4. Psychosocial assessment should include anxiety, childbirth educations, support systems, and client’s response to labor.
5. Labor progress assessment should include:
a. Palpation or electronic monitoring (external with tocodynamometer and internal with intrauterine pressure catheter) is performed to assess the duration, frequency, and intensify of contractions. The frequency of contraction assessment is as follows.
- First latent – every 30 minutes
- First stage active – every 15 to 30 minutes
- First stage transition – every 15 minutes
- Second stage – each contraction
e. Sterile vaginal examination is performed to assess cervical (opening of external or from closed to 10 cm) and cervical effacement (thinning and shortening of the cervix, as measured from 0% [thick] to 100% [paper thin] effaced).
f. Station is determined (that is, the relationship of the presenting part to the pelvic ischial spines).
A. Fetal Assessment
1. Inspect the maternal abdomen to determine fetal lie – the relationship of the long axis (spine) of the fetus to the long axis of the mother. Fetal lie can longitudinal or transverse.
a. Longitudinal lie is when the long axis of the fetus is parallel to the long axis of the mother.
b. Transverse lie is when the long axis of the fetus is perpendicular to the long axis of the mother.
2. Palpate the abdomen using the four Leopold Manuevers to determine fetal position and possible size.
3.Montior fetal status
a. Auscultate the FHR every 30 minutes during the first stage latent; every 15 minutes during first stage active and stage transition; every 5 to 15 seconds.
b. Assess changes in FHR to identify the following.
- Early deceleration – slowing of the FHR early on the contraction. It is considered benign, minor the contraction and has a characteristics V or U pattern.
- Late deceleration – an indication of fetal hypoxia due to uteroplacental insufficiency. It usually begins at the peak of the contraction and ends after the contraction ends.
- Variable deceleration – a transient decrease in FHR before, during or after the contraction. It indicates cord compression and has a characteristics V or U pattern.
- Bradycardia – an FHR less than 100 beats per minutes or a drop of 20 beats per minutes below baseline. In indicates cord compression or placental separations.
- Tachycardia – an FHR greater than 160 beats per minute. It indicates fetal distress if it persists for more than 1 hour is accompanied by late deceleration.
- Loss of beat-to-beat variability – indicates fetal reaction to maternal drugs, fetal sleep, or fetal demise.
c. Assess fetal acid-base status with fetal blood sampling or fetal scalps stimulations.
4. Continually assess the fetal response to the pain-relief methods used.
