Factors Influencing the Process of Labor and Birth
Pathophysiology
Labor progression is determined by the interaction of the five Ps: power (uterine/pushing force), passage (bony and soft tissues), passenger (fetal size, lie, attitude, position), position (maternal movement/posture), and psyche (fear, coping, support). Small changes in one domain can accelerate or hinder labor.
Nursing Assessment
- Evaluate contraction pattern, cervical change, and fetal descent trend.
- Assess fetal lie/presentation/position and response to positional interventions.
- Screen for maternal fatigue, fear, pain coping, and support adequacy.
- Identify warning signs requiring escalation (bleeding, fetal movement change, severe headache, rupture concerns).
Nursing Interventions
- Promote mobility and frequent position changes to support rotation/descent.
- Provide comfort and hydration while monitoring progression objectively.
- Reinforce education on true-labor versus prodromal signs.
- Escalate promptly for dysfunctional labor patterns or safety concerns.