- Dysfunctional labor is difficult, painful, prolonged labor due to mechanical factors.
- Fetal factors (passenger) include unusually large fetus, fetal anomaly, malpresentation, and malposition
- Uterine factors (powers) include hypotonic labor, hypertonic labor, precipitous labor, and prolonged labor.
- Pelvic factors (passage) include inlet contracture, midpelvis contracture, and outlet contracture.
- “Psyche” factors include maternal anxiety and fear and lack of preparation.
- Uterine contractions are ineffective secondary to muscle fatigue or overstretching.
- Clinical manifestations include irregular uterine contractions and ineffective uterine contractions in terms of contractile strength and duration.
- Optimize uterine activity. Monitor uterine contractions for dysfunctional patterns; use palpation and an electronic monitor.
- Prevent unnecessary fatigue. Check the client’s level of fatigue and ability to cope with pain.
- Prevent complications of labor for the client and infant.
- Assess urinary bladder; catheterize as needed.
- Assess maternal vital signs, including temperature, pulse, respiratory rates, and blood pressure.
- Check maternal urine for acetone (an indication of dehydration and exhaustion).
- Assess condition of fetus by monitoring FHR, fetal activity, and color of amniotic fluid.
- Provide physical and emotional support.
- Promote relaxation through bathing and keeping the client and bed clean, back rubs, frequent position changes (sidelying), walking (if indicated), and by keeping the environment quiet.
- Coach the client in breathing and relaxation techniques.
- Provide client and family education.