NCP Precipitous Labor/Delivery or Unplanned/Out-of-Hospital Delivery

Rapid progression of labor, lasting less than 3 hr from onset to delivery, and out-of-hospital delivery are emergency situations that place the client/fetus at increased risk for complications and/or untoward outcomes. The attending nurse may have primary responsibility for the safety of the mother and fetus.

CLIENT ASSESSMENT DATA BASE

Ego Integrity

Irritability

Food/Fluid

Nausea/vomiting

Pain/Discomfort

May have an unusually high pain threshold or not be aware of abdominal contractions
Possible absence of palpable contractions, as occurs with maternal obesity
Low back discomfort (may not be recognized as a sign of progressing labor)
Intense/prolonged uterine contractions; inadequate uterine relaxation between contractions
Involuntary urge to bear down

Safety

Accelerated cervical dilation and fetal descent
Preterm or small-for-gestational age infant (increases potential for rapid labor/delivery)
Rectal/perineal bulging
Increased vaginal show

Sexuality

History of short or rapid labor
Young maternal age; large pelvis
Multiparity or previous vaginal surgery (decreases soft-tissue resistance)

NURSING PRIORITIES

1. Promote maternal and fetal/newborn well-being.
2. Provide a physiologically and psychologically safe experience for client and newborn.
3. Prevent complications.