Chapter 23: Labor & Birth Complications Nursing Care

Dysfunctional labor, a problem of power, manifests as ineffective uterine contractions, classified as hypotonic (infrequent and weak, occurring in the active phase, increasing the risk of prolonged labor and postpartum hemorrhage) or hypertonic (frequent contractions with high resting tone, often painful, and potentially compromising fetal oxygenation). When contractions are ineffective, nurses assist with management strategies, including the use of oxytocin for induction or augmentation of labor, a process requiring careful adherence to safety protocols, continuous fetal heart rate (FHR) monitoring, and observation for complications such as uterine hyperstimulation (tachysystole) or water intoxication. Prior to induction, cervical readiness is assessed using the Bishop score, and ripening may be achieved using mechanical methods like stripping the membranes or pharmacological agents such as prostaglandins. Complications related to the passenger include fetal malposition, most commonly the occipitoposterior (OP) position, which leads to prolonged labor and intense back pain that can often be alleviated by specific maternal posturing like the hands-and-knees position. Malpresentation includes breech, face, and brow presentations, frequently necessitating planned cesarean birth due to increased fetal risk. Fetal size can also complicate labor, particularly macrosomia (an oversized fetus), which is a key risk factor for shoulder dystocia—an emergency requiring immediate maneuvers such as McRoberts and suprapubic pressure to facilitate delivery. Critical obstetric emergencies detailed include umbilical cord prolapse, requiring prompt action to relieve compression on the cord by elevating the presenting part or placing the patient in a Trendelenburg or knee-chest position, as well as uterine rupture (a major hemorrhage risk) and amniotic fluid embolism (a severe cardiopulmonary collapse). Issues with the passageway generally result in cephalopelvic disproportion (CPD), necessitating vigilant assessment during a trial of labor. Furthermore, the chapter reviews anomalies of the placenta (e.g., placenta accreta, placenta succenturiata) and the umbilical cord (e.g., vasa previa, two-vessel cord), which require special attention during the third stage of labor and the newborn assessment. Throughout all labor deviations, nursing care is grounded in Quality and Safety Education for Nurses (QSEN) competencies, emphasizing continuous assessment and effective communication to support the patient and family through difficult circumstances.