Maternal Child Nursing Care Analysis

Case Summary

Carla is a 24-year-old 40 weeks gestation. She is married to her high-school sweetheart. Carla is planning a home birth. She is five feet tall and currently weighs 140 lbs. Her pre-pregnancy weight was 125 lbs. She has been in active labor for 16 hours. For the past six hours, her SVE has been unchanged, at 6/100/-2. Because of this, she has been transported to the hospital. She is GBS positive and at the time of transport has already received two doses of Ampicillin 1 gram each, six hours apart by IV.

SROM occurred two hours before transport. On admission to L&D, her BP is 110/78, T 98.4, P 72, and R20. UCs are q5-6 min, lasting 50-60 seconds in length, and are strong by palpation. Carla is having good relaxation between contractions. The FHT has a baseline of 130-140, with accelerations present. LTV is moderate. There is no decelerations present. The EFW is 8#. Carla’s last baby was 7#10oz and was an NSVD at home with a CNM. The baby is in a cephalic presentation and is LOA.

Reason for transfer: maternal fatigue with FTP in the last six hours despite adequate contractions, which in the past three hours were becoming farther apart and weaker.

  1. Pitocin IV to be increased every 20 minutes until UCs are coming every 2-3 minutes and lasting 90 seconds
  2. Continue Ampicillin 1 gram every 6 hours until delivery
  3. IUPC and FSE

Two hours after Carla’s admission, her contractions are every two minutes, strong, and 90 seconds in duration. Carla has requested epidural anesthesia and is now resting. The nurse notes the following at this time:

BP 100/60

Temperature 99

Pulse 82

Respirations 20

VE 8/100/-2

FHT 150s no accelerations, minimal LTV, no decelerations, the baby is moving during rest periods between contractions

The uterus is relaxed between contractions

A foley catheter has been inserted and output is sufficient.

The significance of a baby still being at a -2 station

During childbirth, the head of the baby may crown. The mother at this time experiences a burning sensation from the pressure exerted by the baby on the vaginal opening ( Perry, Hockenberry, Lowdermilk, & Wilson, 2014). When this happens, the mother is supposed to stop pushing. Taking the above step is crucial because continuing to push the baby, increases the risk of tearing.

Assessing the following: FHT 150s, no acceleration, minimal variability, no deceleration, and the baby moving during rest periods between contractions

Acceleration is interpreted as a reassuring sign; therefore, with no acceleration, it means there is no reassuring sign ( Luxner, 2005). Since the normal fetal heart rate ranges from 30 and 160 beats per minute, thus, 150s is within the normal range ( Perry et al., 2014). However, the baseline rate is only interpreted as completely changed if the alteration continues for more than fifteen minutes. Minimal variability signifies no risk or simply a minimally enhanced risk of acidosis.

The rationale for ampicillin during birth

Usually, some infections occur during and after the delivery of the baby. One of the conditions is Chorioamnionitis. It is an infection of both the amniotic fluid and placental tissues and usually occurs before, during, or after birth ( Luxner, 2005). The risk factors for developing this condition include prolonged active labor like the case of Carla. Therefore, ampicillin is used as an antibiotic. Studies show that infections during and after birth occurs in approximately 25 percent of preterm deliveries and 1-5 percent of term pregnancies ( Luxner, 2005).

Carla had desired an NCB at home. Reasons for an epidural

Generally, epidurals are used to relieve the pain of women in labor, although other methods are available when epidurals are contraindicated. Therefore, the reason Carla had requested an epidural was for the fear of pain. Mainly because, delivering at home leaves the mother with very few options of relieving the pain (Perry et al., 2014). The other factor was to minimize the risk of having a cesarean section. Studies show that early placement of an epidural reduces the rate of cesarean section ( Perry et al., 2014). This may have been the reason that informed her choice of an epidural.

What it means for the head to turtle during delivery

When the fetus is huge during delivery, there is a likelihood of shoulder dystocia. Due to the large size of the baby, during delivery or when pushing out the head, it partially withdraws back ( Luxner, 2005). The condition whereby the head of the baby partially withdraws back into the birth canal during delivery is called the “turtle sign” (Perry et al., 2014). Turtle sign, therefore, occurs when the baby is blocked from slipping out by the pubic symphysis.

Shoulder dystocia is common amongst women with huge fetuses and those suffering gestational diabetes ( Perry et al., 2014). The other cause is the pubic symphysis which prevents the anterior shoulder of the baby from slipping out. In some cases, the posterior shoulder may be held by the sacral promontory making it hard for the baby to pass ( Luxner, 2005). However, these are not the only conditions, as they can occur even in normal-sized babies.

The position the nurse assist Carla into to assist the birth of a baby

There are about two positions that can be used: The lithotomy position and Side-lying. These two positions easily allow for McRobert’s Maneuver or natural extension of the birth canal ( Perry et al., 2014). During this process, the following factors are taken into consideration:

  • Since the pressure is applied on the lower part of the mother’s abdomen, it offers suprapubic pressure that is sufficient to push the shoulder of the fetus past the pubic symphysis.
  • During these positions, either Lithotomy position or Side-lying, the birth canal is enlarged in a way that creates more room for the baby to be pushed out more easily.

The major differences between suprapubic pressure and fundal pressure

According to Luxner (2005), suprapubic pressure is mainly the pressure generated when attempting to push or dislodge the baby from the pubic bone during birth. Normally, it is performed by inserting the hand above the pubic bone and pushing the shoulder of the fetus in one direction ( Luxner, 2005). Fundal pressure is a practice that is widely used during delivery and involves the use of mechanical or manual pressure on the maternal abdomen ( Luxner, 2005). Therefore, whilst suprapubic pressure aims to dislodge the baby from the pubic symphysis, fundal pressure accelerates labor.

The OB will use suprapubic pressure to deliver the baby. Since the condition is caused by the pelvis or pubic bone, pushing the anterior shoulder of the baby from above can easily change the position or dislodge the baby from that position for easy delivery ( Luxner, 2005). Most importantly, McRoberts is used with Suprapubic pressure to get the best results. In other words, they are used together to ensure faster delivery with the least pain to the mother and baby. These two methods can easily counter fundal pressure, which can put the mother in a precarious situation.

The measures to prepare for the immediate care of the baby

Normally prolonged labor increases the chances of the baby having low levels of oxygen, abnormal heart rhythm, uterine infection, and uptake of abnormal substances available in the amniotic fluid ( Perry et al., 2014). Therefore, the immediate care for the baby is to ensure that the baby is safe from all these conditions.

Possible injuries that the baby might sustain during delivery

Head and Brain Injuries usually occur when the baby reaches the birth canal and experiences excessive pressure ( Luxner, 2005). The resultant injuries are bruises and enlargement of the scalp. The damage to the nerves may occur when the nurse attendant attempts to insert her hands in the pelvis to push the baby out. Such an undertaking may result in the weakness of the muscles.

Possible injuries Carla might sustain during delivery

There are many injuries that Carla might sustain during delivery, but the main one is birth trauma. Birth trauma is the damage of the organs or tissues of a newly delivered baby often resulting from physical pressure during delivery ( Luxner, 2005). It may also cause perinatal tears. Whereas first and second-degree tears can be repaired by suturing; the third and fourth-degree tears are likely to require specialist treatment.


Luxner, K. (2005). Delmar’s maternal-infant nursing care plans (2nd ed.). Clifton Park, NY: Delmar Learning.

Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2014). Maternal child nursing care (5th ed.). St. Louis, Missouri: Elsevier.