Planning and Intervention in Intrapartum Care
Planning is the tertiary step in the nursing process.
During intrapartum care, nurses and medical staff
establish plans and goals to meet expected specific
outcomes that directly impact the patients care. These
patient-specific goals, and their achievement, aims to
ensure a positive outcome and relief for the clients.
Nursing care plans are essential in this phase of goal
setting because this helps define clear guidelines and
directions along the nurse's roles in providing standard
quality patient care and interventions. Furthermore,
planning helps nurses in focusing on the nursing plan
and avoid overlooking necessary steps during the intrapartum care.
A nursing care plan for a client in labor revolves around promoting maternal and fetal well-
being, prevention of complications, and providing a safe delivery. It includes interventions such
as bed rest/recumbent position, procedure preparation, providing information about labor and
birth, providing comfort and pain relief measures, supportive care interventions, monitoring
the client's vital signs and fetal heart rate, facilitating postpartum care, and preventing
complications after birth.
Goals should be:
Specific
Measurable or Meaningful
Attainable or Action-Oriented
Realistic or Results-Oriented
Timely or Time-Oriented
And then the interventions, these are the actions taken by midwives, nurses, or doctors to
intervene in the birthing process to give assistance in the delivery of the newborn. During
intrapartum care, these actions are conducted in accordance with the patient care plan. It is the
actual execution of the nursing interventions, treatment, procedures, and teaching moments
outlined in the care plan in order to assist with the patient's comfort, health, and the newborns
health as well.
Example of a Nursing Care Plan
Anxiety during Labor
Labor and childbirth involve a
plethora of psychological and physical
demands that cause maternal stress to
the birthing mother. Given that
maternal stress levels have shown to
peak during labor, this time may
represent an important opportunity to
reduce stress and associated negative
outcomes by focusing on the factors
that contribute to the stress response.
These include apprehension about
labor pain or episiotomy, anxiety, fear about her inability to give birth, the possibility of dying
during childbirth, and a lack of healthcare support (Tan et al., 2021).
Nursing Diagnosis
Anxiety
May be related to
Situational crisis
Threat to self and/or fetus
Interpersonal transmission
Possibly evidenced by
Increased tension
Fearful
Restless, jittery
Sympathetic stimulation
Desired Outcomes
Patient will use breathing and relaxation techniques effectively
Patient will cooperate with necessary preparations for a rapid delivery
Patient will follow directions and/or actively participate in delivery process
Nursing Interventions Rationale
Maintain a calm, deliberate An emergency or extremely rapid delivery occurring
manner. Offer clear and concise out of the hospital or in a hospital setting without
instructions. Provide the presence of a clinician can be extremely anxiety-
explanations. provoking for the client or couple, who had
anticipated an orderly progression through labor
and delivery. When the actual birth event is not in
keeping with their expectations, reactions may
include hostility, fear, and disappointment. The
composure of the nurse and her reassurance helps
prevent or alleviate anxiety.
Provide a quiet environment Reduces distractions and discomfort, allowing the
and privacy within parameters client to focus. Helps reduce “contagious” anxiety of
of the situation. Position client onlookers in or out of hospital delivery and supports
for optimal comfort. modesty.
Encourage partner or SO to Allowing full participation by an SO enhances self-
remain with the client, provide esteem, furthers cohesion of family unit, reduces
support and assistance as anxiety, and helps with the professional.
needed
Remain with the client. Provide Reduces anxiety, fosters positive coping and
ongoing information cooperation, and reduces fear associated with the
regarding labor progression unknown
and anticipated delivery.
Encourage appropriate coping Enhances sense of control; optimizes participation in
or relaxation techniques. the birth process.
Arrange for services of medical The arrival of assistance helps the client, or couple
or nursing staff as soon as feel less anxious and more secure.
possible. Inform client that
help has been requested.
Conduct delivery in a calm Helps client remain calm and cooperate with
manner; provide ongoing instructions
explanation.
Place newborn on maternal Helps promote bonding and establishes a positive
abdomen once newborn feeling about the experience.
respirations is established.
Allow partner to hold infant.
Administer sedation as May help slow labor progress and allow client to
appropriate. regain control.
Early Essential and Newborn Care
Early Essential and Newborn
Care or EENC is the standard safety
and quality care provided to birthing mothers and their newborns, within the 48 hours of the
intrapartum period from the onset of the mother’s labor to delivery of the placenta and a week
of life for the newborn. This includes immediate drying and stimulating, assessing breathing,
proper cord clamping, and cutting, skin-to-skin contact, initiating exclusive breastfeeding, eye
care, vitamin k provision, place of identification band, and weighing.
Four (4) Core Interventions involved in EENC:
1) immediate and thorough drying,
2) early skin-to-skin contact followed by,
3) properly timed clamping and cutting of the cord after 1 to 3 minutes, and
4) non-separation of the newborn from the mother for early breastfeeding initiation and
rooming-in.
What do these four (4) interventions do to the newborn?
1. Immediate and thorough drying of the newborn prevents hypothermia which is extremely
important to newborn survival
2. Keeping the mother and baby in uninterrupted skin-to-skin contact prevents hypothermia,
hypoglycemia, and sepsis increases colonization with protective bacterial flora, and improved
breastfeeding initiation and exclusivity
3. Properly timed cord clamping and cutting until the umbilical cord pulsation stops decreases
anemia in one out of every seven-term babies and one out of every three preterm babies. It
also prevents brain (intraventricular) hemorrhage in one of two preterm babies.
4. Breastfeeding initiation within the first hour of life prevents an estimated 19.1% of all
neonatal deaths.
The Early Essential and Newborn Care interventions before conception, during pregnancy, at
and soon after birth, and in the postnatal period is crucial to improving the health of the
newborns, minimizing their risk of infection and disease, and maximizing their developmental
growth. The interventions delivered to the mother and quality newborn care to the newborn
are important in the stage of labor and after delivery to ensure both positive maternal and
newborn outcomes.
Sources:
Martin, BSN, R.N., P. (n.d.). 41 Labor Stages, Induced and Augmented Dystocia Labor Nursing
Care Plans. Nurseslabs.Com. Retrieved August 16, 2022, from
https://nurseslabs.com/labor-stages-labor-induced-nursing-care-plan/
Toney-Butler, T. J., & Thayer, J. M. (n.d.). Nursing Process. StatPearls - NCBI Bookshelf.
Retrieved August 16, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK499937/
Essential Newborn Care (ENC) How was the ENC Protocol developed? (n.d.). Doh.Gov.Ph.
Retrieved August 16, 2022, from https://doh.gov.ph/book/export/html/1125
Belleza, R.N., M. (n.d.). 3 Precipitous Labor Nursing Care Plans. Nurselabs.Com. Retrieved
August 17, 2022, from https://nurseslabs.com/precipitous-labor-nursing-care-plans/2/
