Chapter 6: Labour & Birth: Nursing Care of Mother & Infant

Labour & Birth: Nursing Care of Mother & Infant begins by establishing the five major factors that influence the birth process, collectively known as the "five Ps": the powers (uterine contractions and maternal pushing efforts), the passage (the maternal bony pelvis and soft tissues), the passenger (the fetus, placenta, and membranes), the position of the mother, and the psyche (the woman's emotional state and response to labour). The text differentiates between true labour, characterized by progressive cervical effacement and dilation, and prelabour or prodromal labour, which involves irregular contractions without cervical change. The mechanisms of labour, or cardinal movements, are explained as the positional changes the fetus undergoes to navigate the birth canal, including descent, engagement, flexion, internal rotation, extension, restitution, and expulsion. A significant portion of the chapter is dedicated to fetal health surveillance, comparing intermittent auscultation with continuous electronic fetal monitoring (EFM). It provides detailed explanations of fetal heart rate (FHR) interpretation, defining baseline rates, variability (absent, minimal, moderate, and marked), and periodic changes such as accelerations and decelerations. Specific attention is given to the clinical significance of early, late, variable, and prolonged decelerations, along with appropriate nursing interventions for abnormal patterns, such as maternal repositioning or intrauterine resuscitation. The narrative guides the reader through the four stages of labour: the first stage of dilation (subdivided into latent and active phases), the second stage of fetal expulsion, the third stage of placental delivery, and the fourth stage of immediate recovery. Furthermore, the summary outlines critical nursing assessments, including Leopold manoeuvres to determine fetal presentation, vaginal examinations to assess station and dilation, and the monitoring of vital signs and amniotic fluid characteristics. It emphasizes the importance of pain management, cultural safety, and inclusivity, specifically addressing care for LGBTQ2 families and women who have experienced female genital mutilation. The chapter concludes with the immediate care of the newborn, highlighting the "golden hour," the benefits of delayed cord clamping, skin-to-skin contact for thermoregulation and microbiome transfer, and the Apgar scoring system for evaluating neonatal transition. Routine prophylactic measures, such as the administration of vitamin K and erythromycin eye ointment, are also discussed alongside the importance of promoting early breastfeeding and maternal-infant bonding.