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18.1 Nursing Care During the First Stage of Labor

Starting at the time the laboring person arrives in the obstetric triage unit, the nurse establishes a relationship with the person during this first stage in the process of becoming a parent. The nurse’s role throughout the first stage of labor can be a simple task, such as obtaining ice chips for dry mucous membranes, or more complex, such as facilitating epidural anesthesia for pain control measures. Whether the care is as simple as getting ice chips or as complicated as fetal monitor interpretation, the nurse is the care provider at the bedside. Knowledge of the process of labor and birth, pain management techniques, fetal and contraction monitoring, and monitoring for complications is applied by the nurse caring for a person throughout the first stage of labor.

18.2 Nursing Care During the Second Stage of Labor

The second stage of labor is an exciting time for families. The birthing person is now fully dilated, and the birth of the newborn is near. When it is time for pushing, the nurse will be available to direct the birthing person with pushing efforts when necessary. During the second stage, the nurse will also assist the birthing person with pain management, positioning, and the birth itself while monitoring the fetus and birthing person continuously.

18.3 Nursing Care During the Third Stage of Labor

The third stage of labor starts immediately after the delivery of the newborn and ends with the delivery of the placenta. Nursing care during the third stage of labor includes assessment of the birthing person and newborn. The nurse will need to assess the birthing person’s vital signs, pain or discomfort, bleeding, uterus, and bladder. For the newborn, the nurse will assess vital signs, assign an Apgar score, and monitor the newborn’s temperature throughout the third stage of labor. The nurse may also initiate skin-to-skin contact between the newborn and the birthing person, while also coordinating clamping of the umbilical cord. The nurse must be aware of potential complications during the third stage of labor related to placental separation and expulsion, such as postpartum hemorrhage.

18.4 Nursing Care During the Fourth Stage of Labor

The fourth stage of labor is a vital time for the nurse to prevent complications while promoting family bonding. Skin-to-skin contact between the newborn and parent can promote bonding and breast-feeding. The nurse will continue to monitor for postpartum bleeding and other postdelivery complications. Patient education is also important during this time, as the birthing person and their partner are learning about their newborn and may be new to parenting. The nurse must provide clinical and emotional support for the birthing person and their family, keeping in mind cultural and personal preferences.

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