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The Modern Women's Labor Curve
Title: The Modern Women's Labor Curve
- Identify the differences between the Friedman's curve and the Partogram
- Describe the use of the Partogram in the nulliparous and multiparous patients
- Review case studies and discuss nursing actions used to assist with the progression of labor
The purpose of the program is to describe the use of the Partogram as a tool for decision making during labor. Review the origins of the Partogram and the recent research related to it. Discuss how the change from use of the Friedman’s curve to the Partogram was implemented at a Community based, non teaching, tertiary care birthing center.
Proposed change: ,The proposed change from the use of the Friedman’s curve to the Partogram developed by the research of Jun Zhang et al. Develop communication points where the RN and MD review the progress of the labor and implement any associated interventions.
Implementation, outcomes and evaluation: ,100 charts of Nulliparous, Term, Singleton, Vertex cesarean section patients were retrospectively reviewed. The labors were plotted on a Partogram and on the Friedman’s curve. Communication points between the RN and MD were identified. Consideration for additional time for a body mass index over 35 was reviewed. The chart audits reviewed revealed that 20% of the NTSV cesarean sections that were performed for failure to progress could have been given more time in labor if the Partogram were used and extra time for obesity were applied. RN and MD education regarding the use of the Partogram consisted of lectures, staff meetings, and hand outs. RNs completed a Partogram on all laboring patients. All Partograms were reviewed for communications and interventions when the patient’s labor varied from the Partogram. Balance measures were applied. The balance measures were: Apgar scores, maternal temperature, postpartum hemorrhage and length of stay. None of the balance measures were increased because of implementation of the Partogram. Evaluating the Partogram use through the PDSA cycles, it was discovered that the use of the Partogram with the patient’s involvement, improved the patient’s satisfaction in relation to their involvement in their care.
Implications for nursing practice:
Using the Partogram requires the Labor and Delivery RN to actively include the patient in the progress of their labor. The Partogram assists the RN in implementation of labor support and nursing interventions at specified times during the labor. It also improves the communication between the RN, MD and patient.
Keywords:
Friedman’s curve, Partogram, NTSV, labor support