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Client Profile: Jennifer is a 17-year-old, G1 P0, single white female. Jennifer is an active high school senior. She attended childbirth classes held at her high school. She attends a special program for pregnant teens. She has been careful to eat well and avoid all hazards that might harm her baby. She is looking forward to holding her baby and does not appear to be afraid of the coming labor. The father of the baby is an 18-year-old senior, who is very committed to their relationship and plans on marrying Jennifer after the baby is born. Case Study: Jennifer is admitted in active labor at 36-2/7 weeks gestation. She has been experiencing contractions for the past 6 hours. For the past 2 hours, they have been getting stronger and lasting up to one minute each. She believes that her membranes may have ruptured. She is accompanied by the father of the baby, her mother, and a doula. Upon examination, the nurse determines that she is 3 cm. dilatated; 90% effaced, and at a station of –3. The baby’s heart tones are 120’s with no decelerations. The nurse confirms that her membranes have ruptured spontaneously (SROM). According to Jennifer, this occurred two hours ago (about 6:00 am). Contractions are one minute in length, q 5 minutes, strong with good relaxation between contractions. Case Study Questions: 1. What is the role of the doula? 2. How did the nurse determine if Jennifer’s membranes have ruptured? Name the ways. What is the significance of the findings from the pelvic exam? What is the significance of the ruptured membranes in Jennifer’s case? 3. After six hours (about 12 noon), Jennifer is 5 cm. 100% effaced, and –3 station. The nurse notes that the baby is in an occiput posterior (OP) position. The presentation puts the hardback of the baby’s head against the mother’s spine. Descent is slower and more painful. What stage of labor is Jennifer in? 4. How does the baby’s presentation impact the labor? What comfort measures might the doula use to help Jennifer cope with the labor? How can her significant other help her cope? 5. What positions might the mother use to help the baby rotate and descend? 6. Four hours later the mother is 8 cms., 100% effaced, and –2 station. The baby has rotated to the left occiput transverse (LOT) presentation. This turns the baby to face the mother’s side and reduces pressure on her back. Jennifer has felt some relief in this change. What does this presentation look like and how does it facilitate the birth? 7. Jennifer complains that she needs to push. What are the consequences if she were to push at this point? 8. Jennifer does not progress in the next two hours, the baby is developing a large caput, and the FHTs are now 150s with an occasional variable deceleration. Contractions are every 2 minutes, 90 seconds in length, and strong with good relaxation between. The obstetrician expresses concern that he may need to perform a cesarean section. Jennifer asks for more time to see if she can begin to progress again. What are the reasons the doctor may need to perform a c/s? What are other concerns regarding the length of time labor is occurring? 9. The doctor says yes he will give about 2 hours more. Which of the following would be appropriate management of Jennifer at this point? Please describe the reason you chose this answer with references. a. The doctor allows her two more hours to dilate and orders Pitocin to make the contractions more effective. b. She is given an epidural to help the baby rotate and descend. c. She is given Stadol 2 mg. for the labor pain to help her relax. d. Jennifer is given IV antibiotics. e. The doula helps Jennifer assume a hands-and-knees position.

SCIENCE
HEALTH SCIENCE
NURSING
NUR 2214C

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