36 Labor Stages, Induced and Augmented Labor Nursing Care Plans


Labor is defined as a series of rhythmic, involuntary, progressive uterine contraction that causes effacement and dilation of the uterine cervix. It is a physiologic process during which the fetus, membranes, umbilical cord, and placenta are expelled from the uterus (Milton & Isaacs, 2019). The process of labor and birth is divided into three stages.

The first stage of dilatation begins with the initiation of true labor contractions and ends when the cervix is fully dilated. The first stage may take about 12 hours to complete and is divided into three phases: latent, active, and transition. The latent or early phase begins with regular uterine contractions until cervical dilatation. Contractions during this phase are mild and short, lasting 20 to 40 seconds. Cervical effacement occurs, and the cervix dilates minimally.

The active phase occurs when cervical dilatation is at 6 to 7 cm and contractions last from 40 to 60 seconds with 3 to 5 minutes intervals. Bloody show or increased vaginal secretions and perhaps spontaneous rupture of membranes may occur at this time. 

The last phase, the transition phase, occurs when contractions peak at 2 to 3-minute intervals and dilatation of 8 to 10 cm. If it has not previously occurred, the show will occur as the last mucus plug from the cervix is released. By the end of this phase, full dilatation (10 cm) and complete cervical effacement have occurred.

The second stage of labor starts when cervical dilatation reaches 10 cm and ends when the baby is delivered. The fetus begins the descent, and as the fetal head touches the internal perineum to begin internal rotation, the client’s perineum begins to bulge and appear tense. As the fetal head pushes against the vaginal introitus, crowning begins, and the fetal scalp appears at the opening to the vagina.

Lastly, the third stage, or the placental stage, begins right after the baby’s birth and ends with the delivery of the placenta. Two separate phases are involved: placental separation and placental expulsion. Active bleeding on the maternal surface of the placenta begins with separation, which helps to separate the placenta further by pushing it away from its attachment site. Once separation has occurred, the placenta delivers either by natural bearing down the client’s effort or gentle pressure on the contracted uterine fundus.

There are instances where labor does not start on its own, so when the risks of waiting for labor to start are higher than the risks of having a procedure to get labor going, inducing labor may be necessary to keep the client and the newborn healthy. This may be the case when certain situations such as premature rupture of the membranes, post-term pregnancy, hypertension, preeclampsia, heart disease, gestational diabetes, or bleeding during pregnancy are present.

Nursing Care Plans

The nursing care plan for a client in labor includes providing information regarding labor and birth, providing comfort and pain relief measures, monitoring the client’s vital signs and fetal heart rate, facilitating postpartum care, and preventing complications after birth.

Here are 36 nursing care plans (NCP) and nursing diagnoses for the different stages of labor, including care plans for labor induction and labor augmentation:


Labor Stage III: Placental Expulsion

The third stage of labor, also known as placental expulsion, begins with the infant’s birth until the delivery of the placenta. The signs of placental expulsion are lengthening of the umbilical cord, a sudden gush of vaginal blood, changes in the shape of the uterus and its firm contraction, and the appearance of the placenta at the vaginal opening. Nursing care plans for placental expulsion or the third labor stage include the following:

  1. Acute Pain
  2. Knowledge Deficit
  3. Risk For Fluid Volume Deficit
  4. Risk For Maternal Injury
  5. Risk For Altered Family Process

Acute Pain

Intermittent uterine contractions may cause afterpains similar to menstrual cramps. Afterpains occur more often in multiparas or clients whose uterus was overly distended. The perineum is often edematous, tender, and bruised. An episiotomy may have been performed, or a perineal laceration may have occurred, which is frequently the cause of pain following placental delivery. Pain control is essential to reduce the client’s distress and facilitate movement to prevent several complications.

Nursing Diagnosis
  • Acute Pain
May be related to

Common related factors for this nursing diagnosis:

  • Physiological response following delivery
  • Tissue trauma
Possibly evidenced by

The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Changes in muscle tone
  • Restlessness
  • Verbalizations
Desired Outcomes

Common goals and expected outcomes:

  • The client will verbalize management/reduction of pain.
  • The client will state that pain relief is adequate with pharmacological and nonpharmacological measures.
Nursing Assessment and Rationales

Here are the nursing assessment cues for this labor nursing care plan.

1. Assess the client’s level of pain.
The severity, frequency, character, and location of discomfort should be assessed. Use a scale of 0 to 10 to evaluate the pain level before and after interventions. This provides a more objective way for the nurse to evaluate the client’s subjective experience of pain. Also, it evaluates the adequacy of pain relief. The scale helps the nurse choose the most appropriate relief methods and provides a method to evaluate the amount of relief the client receives from the pain interventions.

2. Assess the extent of lacerations to the perineal and cervical tissues.
Small lacerations or tears of the birth canal are common and may be considered a normal consequence of childbearing. Perineal lacerations are more apt to occur when the client is placed in a lithotomy position for birth because this position increases tension on the perineum.

3. Assess for signs of perineal hematomas.
A perineal hematoma is a collection of blood in the subcutaneous layer of tissue of the perineum. The overlying skin, as a rule, is intact with no noticeable trauma. Hematomas are most likely to occur after rapid, spontaneous births and in clients with perineal varicosities. If the client reports severe pain in the perineal area or a feeling of pressure between her legs, inspect the perineal area to see if a hematoma could be causing this.

Nursing Interventions and Rationales

Below are the nursing interventions for this labor nursing care plan.

1. Apply ice bags to the perineum after delivery.
An ice pack or a chemical cold pack is applied for the first 12 to 24 hours to reduce edema and bruising and numb the perineal area. Cover the ice with a towel to prevent injury to the skin. A disposable rubber glove filled with ice chips and taped shut at the wrist can also be used. The cold pack is left off for 10 minutes when the ice melts before applying another for maximum effect. Sitting in a cool sitz bath, adding ice cubes, and remaining in the water for 20 minutes often provides immediate pain relief.

2. Apply a warm pack to the perineum or provide a sitz bath after 24 hours.
After 24 hours, heat in a warm chemical pack, a bidet, or a sitz bath increases circulation and promotes healing. The sitz bath may circulate either cool or warm water over the perineum to cleanse the area and increase comfort.

3. Provide a heated blanket.
Post-delivery tremors/chills may be caused by a sudden release of pressure on pelvic nerves or related to a fetus-to-mother transfusion occurring with placental separation. Warmth promotes muscle relaxation and enhances tissue perfusion, reducing fatigue and enhancing a sense of well-being.

4. Provide an air ring or “donut” during sitting.
To reduce pain when sitting, the client can be taught to squeeze her buttocks together as she lowers herself to a sitting position and then relax her buttocks. When sitting, an air ring or “donut” takes the pressure off the perineal area. The client should inflate the ring about halfway because she may wobble on a fully inflated ring. A small egg crate is an alternative to the air ring.

5. Assist with breathing techniques during surgical repair, as appropriate.
Breathing techniques help direct attention away from the discomfort, promote relaxation. They are largely distraction techniques because the client concentrating on slow-paced breathing cannot concentrate on the pain.

6. Promote lavender in any form to relieve perineal pain.
The use of lavender for episiotomy in several studies showed a significant reduction in inflammation and pain compared with placebo and other available methods, with no reported side effects. Using lavender in any form (aromatherapy or topical application) and any duration (every day of use from 1 to 10 days) leads to reduced pain and improved healing in episiotomy wounds (Abedian et al., 2020).

7. Administer medications to relieve or reduce pain.
Topical and systemic medications may be used to relieve perineal pain. Topical perineal medications such as hydrocortisone or benzocaine reduce inflammation or numb the perineum. Mild analgesics may be prescribed for the afterpains. However, aspirin is not used postpartum because it interferes with blood clotting.

Knowledge Deficit

The third stage of labor is the time from the baby’s birth until the placenta is delivered. For most clients, this is a time of great excitement because the infant has been born, but this can also be a time of feeling anticlimactic because the infant has finally arrived after being anticipated for so long. The nurse must adapt care to the client’s circumstances, such as those of the single or adolescent parent and families from other cultures. 

Nursing Diagnosis
  • Knowledge Deficit
May be related to

Common related factors for this nursing diagnosis:

  • Lack of information or recall
  • Misinterpretation of information
  • Cognitive limitation
Possibly evidenced by

The common assessment cues could serve as defining characteristics or part of your “as evidenced by” in your diagnostic statement.

  • Lack of cooperation
  • Verbalizations of questions/concerns
  • Inappropriate or exaggerated behaviors
Desired Outcomes

Common goals and expected outcomes:

  • The client will verbalize an understanding of physiological responses.
  • The client will actively engage in efforts to push to promote placental expulsion.
Nursing Assessment and Rationale

The following are the nursing assessment for this labor nursing care plan.

1. Ascertain the client’s ability to learn and any cultural concerns.
The client may not be physically, mentally, or emotionally capable at the time to receive new information. The nurse may also need an interpreter to understand and provide optimal care to the client and her family. Cultural preferences influence the presence of partners, parents, siblings, and children in the labor and delivery room.

Nursing Interventions and Rationales

Here are the nursing interventions for this labor nursing care plan.

1. Explain why such behavioral responses are chills and leg tremors.
Understanding helps the client accept such changes without anxiety or undue concern. Chills may be due to the low temperature of a birthing room. Still, they may also result from the sudden release of pressure on pelvic nerves or excess epinephrine production during labor. The nurse may reassure the client that this is a transitory sensation, is very common, and passes quickly.

2. Discuss/review normal processes of stage III labor.
This provides an opportunity to answer questions/clarify misconceptions, enhancing cooperation with the regimen. Inform the client that the placenta will deliver spontaneously following most births. However, delivery up to 30 minutes is normal.

3. Advise the client to ask for assistance when planning to move or get out of bed.
When placed in the postpartum unit following delivery, all postpartum clients should be informed of the availability of assistance- and the advisability of asking for it the first time they get out of bed to prevent accidental falls. The first time the client gets out of bed, she is at increased risk for a fall because of the physiological events during delivery that can cause unstable blood pressure and syncope.

4. Discuss routine for recovery period during the first 4 hr following delivery. Orient the client to new staff and unit if a transfer occurs at the end of this stage.
This provides continuity of care and reassurance and enhances cooperation. Following the third stage of labor, there is a fall in the blood levels of placental hormones, human placental lactogen, human chorionic gonadotropin, estrogen, and progesterone that help return the body to the pre-pregnant state. The most dramatic changes after birth occur in the client’s reproductive system.

5. Inform the client if pharmacological interventions are needed during this stage.
If the client’s uterus has not contracted firmly on its own, the primary care provider will massage the fundus to urge it to contract. Oxytocin may be prescribed to be administered intramuscularly or per 1,000 ml fluid intravenously to also help contraction. Inform the client of these interventions to prevent apprehension on why medications are being given during this period.

Risk For Deficient Fluid Volume

An integral component of the birth process, the third stage of labor, is defined as the period from the delivery of the fetus to the delivery of the placenta and membranes. It is a normal physiologic period laden with possibilities of compromise, the most common being postpartum hemorrhage (PPH). The four most probable causes of bleeding in stage 3 begin with the letter T: Tone (uterine atony), Trauma (torn vessel, cervical or vaginal laceration), Tissue (placental or amniotic fragments, uterine rupture), and Thrombin (maternal bleeding disorders).

Nursing Diagnosis
  • Risk For Deficient Fluid Volume
May be related to

Common related factors for this nursing diagnosis:

  • Diaphoresis
  • Increased insensible water loss
  • Lack/restriction of oral intake
  • Lacerations of the birth canal
  • Retained placental fragments
  • Uterine atony
  • Vomiting
Possibly evidenced by
  • Signs and symptoms do not evidence a risk diagnosis. Interventions are directed at prevention. 
Desired Outcomes

Common goals and expected outcomes:

  • The client will display BP and heart rate within the normal limits, palpable pulses.
  • The client will demonstrate adequate contraction of the uterus with blood loss within the normal limits.
Nursing Assessment and Rationales

Here are the nursing assessment techniques for this labor nursing care plan.

1. Assess vital signs before and after administering oxytocin.
Because oxytocin causes hypertension by vasoconstriction, be certain to obtain a baseline blood pressure measurement before administration. Obtain vital signs every 15 minutes for the first hour and then according to agency policy or the client’s condition. Pulse and respiration may be fairly rapid immediately after birth, and blood pressure may be slightly elevated due to exertion and excitement of the moment or recent oxytocin administration.

2. Monitor for signs and symptoms of excess fluid loss or shock (i.e., check BP, pulse, sensorium, skin color, and temperature).
Hemorrhage associated with a fluid loss greater than 500 ml may be manifested by increased pulse, decreased BP, cyanosis, disorientation, irritability, and loss of consciousness. If the loss of blood is extremely copious, the client will quickly begin to exhibit symptoms of hypovolemic shock such as falling blood pressure; a rapid, weak, or thready pulse; increased and shallow respirations; pale, clammy skin; and increasing anxiety.

3. Inspect maternal and fetal surfaces of the placenta. Note size, cord insertion, intactness, vascular changes associated with aging, and calcification (possibly contributing to abruption).
If the placenta separates at its center and edges, it tends to fold on itself like an umbrella and presents at the vaginal opening with the fetal surface evident. Approximately 80% of placentas separate and present this way. Appearing shiny and glistening from the fetal membranes, this is called a Schultze presentation. If the placenta separates first at its edges, it may look raw, red, and irregular, with the ridges or cotyledons that separate blood collection spaces evident; this is called a Duncan presentation. Record which way the placenta is presented.

4. Obtain and record information related to inspection of uterus and placenta for retained placental fragments.
The uterus needs to be inspected after delivery to ensure it is intact and part of it was not retained. Retained placental tissue can contribute to postpartal infection and immediate or delayed hemorrhage. If detected, the fragments should be removed manually or with appropriate instruments.

5. Obtain and record information related to inspection of the birth canal for lacerations.
A laceration is an uncontrolled tear of the tissues resulting in a jagged wound. Lacerations of the perineum, vagina, cervix, or area around the urethra (periurethral lacerations) can cause postpartum bleeding. The vascular beds are engorged during pregnancy, and bleeding can be profuse. Blood lost in lacerations is usually a brighter red than lochia and flows in a continuous trickle.

6. Palpate uterus; note “ballooning.”
Palpate the client’s fundus for size, consistency, and position. A rapid contraction of the uterus accomplishes the sealing of the placenta site immediately after the delivery of the placenta. Because uterine contraction begins immediately after placental delivery, the fundus is palpable through the abdominal wall, halfway between the umbilicus and the symphysis pubis, within a few minutes after birth.

7. Assess and record the characteristics, amount, and site of the bleeding, including the stage of labor.
The amount of blood loss and blood clots will help determine the necessary interventions. The characteristics and quantity of blood passed can suggest excessive bleeding. For example, bright red blood is arterial and can indicate lacerations of the genital tract; meanwhile, dark red blood is likely of venous origin and may indicate superficial lacerations or varices of the birth canal. Spurts of blood with clots can indicate partial placental separation, and failure of the blood to clot or remain clotted may indicate coagulopathy, such as disseminated intravascular coagulation.

8. Assess the lochia for color, quantity, and clots.
Observing the lochia provides for an estimate of the actual blood loss. Lochia rubra should be dark red. During the first few hours, the amount of lochia should be no more than one saturated perineal pad per hour. Small clots may appear in the drainage, but large clots are not normal.

9. Assess for the presence of a vulvar and vaginal hematoma.
A hematoma is a collection of blood within the tissues. It may result from birth trauma and appear as a bulging or purplish mass. The client may also develop signs of concealed blood loss if the hematoma is large. Larger ones may require incision and drainage of the clots. Signs of concealed blood loss accompanied by maternal complaints of severe pain, perineal or vaginal pressure, or inability to void should be reported. Small hematomas usually resolve without treatment or with cold application.

10. Count and weigh perineal pads.
It is difficult to estimate the amount of blood a postpartal client loses because it is difficult to estimate the amount of blood it takes to saturate a perineal pad (between 25 and 50 ml). By counting the number of perineal pads saturated in given lengths of time, such as half-hour intervals, a rough estimate of blood loss can be formed. Five pads saturated in half an hour is different from five pads saturated in 8 hours. Weighing the perineal pads before use and then subtracting the difference is an accurate technique to measure vaginal discharge: 1 g of weight is comparable to 1 ml of blood volume.

11. Record time and mechanism of placental separation, i.e., Duncan’s mechanism (placenta separates from the inside to outer margins) versus Schulze’s mechanism (placenta separates from outer margins inward).
Separation should occur within 5 min after birth. Duncan’s separation mechanism carries an increased risk of retained fragments, necessitating close inspection of the placenta. Failure to separate may require manual removal. The more time it takes for the placenta to separate, and the more time the myometrium remains relaxed, the greater the blood loss.

Nursing Interventions and Rationales

Here are the nursing interventions for this labor nursing care plan.


1. Massage the uterus gently after placental expulsion.
Myometrium contracts in response to gentle tactile stimulation, reducing lochial flow and expressing blood clots. Even if the uterus responds well to massage, the problem may not be completely resolved with uterine atony. As soon as you remove your hand from the fundus, the uterus may relax, and the lethal seepage will begin again. To prevent this, remain with the client after massaging her fundus and assess to be certain her uterus is not relaxing again.

2. Place infant at client’s breast if she plans to breastfeed.
Suckling stimulates the release of oxytocin from the posterior pituitary, promoting myometrial contraction and reducing blood loss. Regarding the effect of early and late breastfeeding on the fundal level and uterine consistency, a study revealed that the majority of women in the early breastfeeding group had firm uterus below the level of the umbilicus compared to mothers in the late breastfeeding group. The oxytocin encourages the uterus to contract. This uterine contraction improves the genital tract involution so that the uterus of the lactating woman goes back to pre-pregnant condition faster (Al Sabati & Mousa, 2019).

3. Elevate fundus by dipping fingers down behind and moving the uterine body up away from symphysis pubis.
The practitioner may request this to facilitate internal examination. The nurse may also elevate the client’s lower extremities to improve circulation to essential organs.

4. Apply an ice pack on the hematomas if indicated.
The cold application can limit small hematoma because applications reduce blood flow to the area. Cold also numbs the area and makes the client more comfortable. Apply an ice pack covered with a towel to prevent thermal injury to the skin to prevent further bleeding. Larger ones may require incision and drainage of the clots.

5. Educate the client and significant others on identifying the signs and symptoms that need to be reported urgently.
Signs and symptoms of a possible cause of bleeding should be reported. A continuous trickling of blood can result in much or more blood loss than the dramatic bleeding associated with uterine atony. The nurse should also teach the client what to expect about changes in the lochia. Instruct the client to report the following signs of late postpartum hemorrhage: persistent bright red bleeding and return of red bleeding after it has changed to pinkish to whitish. 

6. Apply controlled cord traction (CCT) on the umbilical cord as appropriate.
Force may contribute to breakage of the cord and retention of placental fragments, increasing blood loss. However, in settings where skilled birth attendants are available, CCT is recommended for vaginal births if the care provider and the parturient woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labor as important. This recommendation is based on a large RCT in which oxytocin 10 IU was used to prevent postpartum hemorrhage (PPH) in all participants. Based on this evidence, CCT was regarded as safe when applied by skilled birth attendants. It provides small beneficial effects on blood loss (average reduction in blood loss of 11 ml) and the duration of the third stage of labor (average reduction of 6 minutes). The care provider should discuss the decision to implement CCT in the context of a prophylactic uterotonic drug with the woman (World Health Organization, 2018).

7. Insert an indwelling Foley catheter (IFC) as ordered.
Catheterization will accurately measure the renal status and perfusion concerning fluid volume. Additionally, bladder distention is an easily corrected cause of uterine atony. The nurse should catheterize the client if she cannot urinate on the toilet or in a bedpan. Most healthcare providers include an order for catheterization to prevent delaying this corrective measure. After the uterus is firm from massage, the bladder should be emptied to keep the uterus firm.

8. Administer fluids through the parenteral route.
If fluid loss is excessive, parenteral replacement helps restore circulating volume and oxygenation of vital organs. Initial fluid replacement with a balanced crystalloid solution is recommended (102 mL of crystalloid for every 1 mL of blood loss). One randomized controlled trial in severe PPH found a very low incidence of fibrinogen depletion and coagulopathy when clients with an estimated blood loss of 1,400-2,000 mL were resuscitated with crystalloids (Muñoz et al., 2019).

9. Administer oxytocin (Pitocin) through the IM route or dilute IV drip in an electrolyte solution. IM methylergonovine maleate (Methergine) or prostaglandins may be given simultaneously.
Oxytocin promotes vasoconstrictive effect within the uterus to control postpartal bleeding after placental expulsion. IV bolus may result in maternal hypertension. Water intoxication may occur if an electrolyte-free solution is used. Oral misoprostol was regarded as an effective drug for the prevention of PPH. However, the relative benefits of oxytocin compared to misoprostol have been considered in preventing blood loss and the increased adverse effects of misoprostol compared to oxytocin.

10. Administer fresh whole blood or other blood products as indicated.
Fresh frozen plasma should be considered in massive ongoing PPH when there is a clinical suspicion of coagulopathy and laboratory tests are not normal. RBC transfusion should only be considered when the hemoglobin concentration is less than 7 g/dL. Platelets should be transfused when the count is <75×10⁹/L, aiming to maintain a level >50×10⁹/L during ongoing PPH (Muñoz et al., 2019).

11. Assist with repairing the cervix, vagina, and episiotomy extension.
Lacerations contribute to blood loss; can cause hemorrhage. Perineal lacerations are sutured and treated the same as an episiotomy repair. Both sutured lacerations and episiotomy incisions tend to heal in the same length of time. Vaginal repairs can be tricky, as vaginal tissue is friable. Oozing often occurs after a vaginal repair, so the vagina may be packed to maintain pressure on the suture line.

12. Assist as needed with manual removal of the placenta under general anesthesia and sterile conditions.
Hemorrhage stops once placental fragments are removed and the uterus contracts, closing venous sinuses. Removing the retained placental fragment is necessary to stop the bleeding and can usually be accomplished by a dilatation and curettage (D&C). If it cannot be removed, methotrexate may be prescribed to destroy the retained fragment.

Risk For Injury (Maternal)

Traumatic causes during delivery would include injury to the soft tissue and lacerations of the cervix or vaginal walls, especially if instrumental operative delivery using forceps or vacuum was performed. Uterine rupture and uterine inversion, although rare, are traumatic obstetric emergencies and lead to significant blood loss. At the time of delivery, the maternal surface of the placenta should be carefully inspected to ensure that no fragments are missing. The fetal surface is then examined, with particular attention to the margins, to look for severed blood vessels that may have led to a succenturiate placental lobe (Burke, 2010).

Nursing Diagnosis
  • Risk for Injury (Maternal)
May be related to

Common related factors for this nursing diagnosis:

  • Abnormal blood profile
  • Difficulty with placental separation
  • Positioning during delivery/transfers
Possibly evidenced by
  • Signs and symptoms do not evidence a risk diagnosis. Interventions are directed at prevention. 
Desired Outcomes

Common goals and expected outcomes:

  • The client will observe safety measures.
  • The client will be free of injury.
Nursing Assessment and Rationales

Below are the nursing assessment for this labor nursing care plan.

1. Assess the client’s respiratory rhythm and blood pressure.
With placental separation, the danger exists that an amniotic fluid embolus may enter maternal circulation, causing pulmonary emboli, or that fluid changes may result in emboli mobilization. Amniotic Fluid embolism is characterized by abrupt onset of hypotension, respiratory distress, and coagulation abnormalities triggered by the thromboplastin contained in the amniotic fluid. A pulse oximeter may be used to monitor the client’s oxygen saturation. 

2. Assess client’s behavior, noting central nervous system (CNS) changes.
Increased intracranial pressure (ICP) during pushing and a rapid increase in cardiac output place the client with a preexisting cerebral aneurysm at risk for rupture. Idiopathic intracranial hypertension, although rare, increases the risk of increased ICP during labor due to pushing and pain. This can be controlled by an instrumental delivery and adequate analgesia during labor and delivery (Dominguez et al., 2017).

3. Palpate fundus to note “ballooning” of the uterus, and massage gently.
This helps identify relaxation of the uterus and subsequent bleeding into the uterus and facilitates placental separation. Palpate the client’s fundus for size, consistency, and position. The sealing of the placenta site is accomplished by a rapid contraction of the uterus immediately after the delivery of the placenta. Because uterine contraction begins immediately after placental delivery, the fundus is palpable through the abdominal wall, halfway between the umbilicus and the symphysis pubis, within a few minutes after birth.

4. Assess the client’s risk for falls.
After childbirth, resistance to blood flow in the vessels of the pelvis drops. As a result, the client’s blood pressure falls when she sits or stands, and she may feel dizzy or lightheaded. The first time the client gets out of bed, she is at increased risk for a fall because of the physiological events during delivery that can cause unstable blood pressure and syncope. Guidance and assistance are needed during early ambulation to prevent injury.

5. Assess the client’s bladder for distention.
To prevent permanent damage to the bladder from overdistention, assess the client’s abdomen frequently in the immediate postpartal period. On palpation, a full bladder is felt like a hard or formed area just above the symphysis pubis. On percussion (placing one finger flat on the client’s abdomen over the bladder and tapping it with the middle finger of the other hand), a full bladder sound resonant, in contrast to the dull, thudding sound of non-fluid-filled tissue.

6. Obtain a sample of cord blood; send to the laboratory for blood typing of newborn and banking as desired—record information regarding the sample being sent.
If the infant is Rh-positive and the client is Rh-negative, the client will require immunization with Rh immune globulin (Rh Ig) in the postpartal period. Cord blood contains hematopoietic stem cells that have a distinct advantage over bone marrow or peripheral stem cells for use in the treatment of multiple diseases such as immune, genetic, or neurological disorders.

Nursing Interventions and Rationales

Here are the nursing interventions for this labor nursing care plan.

1. Remove the client’s legs simultaneously from the leg supports if used.
Ambulation and limiting the time the client remains in obstetric stirrups encourages circulation in the lower extremities, promotes venous return, and decreases the possibility of clot formation, thus helping to prevent thrombophlebitis. If stirrups on examining tables or birthing rooms are used, be certain that they are well padded to prevent any sharp pressure against the calves of the legs and that the client remains in a lithotomy position for as short a time as possible.

2. Gently massage fundus after placental expulsion.
This enhances uterine contraction while avoiding overstimulation/trauma to the fundus. A poorly contracted (soft or boggy) uterus should be massaged until firm to prevent bleeding. It is essential not to push down on an uncontracted uterus to avoid inverting it.

3. Clean the vulva and perineum with sterile water and antiseptic solution; apply a sterile perineal pad.
This removes possible contaminants that might result in an ascending tract infection during the postpartal period. Teach the client to do perineal care after each voiding or bowel movement to cleanse the area without trauma. Perineal pads should be applied and removed in the same front-to-back direction to prevent fecal contamination of the perineum and vagina.

4. Assist the client when changing positions or sitting on the bed.
Advise the client always to sit up slowly and dangle her feet on the side of her bed before attempting to walk. If she notices obvious dizziness on sitting upright, support her during ambulation to avoid the possibility of a fall. Caution her not to attempt to walk carrying her newborn until her cardiovascular status adjusts to her blood loss.

5. Encourage the client to empty her bladder frequently.
If the client can ambulate, she should urinate in the bathroom. The first two or three voidings after birth or after catheter removal are measured. Provide her as much privacy as possible, but remain near her in case she may need assistance. Turning on running water or having the client squirt warm water over her perineal area to relax and stimulate the urethral sphincter may help her void.

6. Assist in transfer from delivery bed to recovery cart, as appropriate.
Although many clients remain in the labor/ delivery bed for the recovery period, if a transfer is required, the client may be unable to move lower limbs due to continued effects from anesthesia/leg “heaviness” or cramping. Additionally, a major complication in clients who have lost an appreciable amount of blood with birth is orthostatic hypotension or dizziness that occurs on standing because of the lack of adequate blood volume to nourish brain cells.

7. Use ventilatory assistance if needed.
Respiratory failure may occur following amniotic or pulmonary emboli. Treatment includes providing respiratory support with intubation and mechanical ventilation as necessary. The client may be transferred to the intensive care unit for closer monitoring and nursing care.

8. Administer Rho (D) immune globulin or rubella immunization, if indicated.
The Rh-negative mother should receive a dose of Rho (D) immune globulin (RhoGAM) within 72 hours after giving birth to an Rh-positive newborn. This prevents sensitization to Rh-positive erythrocytes that may have entered her bloodstream when the newborn was born. A mother who did not receive a rubella titer early in pregnancy should receive one in the immediate postpartum period to prevent infection with the rubella virus, which could cause congenital disabilities. Consent is needed for these vaccines.

If uterine inversion occurs:

9. Administer prophylactic antibiotics.
Uterine inversion refers to the uterus turning inside out with either the fetus’s birth or delivery of the placenta. Because the uterine endometrium is exposed, the client will need antibiotic therapy to prevent infection. 

10. Administer volume replacement, insert indwelling urinary catheter; obtain blood type and cross-match; monitor vital signs. And maintain careful intake/output records.
Rapid maternal hemorrhage and shock follow inversion, and immediate lifesaving interventions may be necessary. Kidney function is a useful indicator of fluid volume levels/tissue perfusion. An IV fluid line should be inserted if one is not already present. Use a large-gauge needle because blood will need to be replaced. If a line is already in place, open it to achieve the optimal fluid flow to restore fluid volume.

11. Administer oxytocin IV, replace uterus under anesthesia, and give ergonovine maleate (Ergotrate) IM after replacement. Assist with the packing of the uterus, as indicated.
The client will immediately be given general anesthesia or nitroglycerin or a tocolytic IV drug to relax the uterus. After manual replacement, oxytocin administration helps the uterus contract and remain in its natural place.

Risk For Altered Family Process

Most parents handle newborn babies tentatively until they have “claimed” them or have become firmly acquainted. If an infant is ill at birth, it may take days or weeks before the parents can handle their baby comfortably and confidently because of the number of tubes involved in the care and their fear of doing something that could hurt the infant. The demands of parenthood may affect the communication between the partners, and there is little doubt that children distract from the relationship at times. Fatigue may trigger irritability, too. Both parents are concerned with increased economic responsibilities. Loss of freedom and a decrease in socialization may give the couple a sense of loneliness.

Nursing Diagnosis
  • Risk for Altered Family Processes
May be related to

Common related factors for this nursing diagnosis:

  • Developmental transition (gain of a family member)
  • Situational crisis (change in roles/responsibilities)
Possibly evidenced by
  • Signs and symptoms do not evidence a risk diagnosis. Interventions are directed at prevention. 
Desired Outcomes

Common goals and expected outcomes:

  • The family will demonstrate behaviors indicative of readiness to actively participate in the acquaintance process when both mother and infant are physically stable.
  • The parents will visit frequently and hold the infant.
  • The parents will speak of their child in positive terms.
Nursing Assessment and Rationales

Below is the nursing assessment for this labor nursing care plan.

1. Determine the relationship of family members to one another.
This can help provide a positive experience to prepare the family for new developmental tasks. The influence of a new child’s birth on siblings depends on their age and developmental level. The grandparent’s involvement with a new child is often dictated by how near they live to the younger family. A little conflict is likely if parents and grandparents agree on the grandparent’s role.

Nursing Interventions and Rationales

Here are the nursing interventions for this labor nursing care plan.

1. Provide client and father with the opportunity to hold the baby immediately after birth if the infant’s condition is stable.
Early physical contact helps foster attachment. Fathers are also more likely to participate in infant caretaking activities and feel stronger emotional ties if they are actively involved with the infant soon after birth. New fathers typically display interest in their new child, called engrossment. Adjustment to fatherhood is facilitated by involvement in the newborn’s care. Fathers should be included when the nurse shares instructions about newborn care and handling.

2. Provide unlimited visiting privileges for family and siblings, as appropriate.
This facilitates the attachment and bonding process. The nurse observes parenting behaviors, such as the amount of affection and interest shown to the newborn. Adults tend to talk with newborns in high-pitched voices. The extent to which the parents encourage the involvement of siblings and grandparents with the newborn should be noted. This information provides a basis for nursing interventions that encourage bonding and foster positive family relationships.

3. Facilitate interaction between the client/couple and the newborn as soon as possible after delivery.
This fosters the beginning of lifelong emotional ties between family members. Both mother and infant have a critically sensitive period during which interactional capabilities are enhanced. Newborns without complications should be kept in skin-to-skin contact with their mothers during the first hour after birth to prevent hypothermia and promote breastfeeding.

4. Delay installation of eye prophylaxis ointments (containing erythromycin or tetracycline) until client/couple and infant have interacted and dim room lights.
This allows the infant to open eyes fully to establish eye contact with the parent and actively participate in the interaction, free from the blurred vision caused by medication. In the past, eye prophylaxis was given immediately after birth, never to forget it. Now it is more customary to delay the ointment administration until after the first reactivity period so the newborn can see the parents during this important attachment period.

5. Provide anticipatory guidance concerning changes to expect and family adaptation options.
Meeting needs concerning housing, equipment, and community resources available for assisting will help the family adapt to changes. Studying the family as the client, rather than an individual as the client, can offer insight into community-based care and can help the nurse integrate the knowledge of the family structure, culture, and composition into a plan of care that will meet some goals of Healthy People 2030 (U.S. Department of Health and Human Services, 2018).

6. Provide written information for parents and suggested books for siblings concerning the new child.
Including the needs of each family member will promote family coping and adaptation. New parents should be given written instructions because they are often overwhelmed by the volume of information provided in such a short time. They should be reassured that the birth facility staff is available 24 hours a day to help them care for their newborn and refresh their memories if they forget what they have been instructed.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans related to the care of the pregnant mother and her infant:

References and Sources

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With contributions by Marianne Belleza RN

Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
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