again after a rupture of the uterus unless the rupture occurred in the inactive lower segment. At the time of the rupture, the primary care provider, with consent, may perform a cesarean hysterectomy or tubal ligation, both of which will result in loss of childbearing ability. The client may have difficulty giving her consent for a hysterectomy because it is unknown whether her present baby will live. Allow them time to express their emotions without feeling threatened.

7. Refer the client to clergy or counselors.
If the fetus dies and the client will no longer be able to have children, they may become almost immediately angry that the rupture occurred. They may want to plan a funeral because, oftentimes, the baby is full term. Utilize the clergy or counselors as needed to help the couple begin the coping process. They are not only grieving for the loss of a child but also the cost of unexpected surgery and perhaps the loss of fertility.

Recommended nursing diagnosis and nursing care plan books and resources.

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Journal readings, books, articles, and other resources you can use to further your reading about labor.

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Which is the priority nursing action for a client in the second stage of labor?

What are the two phases of second stage of labour?

Which may alter the absorption of medications taken orally during pregnancy?