Pregnant women face life-changing moments during the latent (early) phase of labor. During this phase, they develop contractions, where the uterus wall muscles stretch and allow the cervix to dilate. These contractions can result in immense pain, and a prolonged latent phase can lead to maternal distress, increasing the likelihood of cesarean delivery (Hanada et al., 2015). Nurses play a vital role during this phase, providing evidence-based interventions to help these pregnant women manage the pain. At the same time, nurses need to show professionalism, encourage the patients, provide comfort measures and support. Hanada et al. (2015) note that prolonged contractions during the latent phase account for higher hospital readmission from pregnant women seeking reassurance. The decision to seek medical assistance stems from pain, anxiety, and uncertainty. Nurses must recognize the need to promote physical health and patient wellbeing through the provision of care management.
The preservation of the patient population’s psychosocial integrity and the nurse's role in pain management during the latent phase are interlinked. Arguably, complications during the latent phase can lead to mortality and other pregnancy-related health problems. A study by Ängeby et al. (2019) on women's labor experiences during a prolonged latent phase demonstrated that maternal distress and quality of care are related to negative birth experiences. Healthcare workers play a significant role in providing psychosocial interventions for pregnant women in promoting their social, behavioral, and psychological wellbeing. When nurses provide adequate care and pain management interventions to these patients, they reduce the number of hospital readmissions and cesarean deliveries resulting from false labor.
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Importance of the Priority Concept
The nursing interventions for pain management during the latent phase are significant in promoting healthy pregnancies and subsequent births. Nurses are central to promoting maternal health through implementing evidence-based practices. Their role is to provide quality care during labor, foster health promotion, and communication, and reduce pregnancy-related problems. Without proper pain management and interventions during the latent phase, expectant mothers can develop complications, including fetal distress, sepsis, and long-term injury risks to the infant (Ängeby et al., 2018). Moreover, unresolved pain management can lead to poor quality of life and patient function. On the other hand, the issue can significantly impact the nursing profession from the poor provision of quality care, increased hospital readmissions, and high mortality rates.
Healthcare Disparities, Inequalities, and Interventions
Pregnant women from marginalized communities are more at risk of experiencing negative effects due to lack of pain management interventions during the latent phase of labor. Access to quality and timely healthcare services for these marginalized communities remains a challenge despite several international communities, governments, and non-profit organizations' efforts to improve care delivery protocols and infrastructure (Biswas et al., 2018). Skilled workforce and midwifery programs effectively support structures that provide evidence-based practices for pain management to pregnant women during the latent phase. Over the past few decades, the health setting has seen innovative improvements in technology, telehealth, and a skilled workforce that coordinate to provide adequate care delivery to patients. Moreover, a shift towards preventive and interdisciplinary care practices has fostered adequate care delivery programs to marginalized communities. Health promotions and prevention interventions are also other health resources geared towards promoting prenatal and postpartum care.
The current U.S healthcare system has made significant strides towards advocating equal access to quality care for all communities. However, the racial disparity remains a multifaceted issue among the marginalized communities, especially the African Americans. While racial ethnicity is cited as the primary driver to healthcare disparities, Moaddab et al. (2018) also acknowledge socio-economic status, education, and sexism as other factors contributing to the inequality gap in the U.S. Moreover, while the Affordable Care Act (ACA) has managed to eradicate healthcare insurance issues for American citizens, a large portion of the population remains uninsured and lacks access to high-quality healthcare services. Disparities in the health care setting contribute to high maternal and infant mortality rates.
Improving prenatal care for the minority groups is a viable solution towards reducing health disparities that lead to increased maternal and infant mortality rates. While prenatal care implementation has not been quick to incorporate health promotion over the past, there is significant evidence to show its contribution to improving childbirths, reducing health disparities, and fostering postpartum care (Gennaro et al., 2016). Additionally, the authors acknowledge that the expansion of insurance cover, such as Medicaid, to these vulnerable women has significantly improved prenatal care and childbirth, further mitigating health disparities and inequalities. While contributions to prenatal care and insurance coverage continue to promise better outcomes, questions over the quality and method of prenatal care delivery remain critical to addressing health disparities.
Pain during labor is a multidimensional phenomenon that concerns the patient population and nursing profession. While labor pain is inherent, unresolved pain management can have adverse consequences from the expectant mother, the unborn child, nurses, and the healthcare system (Hanada et al., 2015). Both pharmacological and non-pharmacological interventions for labor pain management have been widely used over the past. However, several studies have documented that pharmacological interventions, such as using analgesics, can negatively affect expectant mothers and infants (Çalik et al., 2018; Thomson et al., 2019). Massages, breathing techniques, and guided imagery are three non-pharmacological interventions that show promise in labor pain management. Patients benefit significantly from reduced stress, depression, and anxiety that result from labor pains.
Legal & Ethical Considerations and Intervention Challenges
Ethical and legal issues are common in the provision of healthcare services to patients. One ethical challenge faced when providing pain management interventions during the latent phase is informed consent associated with prenatal care. Patients have the right to make decisions that concern them and their well-being. As such, nurses must conform to these decisions, and at the same time, ensure that no harm befalls the patient (Çalik et al., 2018). For instance, the patient can request the use of the pharmacological intervention. Yet, the attending nurse is aware of the implication of such an intervention to the well-being of the expectant mother and the unborn child. Educating the patient on the available interventions and their health implications will better inform their decision-making prowess.
On the other hand, medicolegal issues during labor have become an increased concern in the nursing profession despite improved labor pain management interventions. Responding to such adverse outcomes requires an interdisciplinary approach. Different expectant mothers develop expectations about the use and effectiveness of anesthetic services provided by obstetricians (Beck et al., 2019). However, lawsuits against medical negligence are rampant. Effective communication and seeking informed consent are critical to preventing legal implications in the nursing field. Nurses should communicate with their patients on the necessary nursing practices and their outcomes (Çalik et al., 2018; Beck et al., 2019). The expectant mothers should be made aware of the interventions available and how effective they are in relieving pain during labor.
The lack of awareness and unavailability of quality prenatal care services are two challenges that impact the success of preventing and resolving challenges in labor pain management, respectively. Without awareness of effective labor pain interventions by nurses and expectant mothers, preventing labor complications is impossible (Ängeby et al., 2018). Rhe unavailability of care services, especially in marginalized communities, is an anticipated challenge that can impact the success of resolving labor pain management issues. According to Biswas et al. (2018), marginalized pregnant women face challenges in managing labor pains and other unexpected complications that may arise without timely access to quality prenatal care.
Participants and Interdisciplinary Approach
The implementation of pain management interventions during the latent phase will involve nurses, obstetricians, midwives, and hospital managers. Nurses, obstetricians, and midwives ensure that patients undertake both pharmacological and non-pharmacological interventions during labor. Moreover, they educate the patients on what to expect during childbirth, the complications that could arise and assist them in making critical decisions. On the other hand, hospital managers ensure that all the nurses follow the laid-down nursing standards of practice and handle any issues. Implementation of labor pain management interventions can also encompass government policymakers and concerned non-profit women groups. These participants can help strengthen the implementation process and provide alternative solutions to the anticipated challenges.
Quality Improvement
Resolving the challenges of labor pain management can improve patients` perceptions of the process and their effectiveness during childbirth. Hanada et al. (2015) note that pain management can significantly foster emotional balance and reduce anxiety, leading to positive childbirth experiences. For the nursing profession, addressing labor pain interventions' challenges can help foster better nurse-patient relationships and enhance health education and promotion (Ängeby et al., 2018). Improving patient outcomes and increasing professional nurse knowledge follow the use of clinical-led resources. Adopting technological tools, such as EHRs and wearable devices can help monitor the patient's progress. Additionally, the training and development approach will enable nurses to sharpen their skills and gain critical knowledge on managing and improving patient outcomes (Carthon et al., 2019). Training will also allow the nurses to air the concerns, further creating a conducive work environment and culture.
Conclusion
Expectant mothers undergo immense pain during the latent phase of labor, and the lack of effective pain management interventions is likely to bring challenges during childbirth. Nurse professional knowledge is critical to guiding, monitoring, and addressing complications these mothers could face during this phase. Improving patient outcomes and nursing standards will mandate effective communication, patient education, health promotion, telehealth tools for proper diagnosis, and training the nurses to increase their skills and knowledge. These resources are essential in creating nurse-patient relationships and improving patient decision-making. Ultimately, addressing the challenges pregnant women face during labor will be crucial for nurses, the patients, healthcare facilities, and the health system in general.
References
Ängeby, K., Sandin-Bojö, A., Persenius, M., & Wilde-Larsson, B. (2019). Women's labour experiences and quality of care in relation to a prolonged latent phase of labour. Midwifery , 77 , 155-164. https://doi.org/10.1016/j.midw.2019.07.006
Ängeby, K., Wilde-Larsson, B., Hildingsson, I., & Sandin-Bojö, A. (2018). Prevalence of prolonged latent phase and labor outcomes: Review of birth records in a Swedish population. Journal of Midwifery & Women's Health , 63 (1), 33-44. https://doi.org/10.1111/jmwh.12704
Beck, R., Malvasi, A., Kuczkowski, K. M., Marinelli, E., & Zaami, S. (2019). Intrapartum sonography of fetal head in second stage of labor with neuraxial analgesia: a literature review and possible medicolegal aftermath. Eur Rev Med Pharmacol Sci , 23 (8), 3159-66. doi: 10.26355/eurrev_201904_17673
Biswas, A., Anderson, R., Doraiswamy, S., Abdullah, A. S., Purno, N., Rahman, F., & Halim, A. (2018). Timely referral saves the lives of mothers and newborns: Midwifery led continuum of care in marginalized teagarden communities – A qualitative case study in Bangladesh. F1000Research , 7 , 365. https://doi.org/10.12688/f1000research.13605.1
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Gennaro, S., Melnyk, B. M., O'Connor, C., Gibeau, A. M., & Nadel, E. (2016). Improving prenatal care for minority women. MCN: The American Journal of Maternal/Child Nursing , 41 (3), 147-153. https://doi.org/10.1097/nmc.0000000000000227
Hanada, N., Matsuzaki, M., Ota, E., & Mori, R. (2015). Psychosocial and educational interventions in latent phase or early labour for improving birth outcomes. Cochrane Database of Systematic Reviews . https://doi.org/10.1002/14651858.cd011516
Moaddab, A., Dildy, G. A., Brown, H. L., Bateni, Z. H., Belfort, M. A., Sangi-Haghpeykar, H., & Clark, S. L. (2018). Health care disparity and pregnancy-related mortality in the United States, 2005–2014. Obstetrics & Gynecology , 131 (4), 707-712. https://doi.org/10.1097/aog.0000000000002534
Thomson, G., Feeley, C., Moran, V. H., Downe, S., & Oladapo, O. T. (2019). Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: A qualitative systematic review. Reproductive Health , 16 (1). https://doi.org/10.1186/s12978-019-0735-4
