Nursing study guide
Intrapartum + postpartum nursing
Support labor, recognize fetal and maternal change, prevent hemorrhage, and protect the first hours after birth.
Nursing filter
Assess the patient first, recognize time-sensitive change, prevent harm, and trend the response.
Connect systems
Symptoms, laboratory patterns, medications, nutrition, function, and psychosocial needs interact.
Safety boundary
Use current orders, facility policy, clinical supervision, and emergency pathways.
Labor assessment
Maternal and fetal status guide every decision
Labor progress is assessed with the complete clinical picture and obstetric plan.
Maternal
Vital signs, pain/coping, contractions, bleeding, membrane status/fluid, intake/output, medications, mobility, support, and comorbid risk.
Fetal
Baseline rate, variability, accelerations/decelerations, relationship to contractions, movement, gestational age, and change over time.
Progress
Cervical findings, fetal station/position, contraction pattern, and response are documented by trained clinicians according to policy.
Fetal monitoring
Describe the tracing before assigning meaning
Use the current standardized terminology and facility response algorithm.
| Element | Describe | Nursing connection |
|---|---|---|
| Baseline + variability | Rate over the defined window; absent, minimal, moderate, or marked variability | Verify signal and maternal pulse; assess oxygenation/perfusion context and trend. |
| Accelerations | Increase relative to baseline by gestational-age criteria | Often reassuring in context; absence alone is not a diagnosis. |
| Decelerations | Early, variable, late, or prolonged by timing and shape | Assess maternal/fetal context, position, contractions, medications, and activate ordered intrauterine-resuscitation/escalation steps. |
| Contractions | Frequency, duration, intensity when measurable, resting tone, tachysystole | Reduce uterine-stimulation exposure and escalate per protocol when pattern is excessive or tracing is concerning. |
Labor support
Safety and physiologic support belong together
Respect informed preferences while continuously reassessing maternal and fetal response.
Comfort
Position changes, movement when safe, breathing, touch, hydrotherapy when permitted, environment, support person, analgesia/anesthesia, and clear explanations.
Safety
Fall and aspiration risk, neuraxial effects, bladder, infection prevention, medication/infusion checks, hemorrhage risk, and readiness for change.
Communication
Explain choices and urgency, obtain help early, document response, and use closed-loop team communication during deterioration.
Immediate postpartum
The first hours require frequent maternal reassessment
Bleeding, tone, perfusion, bladder, pain, and bonding can change quickly.
Assess
Fundal tone/location, lochia and quantified blood loss, vital signs/perfusion, bladder, perineum/incision, pain, legs, respiratory status, and level of consciousness.
Support
Skin-to-skin and feeding when safe, warmth, hydration/nutrition plan, mobility and voiding safety, pain control, and family education.
Escalate
Heavy or increasing bleeding, boggy uterus unresponsive to initial protocol, hypotension, tachycardia, severe pain, dyspnea, chest pain, headache/vision change, seizure, or fever.
Postpartum hemorrhage
Find the cause while resuscitation begins
Tone, trauma, tissue, and thrombin organize the differential; multiple causes can coexist.
| Cause | Clues | Nursing priorities |
|---|---|---|
| Tone | Boggy enlarged uterus | Fundal massage and uterotonic/emergency pathway as ordered; empty bladder; quantify loss and reassess. |
| Trauma | Firm uterus with continued bleeding, pain, hematoma concern | Escalate for examination/repair; monitor concealed loss and perfusion. |
| Tissue | Placental concern or persistent atony/bleeding | Prepare for evaluation/removal procedure and hemorrhage support. |
| Thrombin | Diffuse bleeding or known coagulopathy | Activate hemorrhage protocol, labs/products as ordered, warming and frequent reassessment. |
Immediate newborn care
Warmth, breathing, circulation, glucose risk, and feeding define the transition
Follow neonatal resuscitation and newborn protocols when adaptation is not routine.
Transition
Warm, dry, stimulate as appropriate, position airway, assess breathing/heart rate/color/tone, identify need for resuscitation, and maintain identification/security.
Ongoing checks
Temperature, respiratory effort, perfusion, feeding, output, glucose risk, jaundice risk, medications/screens, cord and skin.
Escalate
Apnea/gasping, persistent cyanosis, severe work, poor tone, temperature instability, symptomatic hypoglycemia, seizure, or poor perfusion.
Discharge + delegation
Teach recovery and danger signs before the family leaves
Postpartum complications can develop after discharge.
Teach maternal
Bleeding, blood pressure warning signs, infection, clots, cardiopulmonary symptoms, pain, incision/perineum, feeding, mood/safety, medicines, activity, and follow-up.
Teach newborn
Feeding and output expectations, safe sleep, cord/skin, jaundice, temperature, breathing, car seat, appointments, and emergency symptoms.
Delegation
Routine stable measurements and hygiene may be assigned; RN retains maternal/fetal/newborn assessment, interpretation, teaching, unstable care, and evaluation.
Sources
Reference notes
Current obstetric, fetal-monitoring, neonatal, and hemorrhage protocols control care.