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.
1. Promote maternal and fetal/newborn well-being.
2. Provide a physiologically and psychologically safe experience for client and newborn.
3. Prevent complications.
Nursing diagnosis of precipitous labor: Anxiety may be related to situational crisis, threat to self/fetus, interpersonal transmission possibly evidenced by increased tension; scared, fearful, restless/jittery; sympathetic stimulation.
1. Use breathing and relaxation techniques effectively.
2. Cooperate with necessary preparations for a rapid delivery.
3. Follow directions and/or actively participate in delivery process.
Nursing intervention with rationale
1. Maintain calm, deliberate manner. Offer clear, concise instructions and explanations.
Rationale: An emergency or extremely rapid delivery occurring out of the hospital or in a hospital setting without the presence of a clinician (physician or nurse midwife) can be extremely anxiety-provoking for the client/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. Composure of nurse reassures client and prevents transmission of undue concern and anxiety.
2. Provide a quiet environment and privacy within parameters of the situation. Position client for optimal comfort.
Rationale: Reduces distractions/discomfort, allowing client to focus attention. May reduce “contagious” anxiety of onlookers in out-of-hospital delivery and support modesty.
3. Encourage partner/support person to remain with client, provide support, and assist as needed.
Rationale: Allowing full participation by a support person enhances self-esteem, furthers cohesion of family unit, reduces anxiety, and provides assistance for the professional.
4. Remain with client. Provide ongoing information regarding labor progress and anticipated delivery.
Rationale: Reduces anxiety, fosters positive coping and cooperation, and reduces fear associated with the unknown.
5. Support appropriate coping/relaxation techniques.
Rationale: Enhances sense of control; optimizes participation in the birth process.
6. Arrange for services of medical/nursing staff as soon as possible. Inform client that help has been requested.
Rationale: The arrival of assistance helps the client/couple to feel less anxious and more secure.
7. Conduct delivery in a calm manner; provide ongoing explanations.
Rationale: Helps client/couple remain calm and cooperate with instructions.
8. Place newborn on maternal abdomen once newborn respirations are established. Allow partner to hold infant.
Rationale: Helps promote bonding and establishes a positive feeling about the experience.
9. Administer sedation as appropriate.
Rationale: May help slow labor progress and allow client to regain control.