Table Of ContentCover: 8.5 x 11 Spine: .6875 (11/16”) Flaps 0
HM
uu
LABOR DELIVERY NURSING er
and lsra
my
A Guide to Evidence-Based Practice
a
Michelle L. Murray, PhD, RNC-OB n
Second Edition Gayle M. Huelsmann, BSN, RNC-OB, C-EFM n
“Where was this book when I was a new nurse just learning the ropes of labor and delivery?
This is a true gem of a book——a must for any new grad going into labor and delivery.
L
I recommend this book for every labor and delivery floor.”
—-Cindy Curtis, RNC, IBCLC, CCE A
Former Director, The Family Birth Center B
Culpeper Regional Hospital
O
Lignum, Virginia
R
“The best one-stop reference book for the experienced and novice Labor and Delivery RN.... a
n
Finally an excellent Labor and Delivery book by RN’s —— for RN’s.” d
—Garla DeWall, RNC D
Presbyterian Hospital in the Family Birthing Center E Michelle L. Murray
Albuquerque, New Mexico
L
Gayle M. Huelsmann
I
V
The clinically focused guide to nursing care during childbirth is distinguished by its strong focus on evidence-based E
practice as well as its engaging style and user-friendly format. It reviews the nursing process from admission to R
delivery, focusing on proper surveillance and care, comprehensive data acquisition, interpretation, and teamwork. Y
LABOR
The second edition continues to help labor and delivery nurses make wise decisions in the delivery room, optimizing
N
both maternal and fetal outcomes. It clearly explains the stages and phases of labor, delivery, and pain assessment and and
U
management—all supported by proven research. This text provides authoritative guidance on intervention options,
R
creating patient-centered care plans, and improving communication with other members of the obstetrics team.
S
NEW TO THE SECOND EDITION:
I
N
• Proper analysis of the partograph to facilitate appropriate patient interventions
G
DELIVERY
• Updated information about clinical pelvimetry
• New information on psyche, including the religious, spiritual, and cultural dimensions of care
• Setting priorities in triage and care related to postpartum hemorrhage
• Identification of “myths” related to childbirth
S
• Individualized patient care related to fetal distress and nonreassuring fetal status
e
c
• Oxytocin infusion and its relationship to permanent Erb’s palsy and autism o NURSING
• Updated information on technology, including connectivity between smart IV pumps and the EMR n
d
• How to distinguish functional from mechanical dystocia and intervene to enhance fetal and E
maternal safety d
i
t
KEY FEATURES: io
n
• Applies to nursing care of childbearing clients worldwide A Guide to Evidence-Based Practice
• Written in engaging, easy-to-understand style for new nurses, seasoned practitioners, and nurses
seeking certification
• Enhances effective decision-making to optimize patient care and outcomes
• Replete with informative references, relevant graphics, and review questions
• Incorporates research to clearly explain concepts and best practices
• Provides orientation fundamentals, checklists, and log charts
ISBN 978-0-8261-8475-7
11 W. 42nd Street
New York, NY 10036-8002
www.springerpub.com Second Edition
Register Now for Online Access to
Your Book!
Your print purchase of Labor and Delivery Nursing, Second Edition includes
online access to the contents of your book—increasing accessibility, portability, and
searchability!
Access today at:
http://connect.springerpub.com/content/book/978-0-8261-8476-4
or scan the QR code at the right with your smartphone
and enter the access code below.
FBN5U2BJ
If you are experiencing problems accessing the digital component of this product, please contact our
Scan here for
customer service department at [email protected]
quick access.
The online access with your print purchase is available at the publisher’s discretion and may be
removed at any time without notice.
Publisher’s Note: New and used products purchased from third-party sellers are not guaranteed for
quality, authenticity, or access to any included digital components.
SPC
View all our products at springerpub.com
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd ii 55//2288//2200 22::3311 PPMM
Michelle L. Murray, PhD, RNC-OB, is an international educator, author, journal editor, and expert in obstetric
nursing. She has taught nursing students and nurses in the United States, Canada, and Bahrain. Dr. Murray
has spent the majority of her career as a labor and delivery nurse and as an educator of nursing students and
practicing labor and delivery nurses, certifi ed nurse midwives, family medicine physicians, and obstetricians. She
is a recognized obstetric nursing expert.
Dr. Murray’s company, Learning Resources International, Inc., produces clinical and continuing education
products for labor and delivery nurses. Her work has been published in journals such as the International Journal
of Childbirth as the editor in chief; Birth: Issues in Perinatal Care; The American Journal of Maternal Child Nurs-
ing (MCN); Journal of Perinatology; Journal of Nursing Care Quality; and Journal of Obstetric, G ynecologic,
and Neonatal Nursing (JOGNN). Dr. Murray was also a contributor to the Association of Women’s Health,
Obstetric and Neonatal Nurses (AWHONN) publication, Nursing Management of the Second Stage of Labor.
Her best-selling books include Antepartal and Intrapartal Fetal Monitoring (Third Edition) and Essentials of
Fetal and Uterine Monitoring (Fifth Edition). Her books and products are available at www.fetalmonitoring.com
or directly from Springer Publishing Company.
Dr. Murray has been an active member and offi cer of the AWHONN as well as the American Nurses Asso-
ciation’s New Mexico Nurses Association. She is an award winner in education from AWHONN (formerly the
Nurses Association of the American College of Obstetricians and Gynecologists), and from the nursing honor
society, Sigma Theta Tau.
Gayle M. Huelsmann, BSN, RNC-OB, C-EFM, is certifi ed in inpatient obstetrics and holds a certifi cate of added
qualifi cation in electronic fetal monitoring from the National Certifi cation Corporation in Chicago, Illinois. She
has been an antepartal nurse and a labor and delivery staff nurse for 35 years. During her 21 years as a maternal
air transport nurse with fi xed wing and rotor wing aircraft, she was awarded the PRIDE nurse distinction from
Presbyterian Hospital for her exemplary contribution to patient care. Ms. Huelsmann has published on a variety
of topics related to labor and delivery nursing and is the coauthor of Essentials of Fetal and Uterine Monitoring
(Fifth Edition) and the monograph on Uterine Hyperstimulation: Physiologic and Pharmacologic Causes With
Results From a Survey of 1000 Nurses with Dr. Michelle L. Murray. Ms. Huelsmann is an experienced Lean Six
Sigma Green Belt for quality and performance improvement projects in healthcare organizations.
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd iiii 55//2288//2200 22::3311 PPMM
Labor and Delivery Nursing
A Guide to Evidence-Based Practice
Second Edition
Michelle L. Murray, PhD, RNC-OB
Gayle M. Huelsmann, BSN, RNC-OB, C-EFM
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd iiiiii 55//2288//2200 22::3311 PPMM
Copyright © 2021 Springer Publishing Company, LLC
All rights reserved.
First Springer Publishing Company edition 2008
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company,
LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood
Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com.
Springer Publishing Company, LLC
11 West 42nd Street, New York, NY 10036
www.springerpub.com
connect.springerpub.com/
Acquisitions Editor: Elizabeth Nieginski
Compositor: S4Carlisle Publishing Services
ISBN: 978-0-8261-8475-7
ebook ISBN: 978-0-8261-8476-4
DOI: 10.1891/9780826184764
20 21 22 23 / 5 4 3 2 1
The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information
that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is
continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes
in procedures become necessary. We recommend that the reader always consult current research and specific institutional
policies before performing any clinical procedure or delivering any medication. The author and publisher shall not be liable
for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the
information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external
or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is,
or will remain, accurate or appropriate.
Library of Congress Cataloging-in-Publication Data
Names: Murray, Michelle (Michelle L.), author. | Huelsmann, Gayle, author.
Title: Labor and delivery nursing : a guide to evidence-based practice /
Michelle L. Murray, Gayle M. Huelsmann.
Description: Second edition. | New York : Springer Publishing Company,
[2021] | Includes bibliographical references and index.
Identifiers: LCCN 2020018446 (print) | LCCN 2020018447 (ebook) | ISBN
9780826184757 (paperback) | ISBN 9780826184764 (ebook)
Subjects: MESH: Obstetric Nursing--methods | Delivery, Obstetric--nursing |
Evidence-Based Nursing | Labor, Obstetric
Classification: LCC RG951 (print) | LCC RG951 (ebook) | NLM WY 157 | DDC
618.2/0231--dc23
LC record available at https://lccn.loc.gov/2020018446
LC ebook record available at https://lccn.loc.gov/2020018447
Contact us to receive discount rates on bulk purchases.
We can also customize our books to meet your needs.
For more information please contact: [email protected]
Publisher’s Note: New and used products purchased from third-party sellers are not guaranteed for quality, authenticity, or
access to any included digital components.
Printed in the United States of America.
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd iivv 55//2288//2200 22::3311 PPMM
Knowledge comes from learning.
Wisdom comes from experience.
—Anonymous
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd vv 55//2288//2200 22::3311 PPMM
Disclaimer
This book is not intended to replace your hospital’s The content of this book was based on the best
policies, procedures, guidelines, or protocols. It is not available research at the time it was written. Some
intended to dictate a standard of care. We recom- studies may appear dated and may have been the
mend that the reader always consult current research only study on the subject that was readily avail-
and specifi c institutional policies before performing able at the time of this publication. Every attempt
any clinical procedure. This book is intended for use was made to provide current information that is
during the process of orientation of nurses in the la- evidence-based.
bor and delivery setting, and to bring experienced Neither the author nor the publisher shall be liable
nurses up to date with regard to current practice and for any special, consequential, or exemplary damages
research fi ndings. It can also be used as a reference or resulting, in whole or in part, from the readers’ use of,
as a study guide by nurses preparing to take a certifi - or reliance on, the information contained in this book.
cation examination in the fi eld of inpatient obstetrics The publisher has no responsibility for the persistence
or labor and delivery. or accuracy of URLs for any external or third-party
This book does not include directions for equip- Internet websites referred to in this publication and
ment use or specifi c tests. These must be learned in does not guarantee that any content on such websites
the hospital setting, preferably with a mastery-based is, or will remain, accurate or appropriate.
skills checklist. In addition, care should be individual-
ized to the patient.
True/false questions appear at the end of each
chapter as a complement to the learning process.
Each chapter contains the information necessary to
answer the questions.
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd vvii 55//2288//2200 22::3311 PPMM
Contents
Preface ix 8. Presentation, Position, and Station 225
Acknowledgments xiii
9. Powers: Force and Physiology 243
1. Advocacy, Communication, Chain of
Command, and Evidence-Based Practice 1 10. Psyche During Pregnancy, Childbirth, and
Postpartum 275
2. Assessment to Create an Individualized Plan
of Care and Informed Consent 25 Appendix A: Abbreviations 301
Appendix B: A bbreviations to Avoid in
3. Labor and Birth 65
Documentation 309
Appendix C: Hospital Labor and Delivery
4. Pain, Pain Reduction, and Evidence-Based
Orientation Fundamentals 311
Practice 115
Appendix D: Orientation Checklist 315
5. Positions for Labor and Birth 147
Appendix E: Orientation Log Chart 321
6. The Passageway, Passenger, Placenta, Glossary 325
and the Umbilical Cord 161
Index 335
7. Passenger–Passageway Problems 199
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd vviiii 55//2288//2200 22::3311 PPMM
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd vviiiiii 55//2288//2200 22::3311 PPMM
Preface
The interests of the patient are the only interests to to provide you with the information to develop an
be considered. evidence-based practice of labor and delivery nursing.
—William Mayo Labor and delivery nursing requires critical thinking,
constant caring, listening to your inner voice, anticipa-
Learning about labor and birth requires effort. tion of the needs of many, teamwork, communication,
Reading books such as this one is one way to learn and collaboration (see Box 1). Translators are often
evidence-based concepts. In addition, learning about family members or friends who speak the language
childbearing care practices that will keep patients safe of the childbearing woman. They are not certifi ed in-
and optimize outcomes can also occur from decades of terpreters. It is also important to listen to signifi cant
experience prior to confi rmation by research. Nurses others who accompany the childbearing woman and
with decades of experience know, for example, that may have important information to share.
the chain of command involves communication that Proper surveillance and care of the fetus and
can take many forms. For example, notifying a nurs- mother during labor and delivery depend on compre-
ing leader of your patient’s vital sign abnormalities hensive data acquisition, attention to detail, adequate
is a form of the chain of command. When the nurs- knowledge to properly understand and interpret the
ing leader comes to the bedside to confi rm that and meaning of data, verbal and nonverbal cues, and
any other abnormalities and assists the primary nurse teamwork. This book was created with these elements
in formulating a plan of care to optimize maternal in mind. Figure 1 illustrates the nursing process from
and fetal outcomes, that is also part of the chain of admission to delivery. If possible, review the patient’s
command. prenatal record before she arrives.
To be an effective care provider, nurses must have
courage, confi dence, and competence. They must
communicate with the patient, nursing leadership, BOX 1 Some characteristics of a critical thinker
and the obstetric care providers. In some cases, there
1. States the question or concern clearly
may be barriers to their patient advocacy. That is why
2. Creates order in complex situations
the courage to speak up and base care on evidence-
based concepts, including physiology, is critical to pa- 3. Diligently seeks relevant information
tient safety. 4. Focuses on the concern at hand
All healthcare providers need to be aware of their 5. Persists until results are obtained in spite of
cognitive biases and keep an open mind and an ac- diffi culties
cepting attitude. They need hands-on skills and a 6. Is inquisitive, well-informed, open-minded, and
broad and deep understanding of the research related fl exible
to pregnancy, labor, and birth. That means they are 7. Acknowledges personal biases
lifelong learners and their work environment allows 8. Bases judgments on analysis of data (clinical
them to provide evidence-based practice (Scott-Find- decision-making)
lay, 2007). 9. Is willing to reconsider
The best care will be evidence based and result in
10. Is clear regarding the issues
good outcomes. Therefore, the goal of this book is
MMuurrrraayy__8844775577__ffmm__ppoodd..iinndddd iixx 55//2288//2200 22::3311 PPMM
