{
  "name": "Normal Labor & Delivery",
  "slug": "labor-delivery",
  "url": "https://nursingplex.com/care-plans/labor-delivery",
  "category": "Maternal & Newborn (OB)",
  "summary": "Stages of labor care: fetal monitoring, comfort measures, progress tracking and support.",
  "nursing_diagnoses": [
    "Acute pain",
    "Anxiety",
    "Risk for fetal injury",
    "Risk for infection"
  ],
  "overview": [
    "Labor is the coordinated work of uterine contractions, cervical change and fetal descent that ends in birth. Nursing care is organized around the four stages: the first stage runs from onset of true labor to full dilation, the second from full dilation to birth of the baby, the third from birth to delivery of the placenta, and the fourth covers the first one to two hours of recovery.",
    "The first stage is subdivided into latent (0–5 cm, slow and irregular), active (6 cm to full dilation, faster and stronger) and transition phases. Most admissions and most nursing hours happen here: monitoring contraction pattern, fetal heart rate, maternal vitals, hydration, bladder emptying, positioning and pain relief.",
    "Two questions drive every assessment in labor: is the mother stable and is the fetus tolerating labor? Contractions transiently reduce placental perfusion, so the fetal heart pattern is the running report card on that tolerance. Everything else — comfort, mobility, coaching, support person involvement — is layered over those two safety questions."
  ],
  "key_facts": [
    {
      "label": "True vs false labor",
      "text": "True labor contractions grow regular, stronger and closer together, are not relieved by rest, and produce cervical change."
    },
    {
      "label": "Reassuring FHR",
      "text": "Baseline 110–160 bpm, moderate variability, accelerations present, no late or variable decelerations."
    },
    {
      "label": "Late decelerations",
      "text": "Uteroplacental insufficiency — reposition to left side, stop oxytocin, give oxygen, increase IV fluid, notify provider."
    },
    {
      "label": "Variable decelerations",
      "text": "Cord compression — reposition, consider amnioinfusion, check for prolapsed cord after rupture of membranes."
    },
    {
      "label": "Cord prolapse",
      "text": "Emergency: lift the presenting part off the cord with a gloved hand, knee-chest or Trendelenburg, call for immediate cesarean."
    },
    {
      "label": "Contraction safety",
      "text": "Contractions should last under 90 seconds with at least 60 seconds of uterine rest; more than five in ten minutes is tachysystole."
    }
  ],
  "nursing_priorities": [
    "Maintain fetal well-being through continuous or intermittent fetal monitoring.",
    "Support effective labor progress and maternal energy.",
    "Provide pain relief matched to the woman's stated plan.",
    "Prevent infection after rupture of membranes.",
    "Recognize obstetric emergencies early.",
    "Keep the woman and her support person informed and in control of decisions."
  ],
  "assessment": {
    "subjective": [
      "Contraction onset, frequency, duration and perceived strength",
      "Pain rating, location and what makes it better or worse",
      "Leaking fluid, bloody show, or vaginal bleeding",
      "Fetal movement over the last 24 hours",
      "Birth preferences, previous birth experiences and fears"
    ],
    "objective": [
      "Cervical dilation, effacement, station and fetal presentation",
      "Contraction frequency, duration and resting tone by palpation or tocodynamometer",
      "Fetal heart rate baseline, variability, accelerations and decelerations",
      "Maternal vital signs and temperature every 2–4 hours, hourly after membranes rupture",
      "Amniotic fluid color, odor and amount; meconium staining",
      "Bladder distention, intake and output"
    ],
    "related_factors": [
      "Uterine contractions and cervical stretching",
      "Fetal descent and pressure on pelvic structures",
      "Ruptured membranes and repeated vaginal examinations",
      "Maternal fatigue, dehydration and NPO status",
      "Anxiety and unfamiliar environment"
    ]
  },
  "goals": [
    "The fetus will maintain a category I heart rate tracing throughout labor.",
    "The client will report pain at or below her chosen acceptable level.",
    "The client will progress in labor without signs of infection or exhaustion.",
    "The client will verbalize understanding of each intervention before it is performed.",
    "The client will deliver with intact maternal hemodynamic stability and estimated blood loss under 500 mL vaginally."
  ],
  "interventions": [
    {
      "title": "Fetal surveillance",
      "points": [
        "Assess FHR every 30 minutes in active first stage and every 15 minutes in second stage for low-risk labor; every 15 and 5 minutes respectively for high risk.",
        "Document baseline, variability, accelerations and decelerations rather than a single number.",
        "For late or prolonged decelerations, use intrauterine resuscitation: left lateral position, stop oxytocin, IV bolus, oxygen by mask, notify provider.",
        "After every rupture of membranes, immediately check FHR and inspect for cord prolapse."
      ]
    },
    {
      "title": "Labor progress and maternal support",
      "points": [
        "Encourage upright positions, walking, birthing ball and position changes every 30 minutes to promote descent.",
        "Offer clear fluids or ice per protocol and keep the bladder empty — a full bladder slows descent.",
        "Limit vaginal exams once membranes are ruptured to reduce chorioamnionitis risk.",
        "Coach effective pushing in second stage; avoid prolonged breath-holding that reduces placental perfusion."
      ]
    },
    {
      "title": "Pain management",
      "points": [
        "Use non-pharmacologic measures first: breathing patterns, counterpressure to the sacrum, hydrotherapy, massage, focal points.",
        "For epidural, preload IV fluid, place a wedge to avoid supine hypotension, monitor blood pressure every 5 minutes for the first 15–20 minutes, and assess for bladder distention and motor block.",
        "Watch for maternal hypotension after regional anesthesia — treat with fluids, left lateral position and vasopressor per order."
      ]
    },
    {
      "title": "Third and fourth stage",
      "points": [
        "After birth, watch for placental separation signs: cord lengthening, gush of blood, globular uterus.",
        "Administer oxytocin per protocol after placental delivery and massage a boggy fundus.",
        "Assess fundus, lochia, perineum, vitals and bladder every 15 minutes for the first hour.",
        "Promote skin-to-skin contact and early breastfeeding, which also stimulates natural oxytocin."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the difference between true and false labor and when to come to the hospital.",
    "Teach paced breathing and position changes before pain becomes intense.",
    "Explain each monitoring device and what the sounds and numbers mean.",
    "Review epidural risks, benefits and the need to call for help before getting up.",
    "Prepare the support person with concrete tasks: counterpressure, ice chips, timing contractions.",
    "Describe normal postpartum bleeding and the warning signs to report."
  ]
}