Case studyMaternal health

Essentials Of Maternity: Newborn And Women’s Health Nursing

Every answer here is anchored to a number in the vignette. Full dilation with complete effacement and a positive station places the stage precisely, and the monitoring answer turns on risk status rather than preference.

Editorial process

Last reviewed · August 22, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

The numbers place the stage, and the stage sets the answer

Read the assessment data as the answer key. Ten centimetres with complete effacement is full dilation, which places Desiree at the beginning of the second stage of labour, and the plus one station tells you the presenting part has descended past the ischial spines. Everything else follows from that. Second stage nursing is about position changes to assist descent, coaching that follows her own urge to push rather than directed pushing on a count, continuous assessment of the fetal heart rate in relation to contractions, bladder emptying, preparation of the delivery area, and support for the person she has with her. Naming the stage precisely is what unlocks the marks, and a paper that says she is in active labour has already lost the sequence, because active labour is first stage and the interventions differ. Say the stage, then justify it from the three findings that establish it.

The monitoring question is about risk rather than preference, and the reasoning should say so. External monitoring is appropriate because she is low risk on personal and family history, her pregnancy has been uncomplicated, the tracing is reassuring, the membranes and cervical status do not require it, and it is non-invasive and supports the mobility her birth plan depends on. Internal monitoring becomes necessary when the external tracing is inadequate or ambiguous and the decision cannot be made without better data, which in practice means an indeterminate or abnormal tracing, difficulty tracing because of maternal habitus or position, or a need to measure contraction strength directly, and it requires ruptured membranes and adequate dilation. For the pain response, the birth plan is not a contract you must enforce against her: acknowledge what she said, tell her where she is because being at full dilation is meaningful news, offer the non-pharmacological measures first, and say that changing her mind is hers to do.

Likely learning objectives

Identify the stage of labour from cervical and station findings.
Match nursing interventions to the stage rather than to labour generally.
Justify external monitoring on risk status and explain what would change it.
Respond to a request for pain relief without treating the birth plan as binding.

Assignment instructions

Read the full question

Review every instruction before using the planning guidance that follows.

1. Desiree, a 28-year-old G2P1, is admitted to the labor and birth unit. Her birth plan indicates that she is planning natural childbirth without pharmacological interventions. She has attended childbirth education classes. Desiree is considered low risk based on her personal and family health history and physical exam. Her pregnancy has progressed without complications. She is approximately 38 weeks pregnant. Vaginal assessment reveals cervical dilation at 10 cm, 100% effaced, and +1 station. Position of the fetus is LOA. The external fetal monitor indicates a reassuring fetal heart rate at 130 beats per minute. Maternal status is stable. (Learning Objectives 1, 2, 6, and 9) Based on the vaginal assessment, identify the stage of labor and appropriate nursing interventions for this stage of labor. Explain how the nurse determined that the external fetal monitor would be appropriate for Desiree. What factors would necessitate a change to internal fetal monitoring during labor? Desiree says, “I’m not sure I can cope with the pain much longer.” How would you respond, considering her birth plan, stage of labor, and assessment data? 2. Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced and +2 station. She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations. Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended. (Learning Objectives 4 and 5) A. What is happening to Emily’s baby at this point in time? What does this mean? B. What role do you, as the nurse, play regarding fetal assessment and what interventions do you need to implement/recommend at this point in time? Chapter 15: Postpartum Adaptations 1. You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 2 and 3) While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process? Linda wants to know how long she should expect to bleed. What would you tell her? The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role? 2. Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms. (Learning Objective 4) A. Based on your observations of Sam’s interactions with Joey, relate where Sam is developmentally in the process of paternal attachment and bonding. B. What nursing interventions could you implement that would assist Sam in the transition to fatherhood?

Turn the brief into deliverables

01The stage of labour, named from the assessment data.
02Interventions specific to that stage.
03The reasoning that made external monitoring appropriate.
04Factors that would necessitate internal monitoring, with their prerequisites.
05A response to Desiree that addresses her statement and her plan.
06Sources supporting the monitoring and pain management claims.