Case Scenario No.

3
Intrapartum: Labor Stage 1

Guide Questions:
1. At what phase of the first stage of labor is Andrea in when she came in the hospital
for admission? Discuss the duration, frequency, interval and intensity of contractions
that Andrea is experiencing and relate these to the characteristics of contractions that
are usually expected in the said phase. (JENNILEE)
Answer:
Andrea was in her FIRST PHASE OR LATENT PHASE when she came into the hospital
for admission. Her labor pains began 5 hours ago, according to the assessment, and
the internal vaginal examination revealed that her cervix is dilated at 3 cm, 50% effaced,
with a fetal head at (-3) station, and the membranes are intact. Uterine contractions are
moderate to strong in intensity and last for 30–40 seconds, usually occurring every 4-5
jkminutes, and the patients' experience is the same with the characteristics of the first
phase or latent phase, as in the said phase, contractions are becoming more frequent
(usually 5 to 20 minutes apart) and somewhat stronger. And the cervix dilates (opens
approximately three or four centimeters) and effaces (thins out).

2. What are the signs that indicate that Andrea is experiencing true labor? Give the
reasons why these are occurring. (BRADLEY)

Andrea is experiencing true labor since she is experiencing:

Strong and regular contractions, These contractions cause the upper part of the
uterus (fundus) to tighten and thicken while the cervix and lower portion of the uterus
stretch and relax, helping the baby pass from inside the uterus and into the birth canal
for delivery.

Abdominal pains with cramping extending to lower back, caused by contractions of

the muscles of the uterus and by pressure on the cervix

Bloody show, because the cervix starts to soften and thin (efface) and widen (dilate) in
preparation for labor

Water Breaks/ Bag of water ruptured, The water breaks when the amniotic sac
ruptures. The fetus is inside this sac and surrounded by the fluid, which protects them
from injury. It is necessary for the sac to rupture so that the baby can be born
B3. Is Andrea's labor considered "normal"? Site conditions/ evidences which will tell that
her labor experience typically exemplifies normal labor. (HANNAH)

- Based on the case scenario, Andrea’s labor is considered normal for these
specific evidences;

● She first experienced abdominal pains w/ cramping extending to her lower back
which is caused by the contractions of the muscles of the uterus and by pressure
on the cervix.
● She is at 37 weeks gestation which is considered a full term and is ready to
deliver.
● Andrea was assessed and upon checking by doing the Leopold’s Maneuver, the
fetus is in a cephalic presentation wherein the baby is positioned head-down with
the chin tucked to its chest and the back of the head is ready to enter the pelvis.
● Her bag of water or the fluid-filled membranous sac called amniotic fluid ruptured
due to the force of contractions Andrea had.
● After hours of labor, an internal examination was done and showed that she is at
full 10cm with the fetal head at (+3) station ready for a normal or vaginal delivery.
● This evidence concludes that Andrea's labor is normal.

4.What specific tests/procedures, as mentioned in the scenario, will allow to measure

the heart rate of the fetus? (KARL)

In the case of Andrea, the doctor determined the Heart Rate of her Baby through
Auscultation (a method of periodically listening to the fetal heartbeat). Mentioned in the
case scenario, the use of Stethoscope to feel and measure the fetal heart tones and
beats was positioned on the Left Lower Abdominal Quadrant of Andrea and measured
at 140 beats per minute.

Other methods not mentioned in the case scenario but very helpful to determine the
fetal heart rate is Ultrasound like Fetal Heart Monitoring accompanied by Doppler
Ultrasound Device.

5.What are the evidences that Andrea's labor has progressed to the active phase of the
first stage? What are the expected changes can a woman in labor usually experience in
this phase? (JANINE)
 According to an internal examination, Andrea's cervix is 7 cm dilated, 70%
effaced, and the fetal head is at station (0), which are signs of active phase labor. There
are already 60- to 70-second contractions occurring around two minutes apart. The
changes expected during this phase of a woman is that cervix will dilate between 6 and
10 centimeters (cm) during active labor. contractions will intensify, space out, and
become regular. You might feel queasy and your legs might cramp. If it hasn't already,
you might feel your water break and feel the pressure in your back rise.

6. What are the evidences that identify that Andrea's labor has progressed to the
transition phase? What are the expected changes can a woman in labor usually
experience in this phase? (ELOISA)

The last part of active labor — often referred to as transition — can be particularly
intense and painful.
The evidences that identifies Andreas labor has progressed to the transitional phase:

● Andrea was complaining that the pain intensity is increasing. While Holding her
abdomen, she shouts and screams loudly, saying, ‘’Why does it hurt so badly! I
wish my boyfriend is here’’.
● After a while, her bag of water ruptured and bloody show was flowing out from
her vagina to her thighs.
● Internal examination was done and revealed a full 10 cm. cervical dilatation with
the fetal head at (+3) station.
● Andrea R was transferred to delivery room per stretcher.

During the third and final phase of labor, called transitional labor, the cervix will dilate to
10 centimeters as it experience strong contractions about every two to three minutes,
though it can vary. While this phase of labor is the most intense, it’s also the shortest,
generally lasting from 15 minutes to an hour (though it can sometimes take longer, like
up to about three hours). This last phase of labor can be physically demanding and
draining, but it can also be exhilarating. It may feel impatient — or elated.

7. Identify 2 main nursing diagnoses/problems that Andrea is experiencing during the

first stage of labor. Explain why these occur. (TRECIA)
● Pain related to Labor Process as manifested by abdominal pain with cramping
extending to lower back.
-It occurs because the patient experiencing abdominal pains with
cramping extending to her lower back.
 ● Risk of Anxiety related to the Labor Process as manifested by increased intensity
of pain.
-This occurs because the client complained about the intensity of the pain
is increasing and she screams, saying “Why does this hurt so badly! I wish my
boyfriend is here.”

8. What are your goals/ objectives of care basing on the 2 nursing problems that you
identified? Present the general and specific objectives of each nursing problem.
(SHEENA)

General Objective

At the end of this presentation, the participants and the audience will gain extensive
knowledge on pregnancy specifically, its labor stage. Grasp an in-depth review of pain
management associated with the labor process and improve the set of knowledge,
skills, and attitude in healthcare management rendered to the client.

Specific Objectives:

A. Knowledge

1. To be able to recognize the signs and symptoms of the client’s condition.

2. To understand appropriate nursing interventions to be applied in pain related to

labor process as manifested by abdominal pain with cramping extending to lower
back as experienced by the client.
3. To be able to grasp a holistic review of the labor stage of pregnancy and its
implications.

B. Skills

1. To improve the skills in assessing the client’s condition and provide appropriate
interventions.
2. To construct a nursing diagnosis relevant to the condition of the client.
3. To put into practice the nursing process proficiently and compliant with the data
gathered from the client.

C. Attitude
 1. To establish a therapeutic nurse-patient relationship that is based on mutual trust
and respect.
2. To strictly adhere to the nursing standards relevant to patient care.
3. To maintain professionalism and competence to effectively render appropriate
nursing services.

General Objective

At the end of this presentation,

the participants and the audience will have a comprehensive insight on the
process of labor and the associated implications in this stage of
pregnancy as well as enhance the knowledge, skills, and attitude in providing care to
the client.

Specific Objectives:

A. Knowledge

1. To determine the signs and symptoms of the client’s condition.

2. To come up with an appropriate nursing intervention in regard to the client’s risk
of anxiety related to the labor process as manifested by increased intensity of
pain.
3. To understand what health teachings must be given to the client.

B. Skills

1. To provide the necessary primary nursing care to the client.

2. To quickly assess the physical and emotional needs of the client throughout the
entire labor and delivery process.
3. To formulate a nursing diagnosis that is in line with the needs of the client

C. Attitude

1. To establish rapport and effective communication with the client.

2. To provide quality and excellence in the care of patients.
3. To deliver nursing services with empathy and in collaboration with patients,
families, and other members of the healthcare team.
9. What are your nursing responsibilities in taking care of Andrea during the first stage
of labor basing on the nursing problems that you have identified? (LEMS)
- During the First (latent) stage of labor it is very crucial. The client state of mind is
not maintained due to the pain she’s experiencing. As a nurse, it is our duty to
give our optimum care to the client. So, In Andrea's case, We should encourage
her in breathing patterns and assist comfort measures by massaging if the client
insisted. And ofcourse, we should help monitor the client and the fetus.

10. What are the necessary preparations/ nursing responsibilities that the nurse should
do/perform before bringing Andrea to the labor room? (NIKKI)
● The main duties of a labor and delivery nurse are to look after the mother and baby
(or infants) throughout the entire labor and delivery process as well as to fight for the
patient's rights. Before the labor and delivery, you should earn the mother's trust and
spend more time with the patient than anybody else. He or she must keep an eye on
the mother and child's health before labor, inform the patient and family about the
birthing process, administer medication, support the mother during labor and
pushing, interact with other healthcare professionals, help the doctor or midwife
deliver the baby, and look after the mother and child afterwards. A skilled nurse will
make a world of a difference during this life event and will tend to the woman’s
physical and emotional needs. We are there to advocate for the patient’s emotional
and physical needs, and the most important thing a nurse can offer is sensitive,
individualized support because no two women, families, or babies are the same
especially in Andrea's situation.