Monitoring the Person in Labor for Complications Developing During the Process of Labor and Birth

Core Concepts

Maternal vital signs and general assessment

Temperature, pulse, respirations, and blood pressure are the baseline story of labor. A rising temperature can signal intra-amniotic infection (chorioamnionitis), especially after prolonged rupture of membranes; maternal and fetal tachycardia often accompany it. Blood pressure elevation with headache or visual changes points toward hypertensive disorders such as preeclampsia. Tachycardia in a laboring person can mean dehydration, pain, infection, or early blood loss. Nurses also observe general condition: skin color and perfusion, urine output, the character of any vaginal bleeding, and reports of pain — especially pain out of proportion to contractions.

Uterine activity: contractions and resting tone

Contractions are assessed for frequency, duration, and intensity — by palpation, by external tocodynamometry, or by intrauterine pressure catheter (IUPC), which measures actual pressure. What matters beyond the contraction itself is the resting tone between contractions: the uterus should relax, because the fetus depends on relaxation for blood flow. Too many contractions (tachysystole), contractions that last too long, or poor relaxation between them can compromise fetal oxygenation. Defining "too many" and "too long" follows current guidelines and facility policy — the concept to internalize is that the resting phase is as important as the contraction.

Fetal heart rate monitoring

Fetal heart rate (FHR) monitoring comes in two forms: intermittent auscultation (listening at scheduled intervals) and continuous electronic fetal monitoring (EFM). Both are legitimate; the choice depends on risk status, facility policy, and guidelines. The tracing is read in components: baseline rate, baseline variability (fluctuations in the rate), accelerations, and decelerations. Decelerations are classified by their timing and shape relative to contractions: early decelerations mirror the contraction (head compression, generally benign), late decelerations begin after the contraction peaks (uteroplacental insufficiency — worrisome), and variable decelerations are abrupt, V-shaped drops (cord compression). Many facilities use the three-tier NICHD system (Category I reassuring, Category II indeterminate, Category III abnormal), but interpreting tracings requires specialized training — this guide teaches the vocabulary, not the certification.

Labor progress: dilation, station, position, membranes

Progress is tracked by cervical dilation and effacement, fetal station (descent relative to the ischial spines), fetal position, and the status of the membranes. When membranes rupture — spontaneously or by procedure — the nurse notes the time and the character of the amniotic fluid: clear, blood-tinged, or meconium-stained (thick green fluid that may signal fetal stress and carries aspiration risk). Progress that stalls, a presenting part that does not descend, or abnormal fluid findings are the raw material for recognizing dystocia, malposition, or cord problems.

Pain, coping, and psychosocial status

Labor pain is expected, but how a person experiences and copes with it matters clinically. A person in severe distress may breathe poorly, push ineffectively, or become exhausted; escalating pain in an unexpected pattern — especially constant pain between contractions — can signal a complication such as uterine rupture. Monitoring includes offering comfort measures and positioning options, respecting the person's preferences and cultural needs, and communicating their experience honestly to the team.

Danger signs that require escalation

Some findings should trigger immediate action and provider notification: vaginal bleeding (especially bright red), sudden severe or constant abdominal pain, fever, severe headache with visual changes, chest pain or difficulty breathing, seizure activity, a nonreassuring or worsening fetal heart rate pattern, and (rarely) shoulder or neck pain. The response includes re-assessing, repositioning, continued monitoring, and escalation through the chain of command — per facility policy and provider orders.

Communication, documentation, and scope

A monitoring finding only helps if it is communicated. Structured tools like SBAR (Situation, Background, Assessment, Recommendation) keep escalation clear and complete. Documentation captures the tracing, the maternal assessments, the interventions tried, and the response — and the timing of each. Finally, remember scope: what the nurse may do independently (repositioning, reassessment, supportive care) versus what requires orders (medications, operative procedures) varies by jurisdiction and facility, so know your own scope and the institutional protocols.

Common Confusions