Precipitous Labor Essay

Labor, from beginning of true contractions to the delivery of the infant and placenta, typically lasts 9-19 hours. Precipitous labor is labor that lasts less than 3 hours, resulting in a precipitous birth, an emergency situation that could cause trauma to the mother and infant. There are many reasons for this anomaly, a large pelvis, small fetus in the optimal position or a previous precipitous birth. Any of these factors in conjunction with intense contractions results in a rapid decent of the fetus through the birth canal. This rapid expulsion could lead to head trauma in the fetus. The mother, enduring the tumultuous contractions, could receive lacerations to the vagina, cervix, urethra, perineal area or uterine rupture. The mother is also at a higher risk for amniotic fluid embolus and postpartum hemorrhage. Precipitous labor accounts for roughly 2% of births in the United States. A history of precipitous labor is the greatest significant risk factor for subsequent rapid deliveries. According to Ladewig, London and Davidson, women with a history of precipitous labor should be monitored closely and generally are suggested to induce labor around 38 weeks gestation to ensure the safety of the mother and fetus. Considering the nature of labor, however, there are no guarantees as to when labor may begin. If a pregnant client presents with intense contractions with little uterine relaxation in between and the client states contractions started within the hour, precipitous labor should be suspected. A thorough history should be obtained as quickly as possible, including any previous precipitous births, any childbirth preparations and a family history of precipitous labor. Leopold’s Maneuvers should be performed to determine the fetal position, if abnormal position is definite, the OR may need to be notified. During the cervical examination, any bulging of the perineal area, crowning, rectal distention, feces, increased vaginal discharge should be noted. A fetal heart monitor needs to be placed either externally or internally if there is time. A contraction monitor, called a tocodynameter, should be placed around the client’s abdomen. Check dilation, greater than 5cm per hour should initiate precipitous labor procedures. Most facilities have a prepared pack for such an emergency for advanced nurses to utilize in the event the doctor or midwife isn’t present. Risk for injury related to rapid labor and birth is the most common concern for the mother and fetus. There are no tests to determine if the client will experience precipitous labor, however there are a few tests to determine if the client is, in fact, in labor and her water has broke. The fern test is done by swabbing the posterior vaginal pool being sure to avoid the mucous plug located in the cervix. After the sample has been collected, smear the swab onto a glass slide. Once the slide is air dry, if the membranes have ruptured, the crystals that appear on the slide will make a fern-like shape. A pH test may also be done to confirm the rupture of membranes. Nitrazine paper is used to detect the vaginal pH of mothers expected of having ruptured membranes. The paper contains an indicator dye Phenaphthazine that changes color depending on the pH. Amniotic fluid pH is approximately 6. 5. The Nitrazine paper is wrapped around gloved fingers and inserted into the vagina. The results are positive for amniotic fluid if the paper turns blue. These tests are rarely done in this situation due to the time constraints. Labor is best controlled in a medical facility if time permits and in most cases, with the use of many different drugs ordered by an attending physician. During a doctor guided labor the client is given an IV and started on fluids, in most cases it is normal saline running at approximately 125ml/hr. Oxytocin is then started if the contractions are not productive or set aside to use after delivery to help prevent hemorrhage. If the client requests pain medication it is started when the client is dilated to 4-5cm. Most women choose an epidural, a form of regional analgesia where an anesthetic such as lidocaine or an opioid like morphine is injected into the epidural space via a catheter that remains in place until the procedure is over. This causes a loss of sensation and pain by blocking the signals through nerves in or near the spinal cord. IV injections of opioid analgesics such as Stadol and Nubain are available if the patient wishes to forego the invasion into the spine. In some instances, such as preterm labor, a tocolytic may also be ordered to slow or stop contractions. Magnesium sulfate or ritodrine is the most common however studies show that Nifedipine is more effective and safer. According to P.  Berstein (2004), a 2002 analysis of 12 controlled studies found nifedipine more effective and clearly safer. The nifedipine-treated neonates had a decreased risk of respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage. During a midwife labor, in majority of births, the client has pre-chosen a natural or drug free birth. Because precipitous labor is so rapid pain medications of any sort are contraindicated and unless the pregnancy is severely preterm, the physician will not offer tocolytics just to reduce contractions. If time permits, an IV may be started before delivery but, is not of the utmost concern. Labor is a very terrifying experience even when it is considered to have gone normally. Precipitous labor is even more so due to the extreme fast pace and increased probability something will go wrong. There is no prevention of precipitous labor because it is not fully understood why it happens. Planned induction is the best way to ensure that delivery occurs at a medical facility and is the safest way for the mother and child. Teaching the mother and support person the signs of true labor, the possible risks to the mother and infant and the importance of induction are essential to a successful precipitous labor. Although precipitous labor is rare, it is a medical emergency that requires quick actions and smart thinking. There is no prevention only education and thoughtful planning. Women who experience this anomaly are insanely scared and tolerate an enormous amount of pain but, with the proper preparation trauma can be limited and safety can be assured.