Chapter 16: Nursing Care During Labor & Birth

Labor is divided into four stages, beginning with the first stage, which contemporary research defines by the latent phase (onset to 6 cm cervical dilation) and the active phase (6 cm to complete 10 cm dilation),. Nursing priorities upon admission include a thorough screening assessment using techniques such as the interview and physical assessment to determine maternal and fetal status and labor progression. Crucially, the nurse must distinguish between true and false labor contractions based on their regularity, intensity, location, and persistence despite comfort measures. The Emergency Medical Treatment and Active Labor Act (EMTALA) mandates that pregnant women presenting with urgent pregnancy problems be assessed and stabilized regardless of their ability to pay. Care during the first stage emphasizes promoting maternal comfort and progress through nonpharmacologic measures like ambulation, hydrotherapy, mindful meditation, and frequent position changes (such as upright or lateral positions),. Ensuring adequate hydration and nutrition, particularly clear liquids for low-risk women, and promoting voiding at least every two hours are vital nursing actions,. Continuous psychosocial support provided by a nurse, partner, or specialized attendant like a doula is shown to decrease the use of analgesia and the likelihood of cesarean birth,. The second stage begins with full cervical dilation and ends with the baby's birth. During this stage, the woman is encouraged to follow her body's cues and use spontaneous, open-glottis bearing-down efforts, as directed pushing may compromise fetal oxygenation,. Birth positions, such as squatting or side-lying, are favored for their ability to use gravity, increase pelvic diameter, and reduce perineal trauma,. Following birth, immediate newborn assessments (including Apgar scores), support for respiratory effort, and thermal regulation are prioritized, typically achieved through immediate skin-to-skin contact with the mother,. Delayed umbilical cord clamping for at least 30 to 60 seconds is recommended to facilitate the physiological transfer of blood to the newborn. The third stage involves placental expulsion. Modern care emphasizes Active Management of Third-Stage Labor (AMTSL), which involves administering prophylactic oxytocin immediately after birth, delayed cord clamping, and controlled cord traction to shorten this stage and significantly decrease the risk of postpartum hemorrhage,. Finally, the fourth stage is the immediate recovery period, during which the mother's stability is assessed every 15 minutes, focusing on uterine fundal firmness, lochia amount, and bladder status to prevent the primary complication of hemorrhage,. Throughout all phases, culturally sensitive care, precise documentation, and continuous advocacy for the woman's birth plan are integral to comprehensive maternal-child nursing.