Chapter 19: Nursing Care During Obstetric Procedures

Labor induction and augmentation are explored extensively through the application of the Bishop scoring system to determine cervical readiness and the selection of appropriate ripening strategies using both mechanical interventions and pharmacological agents such as prostaglandins including dinoprostone and misoprostol. Oxytocin administration is thoroughly addressed as a high-alert medication requiring strict safety protocols, precise dose titration in response to uterine contractility patterns, and immediate recognition and management of uterine tachysystole or hyperstimulation through discontinuation of medication, maternal repositioning, oxygen therapy, and tocolytic intervention when necessary. The chapter details external cephalic version as a procedure to reposition breech and transverse presentations toward optimal cephalic alignment using tocolytic support and continuous ultrasound visualization to potentially avoid operative delivery. Operative vaginal delivery techniques including forceps and vacuum extraction are examined with attention to clinical indications such as maternal exhaustion or signs of fetal compromise, alongside associated maternal risks such as perineal lacerations of varying severity and neonatal complications including cephalhematoma, chignon formation, and cranial nerve injuries. The chapter emphasizes the contemporary shift toward restrictive episiotomy protocols rather than routine performance to reduce long-term maternal morbidity. Cesarean delivery is comprehensively addressed, distinguishing between low transverse and classic uterine incision techniques and their respective implications for vaginal birth feasibility in subsequent pregnancies, alongside the intricate clinical decision-making regarding trial of labor after cesarean and vaginal birth after cesarean candidacy. Complete perioperative nursing care encompasses preoperative interventions including informed consent acquisition, nothing-by-mouth protocols, gastric acid prophylaxis, and comprehensive postoperative surveillance of uterine involution, lochia characteristics, pain management, and hemorrhage and infection prevention.