07.06 Precipitous Labor

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Overview

  1. Delivery of baby in 3 hours or less from beginning of labor to the end

Nursing Points

General

  1. More common in multiparous mothers
  2. Increased risk for those with a history of precipitous delivery

Assessment

  1. Rapidly progressing labor
  2. Strong close together contraction
  3. Feeling pressure to push early in labor
    1. “This baby is coming now!”
  4. Hemorrhage
  5. Tears

Therapeutic Management

  1. Prepare to potentially deliver baby if MD or midwife will not arrive in time
  2. Have supplies for delivery readily available
    1. Many ED’s and OB triage units have Precipitous Delivery Kits prepared
  3. Stay with mother, provide emotional support as pain is typically more intense and due to rapid progression and inability to administer pain meds so quickly

Nursing Concepts

  1. Safety
  2. Comfort

Patient Education

  1. Deep breathe
  2. Stay calm
  3. Focus on pushing

Reference Links

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Video Transcript

In this lesson I will explain precipitous labor and your role in providing care.

Let’s define what this is. Precipitous labor is a labor that from start to finish is under 3 hours. So labor starts and with in 3 hours we deliver a baby. This is really fast! Labor is usually 12 hours or longer for some just to give an idea. These patients are the ones that barely make it to the hospital. They deliver in the car, in the emergency room, or they are being wheeled in leaning to one side. That lean is never a good sign, it means there is a baby very close to being between her legs! So this is super fast! So who does this happen to? It can happen to anyone but those that have had multiple pregnancies and delivers are more at risk. There bodies have done this before and know what to do. Women with a history of precipitous delivery are also at risk to have this occur again.
Alright so when we assess this patient she is going to have rapid progression of labor. So contractions are close together and are strong. The patient might also have a feeling of intense rectal pressure. This is because the baby is so low in the perineum. So you might hear her saying things like “I have to push” or “This baby is coming now!” After delivery the patient needs to be assessed for a few things. This patient is at risk for hemorrhage because of the fast labor. The uterus in worn out from that very fast strong labor and bleeds. The patient also needs to be assessed for tears because the baby doesn’t have time to sit at the perineum and stretch the tissue. It flies out which tears the tissue.
Our management for this patient is going to be to quickly get prepared for delivery. I can’t tell you how many times these patients come in and quickly deliver within 5 minutes. Everything is chaos. There are many times that the labor nurse even has to delivery because the doctor doesn’t arrive in time. So all supplies need to be quickly gathered and set up. You never want to leave this patient. A baby is going to come flying out and you don’t want to miss that! Also these mothers need your support. Their body is moving quicker then their mind is so they are freaking out and need you to help keep them focused. If the patient wants pain medication and you can give it then do it. So she probably won’t be able to get an epidural if she is too far along so another option that some hospitals offer is nitrous oxide. So some laughing gas just to help take the edge of.
This patient needs some very quick education. She needs to deep breathe, stay calm, and focus on pushing when it is time. So these patients they come in and they are so out of control. All over the bed, screaming and they don’t know what is going on. Most of them want pain medication and aren’t able to get it. So you really have to get in their face, nicey, and say “hey you can do this focus and push!” After the baby delivers the mom is usually in shock. She just sits there stunned. This is the classic story. The baby usually also will be stunned. They just got evicted from their home and quickly! So I say the baby has the “help me Jesus look”. This means they just stare and are stunned, not really crying. So they need to be stimulated vigorously to breathe. So both mom and baby are a little shocked about what happened to them.

Safety and comfort are our concepts. We need to ensure safety during and after delivery as well as provide comfort to the mom as she gets through this and then processes what just happened.
Our key points for a precipitous labor is that it is a labor that from the start to end is under three hours so it is really fast! Multigravida women, so those that have had multiple babies are at risk. Their bodies have done this before and know what to do and they spit out a baby fast. Those that have a history of fast labor are at risk to do it again. If the women has a precipitous delivery she is at risk for hemorrhage because her body is like “whoa what just happened?” and can’t get it together and at risk for tears also because the baby didn’t have a chance to sit in the perineum and stretch the tissue. Remember it just flew out. Because the fetus flew out it could have bruising and also some respiratory difficulty because they didn’t get that squeeze during delivery to get all the fluid out.

Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 8

A nurse is caring for a client postpartum who just delivered her third baby precipitously. What complication should the nurse watch this client closely for?

  • Question 2 of 8

A 39-week pregnant client arrives to the labor and delivery unit. Upon cervical exam, the client is 8 cm dilated, 100% effaced, and the fetus is at +2 station. What is the priority action of the nurse?

  • Question 3 of 8

A 39-week pregnant client arrives to the L&D unit having contractions 1-2 minutes apart. What is the priority nursing action?

  • Question 4 of 8

A nurse is educating pregnant clients on the risks of illicit drug use during pregnancy. Which illicit drug can cause precipitous delivery?

  • Question 5 of 8

A pregnant woman approaches a nurse in the hospital and asks for help. She states “My water broke and it feels like the baby is coming right now!” What actions should the nurse perform in response? Select all that apply.

  • Question 6 of 8

A nurse is caring for a client and newborn after a precipitous delivery. What possible complications should the nurse be alert to? Select all that apply.

  • Question 7 of 8

A nurse is working in the emergency department when a man rushes up to her and says “I need help! My wife is in the car having intense contractions and says she is going to push the baby out right now!” Which response by the nurse is best?

  • Question 8 of 8

A pregnant client comes into the hospital in active labor; the nurse notes that her contractions are less than one minute apart. Which of the following interventions should the nurse include to manage precipitous labor?

Module 0 – OB Course Introduction

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