NU143 Unit 4 Care Plan Example

A Plan That Moves With the Labor: A Care Plan Following a Composite First-Time Mother, 24, From Active Labor at Six Centimeters Through Birth and the First Hour, With Her Written Wish to Avoid an Epidural

[Student Name]

Purdue University Global

NU143: Maternal Infant Nursing

Unit 4 Care Plan

[Instructor Name]

[Date]

The patient is composite; times and values are bracketed where illustrative, and the plan follows common labor nursing practice.

The Patient

[Ms. K.], composite, 24, gravida 1, para 0, at [39] weeks and [5] days, arrives at [0900] with contractions every [3] to [4] minutes for five hours, cervix [6] cm, membranes intact, fetal heart rate baseline [135] with moderate variability. Her written plan asks for freedom to move, intermittent monitoring if allowed, no epidural unless she asks, and immediate skin-to-skin contact. Her partner is with her.

Stage One, Active Phase: [0900] to [1200]

Priority: acute pain related to labor contractions, with the goal of coping in the way she chose. Interventions: intermittent auscultation of the fetal heart at the intervals set by protocol for low-risk labor; position changes, walking, a birthing ball and shower; counter-pressure on her lower back by her partner, who is taught how; encouraging her to empty her bladder every two hours, since a full bladder can slow descent; offering fluids. Supporting movement and limiting routine interventions in low-risk labor is consistent with national guidance (American College of Obstetricians and Gynecologists, 2019). Evaluation at [1130]: cervix [8] cm; she rates coping as "hard but okay"; fetal heart rate baseline and variability unchanged, consistent with a normal pattern (Macones et al., 2008).

Stage One, Transition: [1200] to [1300]

Priority: risk for loss of coping as contractions peak. Interventions: staying in the room continuously; short, calm instructions; breathing with her through each contraction; cool cloths; reminding her of progress. At [1215] she says she cannot go on and asks about an epidural. The nurse acknowledges her request, explains that she is at [9] cm and that an epidural takes time to place and work, and asks what she wants. She chooses to try nitrous oxide first, which the unit offers, then decides it is enough.

Her birth plan was a starting point, not a contract; the plan is revised around what she asks for at 1215, not what she wrote in advance.

Stage Two, Pushing: [1300] to [1400]

Priority: risk for maternal fatigue and perineal injury; continued fetal assessment. Interventions: allowing her to push with the urge rather than on command; upright or side-lying positions as she prefers; warm compresses to the perineum as the head crowns; fetal heart rate checks after each contraction per protocol. Evaluation: spontaneous vaginal birth at [1352] of a girl; small first-degree tear.

Stage Three and the First Hour

Priority: risk for postpartum hemorrhage; promotion of bonding. Interventions: skin-to-skin contact immediately, as she requested; oxytocin after birth per protocol; checking the fundus at [15]-minute intervals through that first hour, confirming a firm uterus at or near the navel; estimating blood loss; helping with a first breastfeed when the baby shows feeding cues (Perry et al., 2022). Evaluation: placenta delivered intact at [1401]; estimated blood loss [300] mL; fundus firm at the navel; baby latched at [1430].

What Would Have Changed the Plan

Each stage carried conditions that would have changed it. In active labor, a fetal heart rate that lost variability or showed recurrent late decelerations would have meant moving from intermittent listening to continuous monitoring and calling the provider. If her membranes ruptured, the fluid's color and the fetal heart rate would be checked at once, since meconium-stained fluid or a sudden slowing could signal a problem. In transition, if she had chosen an epidural, the plan would have added an IV fluid bolus as ordered, blood pressure checks after placement and help with position changes, since she would lose the ability to walk. In the first hour, a boggy uterus or bleeding above [500] mL would have triggered fundal massage, a call for help and the hemorrhage protocol. Writing these conditions into the plan beforehand means the nurse does not have to invent a response under pressure.

The Partner's Role

Her partner was part of the plan from the start. He was shown how to give counter-pressure on her lower back, how to offer sips of water between contractions and how to remind her to change position. During transition, when she asked for an epidural, he looked at the nurse for guidance; the nurse turned the question back to Ms. K., so the decision stayed hers. After the birth, he cut the cord and held the baby skin-to-skin while she was being checked, which kept the baby warm and gave him a role he later described as the best part of the day.

Reflection on the Plan

The care plan worked because each stage had its own priority and its own evaluation. A single plan for the whole labor would have kept pain management at the top long after hemorrhage risk had become the more important problem.

References

American College of Obstetricians and Gynecologists. (2019). Approaches to limit intervention during labor and birth (Committee Opinion No. 766). Obstetrics & Gynecology, 133(2), e164-e173. https://doi.org/10.1097/AOG.0000000000003074

Macones, G. A., Hankins, G. D. V., Spong, C. Y., Hauth, J., & Moore, T. (2008). The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: Update on definitions, interpretation, and research guidelines. Obstetrics & Gynecology, 112(3), 661-666. https://doi.org/10.1097/AOG.0b013e3181841395

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.