Intrapartum Care Fundamentals

Intrapartum care spans from the onset of true labor through delivery of the placenta. The nurse's primary responsibilities include monitoring maternal and fetal well-being, supporting the laboring woman, and recognizing complications.

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Stages of Labor

First Stage Phases

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Electronic Fetal Monitoring (EFM)

Electronic fetal monitoring assesses fetal oxygenation status through heart rate patterns.

Baseline FHR

Normal range: 110-160 bpm

Variability

Variability refers to the fluctuation of the FHR from the baseline - the most important indicator of fetal oxygenation.

Key Point: Moderate variability is the BEST indicator of fetal well-being.

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VEAL CHOP Mnemonic

Use this mnemonic to remember deceleration causes:

Variable Decelerations

Pattern: Abrupt decrease, variable shape (looks like a "V" or "W") Cause: Umbilical cord compression Characteristics:

• Most common deceleration type
• Variable in timing, shape, and depth
• Abrupt onset and return to baseline

Interventions:

1. Change maternal position (relieve cord pressure)
2. Assess for cord prolapse
3. IV fluids if indicated
4. If severe/repetitive: notify provider

Early Decelerations

Pattern: Gradual decrease that mirrors contraction (looks like a "U") Cause: Fetal head compression during contractions Characteristics:

• Onset, nadir, and recovery mirror contraction
• Usually benign
• Common during active labor and pushing

Interventions:

• Monitor and document
• No specific intervention required
• Reassure patient

Late Decelerations

Pattern: Gradual decrease occurring AFTER contraction peak Cause: Placental insufficiency (uteroplacental insufficiency) Characteristics:

• Onset after contraction begins
• Nadir after contraction peak
• Return to baseline after contraction ends
• ALWAYS concerning

Interventions - LION Mnemonic:

• Lie on left side (improve uterine blood flow)
• IV fluids (improve hydration and placental perfusion)
• Oxygen (8-10 L/min via non-rebreather mask)
• Notify provider immediately

Accelerations

Pattern: Temporary increase in FHR ≥15 bpm for ≥15 seconds Cause: Fetal movement, stimulation Significance: REASSURING - indicates well-oxygenated fetus

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FHR Category System

Category I (Normal)

All of the following:

• Baseline 110-160 bpm
• Moderate variability
• No late or variable decelerations
• Accelerations may or may not be present

Category III (Abnormal)

Either:

• Absent variability WITH recurrent late decelerations, OR
• Absent variability WITH recurrent variable decelerations, OR
• Absent variability WITH bradycardia, OR
• Sinusoidal pattern

Action: Immediate intervention, prepare for emergency delivery

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Fetal Monitoring Diagram

Normal (Reassuring) Tracing:

• Baseline 110-160 bpm
• Moderate variability (6-25 bpm fluctuation)
• Accelerations with fetal movement
• No late decelerations

Non-Reassuring Signs:

• Absent or minimal variability
• Late decelerations (especially recurrent)
• Severe variable decelerations
• Prolonged bradycardia

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Nursing Interventions for Non-Reassuring FHR

Immediate Actions

1. Position change - Left lateral preferred (improves placental perfusion)
2. IV fluids - Bolus to improve blood volume
3. Oxygen - 8-10 L/min via non-rebreather if indicated
4. Discontinue Pitocin - If hyperstimulation present
5. Notify provider - Communicate findings clearly

Prepare for Potential Emergency Delivery

• Ensure consent is on file
• Notify OR/surgical team if cesarean section may be needed
• Keep patient NPO
• Verify blood type and crossmatch

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Exam Tips

• Moderate variability = Fetal well-being (most important indicator)
• Late decelerations = Always concerning, always intervene
• Early decelerations = Benign, continue monitoring
• Variable decelerations = Most common, usually respond to position change
• VEAL CHOP = Essential mnemonic for matching patterns to causes
• LION = Remember this intervention sequence for late decelerations