Chapter 21: Nursing Management of Labor and Birth at Risk

Nurses learn to differentiate between hypertonic and hypotonic uterine dysfunction and recognize precipitate labor as distinct contractility patterns requiring specific interventions. Preterm labor management emphasizes early identification using fetal fibronectin testing and transvaginal cervical length assessment to stratify risk, followed by tocolytic medications to suppress contractions and antenatal corticosteroids to accelerate fetal pulmonary maturation. Post-term pregnancy surveillance employs intensive fetal monitoring protocols with consideration for labor induction when expectant management poses unacceptable risks. The chapter explores cervical ripening techniques and oxytocin augmentation protocols, with emphasis on Bishop score assessment to predict successful vaginal delivery and prevent iatrogenic complications like uterine hyperstimulation. Critical obstetrical emergencies including umbilical cord prolapse, placenta previa, placental abruption, uterine rupture, and amniotic fluid embolism are examined for rapid recognition and coordinated emergency response. Operative delivery methods including vacuum-assisted and forceps-assisted vaginal birth, amnioinfusion for oligohydramnios management, and cesarean birth are detailed with appropriate clinical indications and safety considerations. The chapter also addresses vaginal birth after previous cesarean delivery as an option requiring careful patient selection and continuous monitoring, alongside the emotional and supportive nursing care required following intrauterine fetal demise and perinatal loss.