FHR Late Decelerations — Nursing Interventions
You see late decelerations on the monitor. The next 60 seconds are about what you do — and the order you do it in determines whether this ends in recovery or an emergency cesarean.
Core Concept
Late decelerations signal uteroplacental insufficiency — the placenta cannot deliver adequate oxygen during contractions. Your interventions target the cause: restore blood flow, maximize oxygenation, and reduce uterine activity. Act in this sequence: (1) Reposition the client to left lateral, then try right lateral or hands-and-knees if the pattern persists — avoid supine because vena cava compression worsens perfusion. (2) Increase the IV fluid rate (bolus with lactated Ringer's or normal saline) to expand maternal blood volume reaching the placenta. (3) Apply oxygen at 8–10 L/min via non-rebreather mask. (4) If oxytocin is infusing, stop it immediately — reducing contraction frequency gives the placenta recovery time between contractions. (5) Notify the provider with SBAR communication including the pattern onset, current variability, and interventions already performed. If late decelerations are recurrent and do not resolve with intrauterine resuscitation, prepare for emergent delivery. Document the time each intervention was initiated and the fetal heart rate response. Tocolytics (e.g., terbutaline 0.25 mg subcutaneous) may be ordered to stop contractions if the pattern is refractory — this is a provider order, but you should anticipate it.
Watch Out For
Don't confuse interventions for late decelerations (stop oxytocin, reposition, bolus fluids) with interventions for variable decelerations (amnioinfusion, position changes to relieve cord compression). Students often forget that stopping oxytocin is a nursing action — you do not need to wait for a provider order to discontinue it when the tracing is nonreassuring. Repositioning means trying multiple positions, not just one turn to the left.
Clinical Pearl
Think 'STOP': Side-lying, Turn off oxytocin, Oxygen on, Push fluids. That's your first-response checklist before you even pick up the phone.
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