Nursing Care of Mother and Infant During Labor and Birth

Labor is the process when uterine contractions cause the cervix to thin and dilate, allowing the fetus to pass through the birth canal. As the nurse, you’ll collaborate with the registered nurse, or RN, to provide care during labor and after delivery.

During labor, you’ll assist with monitoring the mother and fetus. Begin by taking vital signs at regular intervals. Be sure to notify the RN if you note a temperature above 100.4 F or 38 C, which can indicate an infection; or a blood pressure above 140/90 mmHg or systolic blood pressures below 90 mmHg, both of which can cause a decrease in blood flow to the fetus.

You’ll also assist with monitoring your patient’s uterine contractions and the fetal heart rate, or FHR, patterns that occur in response to each contraction. Uterine contractions can be monitored by palpating your patient’s uterus, or by using a tocotransducer, sometimes called a tocodynamometer, or toco for short, which is a pressure-sensitive button that’s placed over the uterine fundus to track uterine activity.

Now, uterine contractions are described by their frequency, duration, and intensity. Frequency is the time in minutes between the start of one contraction to the start of the next contraction. Normally there should be no more than 5 contractions present in a 10-minute period, averaged over 30 minutes. Duration is the length of the contraction in seconds, measured from the beginning to the end of the contraction, and is typically between 30 to 60 seconds. Intensity is the relative strength of the contraction, and is assessed as mild, moderate, or firm by palpation.

Keep in mind that during a contraction, the flow of blood to the placenta decreases, which means the fetus is receiving less oxygen. So, you should immediately report to the RN if you observe abnormal uterine activity, like tachysystole, meaning there are more than 5 consecutive contractions in a 10-minute period; or tetany, which means contractions last longer than 90 seconds.

Now, the FHR can be monitored by intermittent auscultation, with a fetoscope or Doppler transducer, or by continuous electronic fetal monitoring, or EFM. First, the baseline FHR is noted, which should be between 110 to 160 beats per minute. Fetal tachycardia, or an FHR more than 160 beats per minute, could be due to maternal fever or dehydration; and fetal bradycardia, or an FHR below 110 beats per minute, could be due to a maternal hypotension or hypoglycemia, or a decrease in blood flow to the fetus. If these changes to the baseline FHR occur, assist the RN to address the underlying cause and help with interventions to increase blood flow to the placenta and fetus, including assisting the patient to a side-lying position, providing fluids, and administering oxygen, as ordered.

Also be sure to consider the baseline FHR variability which refers to the fluctuations of the baseline FHR due to normal irregularities of the fetal cardiac rhythm and is an indication that the fetus is well-oxygenated. Variability is graded based on the amplitude of fluctuations in the FHR from the baseline as absent or undetectable; minimal, which ranges from more than undetectable to 5 beats per minute or less; moderate, which ranges between 6 and 25 beats per minute; and marked, which is over 25 beats per minute. The RN should be notified if the variability is absent, minimal, or marked.

Finally, there are periodic changes in the FHR, which include accelerations and decelerations. Accelerations represent an increase in the FHR, and are a normal, reassuring sign, usually associated with fetal movement. On the flip side, decelerations are a decrease in the FHR. Now, based on when they occur in relation to uterine contractions, decelerations can be classified as early, late, variable, or prolonged.
Early decelerations are a normal decrease in the FHR below the baseline that mirrors the uterine contraction. They occur when the uterus compresses the fetal head, causing changes in cerebral blood flow and stimulation of the vagus nerve which decreases the FHR. Early decelerations are considered benign, so no interventions are needed.