Labor is a remarkable physiological process, characterized by a series of uterine contractions. These contractions are instrumental in dilating and effacing the cervix, ultimately facilitating the fetus’s journey through the birth canal and out of the vagina. While labor typically commences around the estimated due date (EDD), the precise timing of its onset remains unpredictable.
Stages of Labor
The labor process is traditionally divided into three distinct stages:
Stage 1: Early and Active Labor. This is often the most protracted stage of labor. It begins with the onset of regular contractions and continues until the cervix is fully dilated to 10 centimeters. Early labor is marked by contractions that gradually increase in frequency, duration, and intensity. As labor progresses into the active phase, contractions become more established, typically occurring every five minutes or less, prompting the patient’s admission to the hospital or birthing center. During this stage, the cervix dilates from 0 to approximately 6 centimeters. As active labor intensifies, contractions become stronger and more frequent. Women may experience an increasing urge to push as the baby descends further into the birth canal.
Stage 2: Delivery of the Baby. This stage commences once the cervix reaches full dilation (10 centimeters) and culminates in the birth of the baby. Contractions in this phase are typically frequent and powerful. The mother is encouraged to actively participate by pushing during contractions to aid in the baby’s descent and expulsion.
Stage 3: Delivery of the Placenta. Following the delivery of the baby, the third stage focuses on the expulsion of the placenta. The placenta detaches from the uterine wall and is delivered through the vagina. This stage is generally the shortest of the three.
The mode of delivery, whether vaginal or via Cesarean section (C-section), is determined by various factors. Vaginal delivery is generally considered the preferred method due to its lower risk of complications and faster maternal recovery.
Alt text: Laboring woman supported by nurse, illustrating active labor and delivery care.
A C-section involves surgical incisions through the abdomen and uterus to deliver the baby. C-sections can be planned in advance for medical reasons or performed emergently during labor if complications arise, such as fetal distress, placental abruption, umbilical cord prolapse, or excessive maternal bleeding.
Nursing Process in Labor and Delivery
Labor and delivery nurses play a pivotal role in the care of women and their newborns throughout the perinatal period – before, during, and after delivery. They act as a crucial link between the patient and the medical team, particularly the physician. Nurses provide essential support to the laboring mother, offering education, comfort measures, and continuous updates on labor progress. They also monitor for potential complications and facilitate necessary interventions. In cases of C-section deliveries, labor and delivery nurses may also assist in the surgical procedure as scrub nurses.
Nursing Assessment in Labor and Delivery
The cornerstone of effective nursing care is a comprehensive nursing assessment. This initial step involves the labor and delivery nurse gathering a holistic dataset encompassing physical, psychosocial, emotional, and diagnostic information. This data collection is crucial for formulating appropriate nursing diagnoses and care plans.
Review of Health History
1. Prenatal Care Review: A thorough review of the patient’s prenatal care record is paramount during the initial labor assessment. This includes confirming the estimated delivery date and identifying any pre-existing conditions or risk factors.
2. Comprehensive History Taking: The nurse should elicit a detailed history from the patient, inquiring about fetal movements, contraction frequency and timing, the status of amniotic membranes (ruptured or intact), and the presence or absence of vaginal bleeding or bloody show. The mother’s past medical, surgical, and obstetric history, along with recent laboratory results and imaging studies, should also be reviewed.
3. Differentiation of True Labor: It is critical to distinguish true labor contractions from Braxton-Hicks contractions (often referred to as “false labor”). Braxton-Hicks contractions are typically irregular, less intense than true labor contractions, and often subside with changes in activity or walking. True labor contractions, conversely, become progressively stronger, more regular, and do not diminish with activity changes.
Physical Assessment
1. Identifying Signs of Labor: The manifestations of labor can vary among individuals; however, common signs include:
- Progressive, regular uterine contractions that increase in frequency, duration, and intensity.
- Rupture of the amniotic sac, often described as “water breaking,” which may present as a gush or a slow leak of clear fluid.
- “Bloody show,” which is the passage of blood-tinged mucus from the vagina, indicating cervical changes.
- Pain localized in the abdomen and lower back, often described as cramping or aching.
2. Leopold’s Maneuvers: These are a series of four palpation techniques used to systematically assess the fetal presentation, position, and lie within the uterus.
- First Maneuver: Involves palpating the uterine fundus to identify the fetal part occupying this area (head or breech).
- Second Maneuver: Involves palpating the sides of the uterus to determine the location of the fetal back and small parts (limbs).
- Third Maneuver: Involves grasping the lower uterine segment just above the symphysis pubis to confirm fetal presentation and assess fetal engagement.
- Fourth Maneuver: Involves assessing the fetal presenting part to determine the degree of descent into the pelvis.
Abnormal fetal presentations, such as breech, brow, face, or shoulder presentation, can lead to complications during labor and may necessitate specific interventions or Cesarean delivery.
3. Vital Signs Monitoring: Regular monitoring of maternal vital signs is essential. Elevated blood pressure may be indicative of preeclampsia or eclampsia, serious pregnancy complications that pose risks to both mother and fetus during labor and delivery.
4. Pelvic Examination: A sterile vaginal examination is performed to assess cervical dilation (opening) and effacement (thinning). If amniotic membrane rupture is suspected but not confirmed, a sterile speculum examination may be performed to visualize amniotic fluid in the cervix.
5. Contraction Pattern Monitoring: As labor progresses, contractions become more frequent and intense. In active labor and the second stage, contractions may occur every two to five minutes and last for 60 to 90 seconds. The mother is instructed to push during contractions and rest between them.
6. Fetal Station Determination: Fetal station refers to the degree of descent of the fetal presenting part in relation to the ischial spines of the maternal pelvis. It is measured in centimeters, ranging from -5 to +5. A station of -5 indicates the presenting part is high above the ischial spines, while +5 signifies that it has descended to the vaginal opening. A station of 0 indicates engagement, where the presenting part is at the level of the ischial spines. Engagement typically occurs approximately two weeks prior to labor in first-time pregnancies.
7. Pain Assessment: Utilizing a validated pain scale, such as the numeric pain rating scale (0-10), is crucial to quantify the patient’s pain level. Frequent pain assessments guide the need for pain management interventions and evaluate their effectiveness.
Diagnostic Procedures
1. Pelvic Evaluation: Clinical pelvimetry (manual examination) or radiographic methods (CT or MRI) may be used to assess the shape and dimensions of the maternal pelvis. This evaluation helps to predict potential cephalopelvic disproportion (CPD) and guide decisions regarding the feasibility of vaginal delivery. Pelvic evaluation may be performed during prenatal visits or upon admission in labor.
2. Routine Laboratory Tests: Standard laboratory tests for laboring patients typically include:
- Complete Blood Count (CBC): To assess hemoglobin, hematocrit, and platelet levels, providing baseline information and detecting potential anemia or infection.
- Blood Typing and Screening: To determine blood type and screen for antibodies, essential for blood transfusion preparedness if needed.
- Urinalysis: To assess for proteinuria, glucosuria, and infection, which can be relevant in conditions like preeclampsia or gestational diabetes.
3. Uterine Contraction Monitoring: External tocodynamometry (toco) is initiated upon admission to the labor and delivery unit to continuously monitor uterine contraction frequency, duration, and relative intensity.
4. Fetal Heart Rate Monitoring: Continuous fetal heart rate monitoring is crucial throughout labor. This can be achieved using an external Doppler device, external fetal monitor, or internal fetal scalp electrode (for higher-risk labors). Fetal heart rate monitoring assesses fetal well-being and detects patterns indicative of fetal distress.
5. Bedside Ultrasound: Bedside ultrasonography may be utilized to confirm fetal presentation, position, and amniotic fluid volume. Ultrasound can also aid in identifying potential complications that might necessitate Cesarean delivery.
Alt text: Nurse using Doppler to monitor fetal heart rate during labor assessment.
Nursing Interventions in Labor and Delivery
Nursing interventions are integral to supporting the laboring woman and promoting a safe and positive birth experience.
Management of Patient and Fetus During Labor
1. Explain the Need for Cervical Exams: Clearly explain to the patient and her support person the purpose and frequency of cervical examinations. Cervical exams are performed to monitor labor progress by assessing cervical dilation and effacement. Typically, sterile cervical exams are performed every 2 to 3 hours, unless specific concerns warrant more frequent assessments. It is important to acknowledge that frequent cervical checks can slightly increase the risk of infection, particularly after membrane rupture.
2. Encourage Ambulation and Position Changes: Promote maternal mobility and encourage frequent position changes throughout labor, if medically appropriate. Upright positions and ambulation can facilitate fetal descent, promote labor progress, and provide pain relief.
3. Intravenous Line Insertion: Establish an intravenous (IV) line for medication administration (e.g., analgesia, oxytocin) and fluid replacement as needed.
4. Oral Intake: Current evidence-based practice generally supports allowing oral intake during labor for low-risk women. Light meals and clear liquids can provide energy and prevent dehydration. However, individual hospital policies and patient-specific risk factors may influence this recommendation.
5. Pain Management: Offer a range of pain relief options, both pharmacological and non-pharmacological. Pharmacological options may include intravenous opioids, inhaled nitrous oxide, and epidural analgesia. Non-pharmacological methods encompass massage, breathing techniques, hydrotherapy, and position changes. Collaborate with the patient to develop a pain management plan that aligns with her preferences and medical needs.
6. Comfort Measures: Implement various comfort measures to enhance relaxation and reduce discomfort during labor:
- Create a calming and supportive environment with dim lighting, quiet surroundings, soothing music, and privacy.
- Encourage movement and position changes such as walking, slow dancing with a partner, pelvic rocking, and utilizing a birth ball.
- Promote relaxation techniques like massage, acupressure, and counterpressure to the lower back.
- Apply thermal therapies, such as warm compresses, showers, or baths, and cold compresses as per patient preference.
7. Amniotomy (Artificial Rupture of Membranes): Prepare for and assist with amniotomy if indicated. Amniotomy may be performed to augment labor or facilitate fetal monitoring. However, it is not always necessary or beneficial and should be considered based on individual labor progress and clinical circumstances.
8. Oxytocin Administration: Administer oxytocin intravenously as prescribed to augment or induce labor if contractions are inadequate or labor progress is slow. Closely monitor maternal and fetal response to oxytocin.
9. Prevention of Complications: Vigilant monitoring and proactive interventions are crucial to prevent and manage potential labor and delivery complications.
- First Stage Complications: Arrest of labor may occur, potentially necessitating Cesarean delivery.
- Second Stage Complications: Maternal and fetal complications during the second stage can arise from the physiological stress of pushing and delivery.
- Fetal complications may include asphyxia, brain damage, acidemia, shoulder dystocia, bone fractures, nerve palsies, and cephalohematoma.
- Maternal complications can include uterine rupture, vaginal and cervical lacerations, uterine hemorrhage, and amniotic fluid embolism.
- Third Stage Complications: Complications in the third stage of labor primarily include postpartum hemorrhage, umbilical cord avulsion, retained placenta, and incomplete placental evacuation.
Postpartum Monitoring and Care
1. Pain Management: Address postpartum pain effectively. Following a C-section, pain management may involve NSAIDs or opioid analgesics. After vaginal delivery, perineal soreness and discomfort from episiotomy or lacerations are common. Offer and implement pain relief measures such as:
- Encouraging the use of a donut pillow for sitting comfort.
- Sitz baths with warm water to promote perineal healing and comfort.
- Application of ice packs or chilled sanitary pads to the perineum to reduce swelling and pain.
- Administration of acetaminophen or ibuprofen as needed for pain and inflammation.
2. Vaginal Discharge (Lochia) Monitoring: Educate the patient about lochia, the normal postpartum vaginal discharge, and its expected progression through three stages:
- Lochia rubra: Dark red, lasting approximately 3-4 days postpartum.
- Lochia serosa: Pinkish-brown, lasting about 4-10 days postpartum.
- Lochia alba: Whitish-yellow, lasting for up to 2-6 weeks postpartum.
Instruct the patient to report any abnormal lochia characteristics, such as excessive bleeding (soaking a pad in an hour), large clots, foul odor, or persistent rubra stage beyond 4 days.
3. Constipation Prevention: Educate the patient on strategies to prevent postpartum constipation, which is common due to hormonal changes, decreased mobility, and pain medications. Recommendations include:
- Stool softeners or mild laxatives as prescribed or recommended.
- A diet rich in fiber and adequate fluid intake.
- Over-the-counter hemorrhoid creams or suppositories for hemorrhoid discomfort.
- Witch hazel pads for perineal soothing.
- Sitz baths to promote perineal comfort and bowel regularity.
4. Hygiene Education: Provide thorough instruction on perineal care and hand hygiene. Emphasize wiping from front to back after voiding or defecating to prevent infection. Advise on frequent pad changes and proper handwashing techniques.
5. Mood and Emotional Changes Recognition: Acknowledge the emotional lability common in the postpartum period (“baby blues”). Educate the patient and family about potential mood swings, anxiety, insomnia, and tearfulness. Differentiate between transient baby blues and postpartum depression. Instruct the patient to report persistent symptoms, loss of appetite, anhedonia, or withdrawal from the newborn, which may indicate postpartum depression requiring professional intervention.
6. Breastfeeding Promotion: Support breastfeeding initiation as soon as the mother and baby are ready. Provide lactation education and resources, including referral to a lactation consultant. Educate on proper latch, positioning, and techniques to prevent and manage breast engorgement, nipple pain, and other breastfeeding challenges.
7. Postpartum Checkup Reminders: Emphasize the importance of postpartum follow-up appointments. The first postpartum checkup is typically scheduled within a few weeks after delivery. Subsequent visits may be needed to monitor maternal well-being, discuss contraception, and ensure adequate healing.
Alt text: Postpartum nurse instructing new mother on breastfeeding techniques.
Labor and Delivery Nursing Care Plans and Diagnoses
Once nursing assessments are complete, labor and delivery nurses formulate nursing diagnoses. These diagnoses guide the development of individualized nursing care plans that prioritize assessments and interventions to achieve short-term and long-term patient goals. Common nursing diagnoses in labor and delivery include:
Acute Pain
Labor pain is a significant physiological stressor, caused by uterine contractions and cervical dilation. Pain perception is subjective and varies greatly among individuals. Labor pain is typically described as intense cramping sensations in the abdomen, groin, and back.
Nursing Diagnosis: Acute Pain
Related Factors:
- Uterine muscle contractions
- Cervical dilation and effacement
- Tissue trauma during delivery
As Evidenced By:
- Self-report of pain (using pain scale)
- Restlessness and agitation
- Moaning, crying, or wincing
- Facial grimacing or mask of pain
- Diaphoresis (sweating)
- Tachycardia and tachypnea
Expected Outcomes:
- Patient will verbalize a reduction in pain intensity using a pain scale.
- Patient will demonstrate relaxed body language and utilize comfort measures.
- Patient will actively participate in pain management strategies, such as breathing techniques and position changes.
Assessments:
1. Pain Assessment using Numeric Pain Scale: Regularly assess and document the patient’s pain level using a numeric pain scale (0-10). Subjective pain assessment is crucial to guide pain management interventions.
2. Vital Signs Monitoring in Conjunction with Pain Assessment: Assess vital signs (blood pressure, heart rate, respiratory rate) concurrently with pain assessment, as pain can elevate these parameters. Pain is often considered the “fifth vital sign.”
Interventions:
1. Establish Nurse-Patient Rapport: Build a trusting and supportive relationship with the patient and her support person. Address questions and concerns to alleviate anxiety and promote relaxation.
2. Breathing Techniques Instruction: Teach and guide the patient in breathing techniques, such as slow, deep breathing, patterned breathing (e.g., pant-pant-blow), to promote relaxation and pain coping.
3. Pain Relief Options Discussion: Engage in shared decision-making regarding pain management. Discuss pharmacological and non-pharmacological pain relief options, empowering the patient to make informed choices aligned with her preferences.
4. Positioning Assistance: Assist the patient in assuming comfortable positions, such as side-lying, leaning forward, or hands-and-knees positions. Position changes can alleviate pressure and promote comfort.
5. Comfort Measures Implementation: Provide comfort measures such as back massage, sacral counterpressure, warm or cold compresses, and supportive pillows to enhance relaxation and pain relief.
6. Analgesic Administration as Prescribed: Administer pharmacological analgesia (e.g., intravenous opioids, epidural analgesia) as prescribed. For epidural analgesia, assist the anesthesiologist with patient positioning and procedural support.
Anxiety
Anxiety is a common emotional response during labor and delivery, particularly for first-time mothers. Anxiety may stem from fear of the unknown, concerns about the baby’s well-being, anticipated pain, and potential interventions like epidural analgesia or Cesarean delivery.
Nursing Diagnosis: Anxiety
Related Factors:
- Perceived threat to maternal or fetal well-being
- Fear of labor and delivery process and outcomes
- Concerns about pain management
- Potential for surgical intervention (C-section)
As Evidenced By:
- Verbalization of anxious feelings and concerns
- Increased muscle tension
- Restlessness and irritability
- Expressed feelings of inadequacy or fear
- Changes in vital signs (elevated heart rate, respiratory rate, blood pressure)
Expected Outcomes:
- Patient will verbalize a decrease in anxiety and increased sense of control.
- Patient will demonstrate relaxed demeanor and effective coping mechanisms.
- Patient will utilize support systems effectively.
Assessments:
1. Psychological and Emotional State Assessment: Assess the patient’s emotional state and psychological well-being. Anxiety and fear can impact labor progress and patient cooperation.
2. Specific Anxiety Triggers Identification: Explore the patient’s specific concerns and sources of anxiety to tailor interventions effectively. Open communication can help address misconceptions and alleviate fears.
Interventions:
1. Acknowledge and Validate Patient’s Feelings: Acknowledge and validate the patient’s anxiety and fears. Provide reassurance and empathetic listening.
2. Support System Inclusion: Involve the patient’s support person (partner, family member) in the care process. Provide information and support to both the patient and her support system.
3. Maintain Calm and Reassuring Demeanor: Maintain a calm and confident demeanor. Provide clear, concise explanations and updates on labor progress. In emergency situations, maintain composure and provide clear directions.
4. Relaxation Techniques Promotion: Encourage and guide the patient in relaxation techniques such as deep breathing exercises, guided imagery, progressive muscle relaxation, and effleurage.
5. Calm Environment Provision: Create a calm and peaceful labor environment by dimming lights, minimizing noise and interruptions, and ensuring privacy.
Risk for Decreased Cardiac Output
During labor, cardiac output physiologically increases to meet the demands of pregnancy and labor. However, certain complications of labor and delivery can compromise cardiac output and lead to decreased cardiac output.
Nursing Diagnosis: Risk for Decreased Cardiac Output
Related Factors:
- Hemorrhage (antepartum, intrapartum, postpartum)
- Dehydration and hypovolemia
- Fluid and electrolyte imbalances
- Preeclampsia and eclampsia
- Cardiac conditions
- Uterine atony
- Anesthesia (spinal, epidural)
As Evidenced By:
A risk diagnosis is not evidenced by actual signs and symptoms, as the problem has not yet occurred. Interventions are focused on prevention.
Expected Outcomes:
- Patient will maintain stable vital signs within normal limits.
- Patient will exhibit adequate peripheral perfusion.
- Fetal heart rate will remain within normal limits (110-160 bpm).
Assessments:
1. Vital Signs Monitoring: Regularly monitor maternal vital signs, including blood pressure, heart rate, and respiratory rate, both between and during contractions. Assess for trends and deviations from baseline.
2. Fetal Heart Rate Monitoring: Continuously monitor fetal heart rate and patterns. Fetal heart rate abnormalities can be an early indicator of uteroplacental insufficiency related to decreased maternal cardiac output.
Interventions:
1. Lateral Positioning: Encourage the patient to lie in a left lateral side-lying position whenever possible. Lateral positioning optimizes venous return and cardiac output by relieving pressure on the inferior vena cava.
2. Bleeding Monitoring and Management: Closely monitor for signs of bleeding (vaginal bleeding, excessive lochia, changes in vital signs). Implement appropriate interventions for hemorrhage prevention and management.
3. Oxygen Administration as Needed: Administer supplemental oxygen as prescribed if signs of maternal or fetal compromise are present.
4. Post-Anesthesia Vital Signs Monitoring: Following spinal or epidural anesthesia, closely monitor vital signs for hypotension, which is a potential side effect that can reduce cardiac output.
5. Continuous Fetal Heart Rate Monitoring: Maintain continuous fetal heart rate monitoring to detect early signs of fetal distress related to decreased cardiac output.
Risk for Imbalanced Fluid Volume
Pregnancy and labor predispose women to fluid volume shifts and potential imbalances due to physiological changes, blood loss, and fluid restrictions or losses.
Nursing Diagnosis: Risk for Imbalanced Fluid Volume
Related Factors:
- Hemorrhage
- Dehydration (inadequate oral intake, prolonged labor)
- Nausea and vomiting
- Diaphoresis
- Third-spacing of fluids
- Oxytocin administration (potential for water intoxication)
As Evidenced By:
A risk diagnosis is not evidenced by actual signs and symptoms, as the problem has not yet occurred. Interventions are focused on prevention.
Expected Outcomes:
- Patient will maintain balanced fluid volume as evidenced by stable vital signs, adequate urine output, and balanced intake and output.
- Patient will exhibit normal electrolyte levels.
- Patient will maintain moist mucous membranes and good skin turgor.
Assessments:
1. Medical History Review for Fluid Imbalance Risk Factors: Review the patient’s medical history for conditions that increase the risk of fluid imbalance, such as preeclampsia, hyperemesis gravidarum, or pre-existing renal or cardiac conditions.
2. Laboratory Values Monitoring: Monitor relevant laboratory values such as hemoglobin, hematocrit, electrolytes (sodium, potassium), and urine specific gravity to assess fluid status.
3. Vital Signs Assessment for Fluid Imbalance Indicators: Assess vital signs for indicators of fluid volume deficit (hypotension, tachycardia, weak pulse) or fluid volume excess (hypertension, bounding pulse, edema).
Interventions:
1. Monitor Blood Pressure and Pulse During Oxytocin Infusion: Closely monitor blood pressure and pulse during oxytocin administration, as oxytocin can have an antidiuretic effect and lead to fluid retention or water intoxication.
2. Encourage Oral Fluid Intake: Encourage oral fluid intake throughout labor, unless contraindicated. Offer clear liquids and ice chips to maintain hydration.
3. Intravenous Fluid Administration as Prescribed: Administer intravenous fluids as prescribed to maintain hydration, replace fluid losses, or administer medications.
4. Intake and Output Monitoring: Accurately monitor and document fluid intake and output, including intravenous fluids, oral intake, urine output, and insensible losses.
Risk for Infection
The rupture of amniotic membranes creates a pathway for ascending infection, increasing the risk of intra-amniotic infection (chorioamnionitis) and postpartum infection (puerperal sepsis).
Nursing Diagnosis: Risk for Infection
Related Factors:
- Rupture of amniotic membranes (prolonged rupture of membranes – PROM)
- Frequent vaginal examinations
- Invasive procedures (IV insertion, urinary catheterization, fetal scalp electrode)
- Prolonged labor
- Compromised immune status
As Evidenced By:
A risk diagnosis is not evidenced by actual signs and symptoms, as the problem has not yet occurred. Interventions are focused on prevention.
Expected Outcomes:
- Patient will remain afebrile and free from signs and symptoms of infection.
- Patient will verbalize understanding of infection prevention measures.
- Patient will demonstrate proper hygiene practices.
Assessments:
1. Amniotic Fluid Assessment: Assess amniotic fluid for color, odor, and consistency upon rupture of membranes. Note and document any signs of infection, such as cloudy or foul-smelling amniotic fluid.
2. Fetal Heart Rate Monitoring for Tachycardia: Monitor fetal heart rate for tachycardia (above 160 bpm), which can be an early sign of intra-amniotic infection.
3. Maternal Vital Signs and WBC Count Monitoring: Monitor maternal vital signs, particularly temperature, and white blood cell count. Elevated temperature (above 100.4°F or 38°C) and leukocytosis can indicate infection.
Interventions:
1. Limit Vaginal Examinations: Limit the number of vaginal examinations, particularly after rupture of membranes, to minimize the risk of introducing pathogens.
2. Aseptic Technique During Invasive Procedures: Strictly adhere to aseptic technique during all invasive procedures, such as IV insertion, urinary catheterization, and fetal scalp electrode placement.
3. Perineal Hygiene and Handwashing Education: Educate the patient on proper perineal hygiene, including wiping from front to back, frequent perineal pad changes, and thorough handwashing.
4. Antibiotic Administration as Prescribed: Administer prophylactic or therapeutic antibiotics as prescribed, particularly in cases of prolonged rupture of membranes, suspected chorioamnionitis, or Group B Streptococcus (GBS) colonization.
5. Oxytocin Administration to Augment Labor: If labor is prolonged after membrane rupture, oxytocin may be administered to augment labor and expedite delivery, thereby reducing the duration of exposure to potential infection.
References
- Lowdermilk, D. L., Perry, S. E., Cashion, K., & Jordon, S. L. (2020). Maternity & women’s health care. (12th ed.). Mosby.
- National Association of Neonatal Nurses (NANN). (2023). Neonatal nursing care guidelines. (4th ed.).
- Ricci, S. S., Kyle, T., & Carman, S. (2021). Maternity and pediatric nursing. (4th ed.). Wolters Kluwer.
- World Health Organization. (2018). WHO recommendations for prevention and treatment of maternal peripartum infections. Geneva: World Health Organization.
