7 Preterm Labor Nursing Care Plans

Anxiety

Anxiety has both short-term and long-term effects on maternal, pregnancy and fetal outcomes. With increased anxiety, the cortisol hormone appears to cross the placenta and affect the fetus, disrupting ongoing processes, affecting the limbic and prefrontal cortex, and releasing chemicals such as acetylcholine and adrenaline in the mother’s body. These chemicals pass through the placenta into the fetus and have detrimental effects on proper fetal growth. Anxiety can also lead to inappropriate maternal responses to the fetus during pregnancy and decrease the ability to play a motherly role. Accordingly, it is essential to find some efficient therapeutic plans to reduce maternal anxiety during pregnancy (Bazrafshan et al., 2020).

Nursing Diagnosis

• Anxiety

May be related to

• Situational crisis
• Perceived or actual threats to self and fetus

Possibly evidenced by

• Increasing tension
• Apprehension
• Sympathetic stimulation

Desired Outcomes

• The client will verbalize understanding of the individual situation and possible outcomes.
• The client will report anxiety is reduced and/or manageable.
• The client will appear relaxed; with maternal vital signs within normal limits.

Nursing Assessment and Rationales

1. Assess support systems available to the client or couple, whether the client remains hospitalized or is to return home to await delivery.
The assistance and caring of significant others, including caregivers, are extremely important during this time of uncertainty and stress. If the client is to return home, additional support will be required to meet self-care needs and homemaker activities as well as child care, as appropriate. Fostering an environment of intentional support and empathetic dialogue can build mutual trust, and assist the nurse in understanding the client’s perceptions of their experiences of preterm labor (Griggs et al., 2020).

2. Monitor maternal signs of preterm labor.
The nurse should be aware of the symptoms of preterm labor because they may occur in any pregnant woman, with or without risk factors. Common symptoms of early preterm labor are persistent, dull, and low backache; vaginal spotting; a feeling of pelvic pressure or abdominal tightening; menstrual-like cramping; increased vaginal discharge; uterine contractions; and intestinal cramping.

3. Continuously monitor maternal and fetal vitals.
Monitor the client’s vital signs and neurologic status closely. Respirations should be at least 12 breaths/min. FHR should be at 120-160 beats/min. Decreasing FHR can indicate fetal distress.

Nursing Interventions and Rationales

1. Explain the procedures, nursing interventions, and treatment regimen.
Information and knowledge of the reasons for these activities can decrease fear of the unknown. Clients desire honest and complete information, an opportunity to answer questions, and an explanation of medical terms, procedures, and expectations of care conferred in the language they understand and at the appropriate literacy level (Griggs et al., 2020).

2. Answer questions honestly, especially information regarding contraction patterns and fetal status.
The provision of clear information can help the client or couple understand what is happening and may reduce anxiety. The healthcare team should avoid using terms with negative connotations such as fetus, nonviable, incompatible with life, spontaneous abortion, and miscarriage as these terms might trivialize or dehumanize the client’s experiences (Griggs et al., 2020).

3. Encourage the use of relaxation techniques.
Application of relaxation exercises among 60 hospitalized primiparous pregnant clients at risk of preterm labor could significantly lessen the pregnancy anxiety level. The relaxation exercises were trained through the educational booklet and CD, and face-to-face and question-and-answer communications (Bazrafshan et al., 2020).

4. Encourage verbalization of fears or concerns.
The nurse should assess the client’s views of their pregnancy at the time of preterm labor. Incorporating this type of assessment will help provide individualized empathetic care (Griggs et al., 2020). Saisto et al., (2006) found that support interventions for pregnant women, which included discussions of concerns and feelings about birth, taught positive birth imagery (Kao et al., 2017).

5. Encourage the client to engage in complementary and alternative medicine (CAM).
Mind-body interventions, which constitute a major portion of the overall use of CAM, can provide support to alleviate or reduce feelings of stress. These include autogenic training, hypnotherapy, imagery, prayer, auto-suggestion, tai-chi, and yoga. These complementary therapies can have physiological as well as psychological benefits, which may consequently reduce the physio-pathological impact of stress (Kao et al., 2017).

6. Provide relaxation-focused nursing care to the client.
Relaxation-focused nursing care (RFNC) was created using Hypnobirthing and the Transactional Model. Hypnobirthing philosophy aims to reduce stress, fear, and tension in the pregnant woman by creating positive thoughts and emotions using the laws of mind. The Transactional Model defines stress as a special relationship between a person and the environment. It identifies the stressors of the person and indicates how they should be handled. RFNC is formed by using these two models and comprises positive language, a positive environment, and reducing stressors. RFNC may reduce the client’s state of anxiety, lower cortisol levels, and thus prevent preterm labor by lowering the severity of uterine contractions (Özberk et al., 2020).

7. Arrange psychotherapy sessions for the client as indicated.
The results of a study indicated that adding six sessions of individual face-to-face psychotherapy, one hour per day for six consecutive days, to inpatient medical care of clients successfully treated for preterm labor, reduced anxiety, and pregnancy stress, while enhancing their perceived control.  Psychotherapy involves supportive elements focusing on responsiveness to needs for helping others through the insight obtained via empathic immersion in the therapy. This approach focuses on the client’s emotions (Mirtabar et al., 2020).