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15.1 Factors Influencing the Process of Labor and Birth

Labor is an intricate process that involves the laboring person, the fetus, and the interactions between them. To remember these interactions, think of the 5 P’s: power, passage, passenger, position, and psyche. If any of these components is not functioning as expected, the labor and birth can be impacted. Nurses should understand the usual progression and assess frequently to identify deviations from the expected so that appropriate nursing interventions can be implemented to improve outcomes. Nurses should also be aware of when nursing interventions have not resolved the situation and contact the provider so that they can make changes to the plan of care. Remember, nurses are an independent resource that can greatly influence the experiences and outcomes of patients they care for in labor. Nurses’ efforts may improve the United States’ maternal morbidity and mortality rates to be closer to the low rates of other developed countries.

15.2 Stages of Labor

The nurse’s understanding of the expected progression of the four stages of labor is crucial when providing care during each step, starting at triage through transfer of the patient to the postpartum recovery room. Correct identification of labor, followed by appropriate monitoring of the health of the birthing person and fetus for each stage, and use of interventions/consultation when necessary if complications present are the core actions of the nurse. Using evidence-based care with up-to-date and accurate information is the most powerful tool nurses have to improve outcomes as well as increase positive experiences for their patients.

15.3 Physiologic Adaptations during Labor and Birth

As the body enters labor and progresses through each of the four stages, significant alterations in body processes occur. Knowing each of these can help nurses identify the progression through labor, identify if the progression is not occurring as expected, and safely identify when pathologic deviations occur. Incorrectly noting a normal change as a pathologic one can increase the risk for unnecessary interventions including cesarean birth, which increases the morbidity and mortality risk for the birthing person and their fetus. However, dismissing a pathologic change as an adaptation of pregnancy can also cause this same increased risk. Nurses must use their hands-on assessment skills early, often, and accurately to ensure that risks for fetal and maternal morbidity and mortality are reduced.

15.4 Psychosocial Adaptations during Labor and Birth

Nurses have been the most trusted professionals for the past 20 years, according to Americans who were polled (American Nurses Association, 2023). This trust is built by caring for the whole person, including mind and body. Labor and birth are times when both mind care and body care are needed. The physiologic and sociologic changes throughout the labor and birth process are multidimensional. High-quality nursing support can make a difference in the outcomes and experiences of new parents.

15.5 Family Adaptations during Labor and Birth

Support during labor and birth can ease the intensity of these overwhelming processes. Whether this support is through a hired doula, a trusted friend, a loving partner, or an entire group including extended family, the support desired should be determined by the birthing person. Nurses should make space for this support and include the support team as much as desired by the birthing person. This continuous support is associated with improved outcomes.

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