Nursing Activities in Labor and Child Birth

There are varied areas of practice that nurses need to be prepared on and one of the most significant ones is labor and child birth for women. In the delivery room after the incidence of labor, there are various activities that fall within the QSEN framework and where nurses have to apply nursing focused on EBP research to ensure the safe and effective coordination of delivery. One of the most important activities is monitoring and timing contradiction during labor. Labor and delivery nurses work in collaboration with obstetricians and other doctors within the labor and delivery rooms, to help administer clinical help focused on monitoring the labor process, which gives rise to child birth. With nurses often having the responsibility to collaborate with doctors and out together a personalized birthing plan for every mother, they are tasked with monitoring and timing the contractions during labor to ensure that the delivery process is safe for both the baby and the mother (Nilsson, 2014).

Monitoring and Timing Contractions as a Quality Improvement (QI) Component

The definition of the Quality Improvement (QI) component is that it involves Integration of the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Labor and delivery nurses basically work within the QI context by monitoring mothers on a personal level with the intent to provide recommendations on the approach to improve the experience of each mother. These nurses work with pregnant mothers during labor and childbirth, providing the necessary care during the important times leading up to child bearing, assisting the patient as well as the other personnel who accompany them to understand the process. Most importantly, they are tasked with providing care for the mother as well as the baby, before and after birth, which is a very important role that requires constant attention until delivery has been achieved (Nirmalan, 2015). These nurses who are mostly referred to as antepartum or ‘before birth’ nurses play a critical role to protect the unborn babies and the QI objective is to ensure that every child and mother have a personalized delivery process.

How to Properly Monitor and Time Contractions during Labor

The progress of child birth has to go three stages namely: labor; delivery of the baby; and delivery of the placenta. Unless it is cut short by C-section, all women have to go through labor, which is the first stage of child birth and hence nurses have to understand the best labor timing and monitoring approaches. During the labor process, nurses have to understand the dynamics of labor through the early, active and transitional phases. Within the early (latent) phase, nurses have various responsibilities which they have to perform to properly monitor labor (Nilsson, 2014). During the latent phase, which is the longest, nurses do not have to keep a close timing when checking the labor intensity and frequency because it is still on the early stages and the intensity is by far the least. Over a span of time of several hours, the nurses have to monitor the pregnant mother for any noticeable and bothersome symptoms. They will also regularly check the dilation state of the cervix while monitoring the contractions.

The process of monitoring labor at the latent phase involves the nurse checking the mild and moderate contractions that last between 30 to 45 seconds, over a space period of 20 to 30 minutes, whereby as time progresses they come closer and closer towards earnest labor. During this time, nurses must check the other symptoms associated with labor including: backache, lower abdominal pressure, menstrual-like cramps, lower abdominal pressure, indigestion, diarrhea, a sensation of warmth in the abdomen; mucus discharge tinged with blood; and rapture of the amniotic membranes, popularly referred to as “water breaking” (Nilsson, 2014).

During this monitoring and timing process, nursing must note down any irregularities within the process and consult doctors for the next intervention necessary. For instance, if the frequency of contractions indicate a near child birth and the amniotic membranes have not raptured nor has the cervix opened, it is time to consider the cesarean section option to child birth. In order to properly conduct monitoring and timing, the nurses also have to verbally engage with the pregnant mothers and find out how they are feeling. Normally, early labor incidence is coupled with a feeling of excitement, anticipation, relief, anxiety, and uncertainty among others (Nilsson, 2014). The monitoring and timing process must be incorporate the physical, emotional and psychological systems of the pregnant mothers.

Importance of timing and Monitoring Contractions during Labor

Clinical literature has highlighted the importance of clinical interventions involving all aspects of patient-health. In the context of monitoring and timing contractions, research has highlighted the critical role that this QI function plays within the healthcare paradigm. Nirmalan (2015) investigates the impact of labor epidural analgesia on the childbirth experience at a tertiary level center by taking the case of southern India. The authors argue that the use of this labor-intensive medication is increasing as an approach to relieving pain in women during labor and childbirth. This intensive pain during labor and the delivery period can be terrifying to the mothers-to-be and the prospect that there is a medication that reduces this pain significantly helps to reduce the fear of child birth to a great extent. The reduced fear consequentially leads to increased satisfaction with childbirth experience for expectant mothers.

As well, Van Der Gucht & Lewis (2015) investigate women’s experience of coping with pain in the process of childbirth. The key conclusions of this research suggest that there is a dissonance between what women really want so as to enhance their ability to cope with the pain during birth and the reality of clinical practice. The study found out that women expected clinical professionals to maintain a continuous presence during childbirth and offer a support model of care that promoted continuous care and an increasing acceptance of pain as part of the natural birth. The study therefore underlines the role that nurses need to play in the context of timing and monitoring contractions during child birth (Gucht & Lewis, 2015).

Conclusion

The Quality and Safety Education for Nurses (QSEN) initiative was specifically designed to help in identifying and addressing the various challenges of preparing nurses in the future with skills, knowledge and attitudes that will be critical for them to perform their duties in the present day workplace. The analyses has focused on timing and monitoring of contractions during labor as a QI phenomenon in clinical practice. There are approaches that nurses need to take to effectively monitor and time labor and these efforts must incorporate the physical, emotional, and psychological systems of the patient. The studies highlighted show that the experience of women in coping with contractions and pain is multi-affected and that nurses play a central role in ensuring this clinical role is played satisfactorily (Nirmalan, 2015).

References

Gucht, N. V., & Lewis, K. (2015). Women’s experiences of coping with pain during childbirth: A critical review of qualitative research. Midwifery, 31(3), 349-358. doi:10.1016/j.midw.2014.12.005

Nilsson, C. (2014). The delivery room: Is it a safe place? A hermeneutic analysis of womens negative birth experiences. Sexual & Reproductive Healthcare, 5(4), 199-204. doi:10.1016/j.srhc.2014.09.010

Nirmalan, P. K. (2015). The Impact of Labour Epidural Analgesia on the Childbirth Expectation and Experience at a Tertiary Care Center in Southern India. Journal Of Clinical And Diagnostic Research, 8(3), 73-76. doi:10.7860/jcdr/2014/8039.4111