When should the nurse transport multipara patient from labor room to delivered room?

WCL Staff Nurse - 2019

Obstetrics & Gynaecology

Medium

Appeared in: WCL Staff Nurse - 2019

Explanation

For a multiparous woman (one who has given birth before), the second stage of labor is significantly shorter, with a median duration of only about 20 minutes.
Transporting the patient when the cervix is 9 cm dilated ensures she is in the delivery room before the expulsive phase begins.
This timing is crucial to prevent a precipitous delivery, which is a birth that occurs rapidly and unexpectedly, potentially in an unsafe location like a hallway.
Waiting for full dilation (10 cm) or the urge to push is too risky in a multipara, as birth can be imminent at that point.

Option A: This represents full cervical dilation. For a multiparous woman, the second stage of labor can be very rapid (median of 20 minutes). Waiting until 10 cm dilation creates a high risk of the baby being delivered during transport or in an unprepared area.
Option B: While 8 cm is also within the appropriate transition phase for transport, 9 cm represents a point of greater urgency, making it a critical time for the nurse to act. Both 8 and 9 cm are considered correct times, but 9 cm is a more precise answer indicating the labor is very advanced.
Option D: The urge to push (Ferguson reflex) signifies that the fetal head is descending onto the pelvic floor, which typically happens at or very near full dilation. In a multiparous woman, this is a sign that birth is minutes away, making it far too late and unsafe to begin transport.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management during the second stage of labor, specifically the timing of transport for a multiparous patient to guide bedside assessment, documentation, and the next nursing action.
Patient safety is the primary concern. Transporting a multiparous woman too late can lead to a precipitous delivery in a non-sterile environment without immediate access to necessary equipment and personnel, increasing the risk of maternal/fetal injury and infection.
Accurate assessment of parity and labor progression is a critical nursing skill. Misjudging the speed of a multipara's labor can have serious consequences.
What if the patient was a primipara (first-time mother)? The nurse would wait until the cervix is fully dilated (10 cm) before transporting her to the delivery room, as the second stage of labor is significantly longer, providing ample time for the move.

How to Approach the Question

First, identify the key patient characteristic in the question: the patient is a 'multipara'.
Recall the physiological differences in labor between a multiparous and a primiparous woman. The most significant difference is the duration of the second stage of labor.
Remember that the second stage of labor is much faster in a multiparous woman (average 20 minutes) compared to a primiparous woman (average 50 minutes).
Evaluate the options based on this knowledge. Transport must occur before the second stage becomes too advanced.
Eliminate 'urge to push' and '10 cm dilation' as they are signs that delivery is imminent and therefore too late for a multipara.
Choose between 8 cm and 9 cm. Both are in the transition phase, but 9 cm indicates a more advanced state of labor, making it the most critical point for transport to ensure safety. Therefore, it is the best answer.

Concept Tested & Keywords

Concept Tested: Nursing management during the second stage of labor, specifically the timing of transport for a multiparous patient.
Stem keywords: nurse, transport, multipara patient, labor room, delivery room
Lead-in keywords: When
Clinical cues: The patient is a multipara, which is the key factor determining the timing of transport due to a faster second stage of labor.

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E6 Obstetrics Williams p. 22-41