Labor Dystocia (Dysfunctional Labor)

Labor dystocia is abnormally slow or stalled labor, and its causes follow the P's of labor: powers, passage, passenger, the position of the client, and psyche. Contraction problems come in two opposite patterns. Hypotonic dysfunction usually begins in the active phase with weak, infrequent, mildly painful contractions that stop cervical change, and once disproportion is ruled out the nurse expects amniotomy and oxytocin as ordered. Hypertonic dysfunction usually occurs in the latent phase with frequent, painful, uncoordinated contractions and a high resting tone; oxytocin is not the first step, and the plan is therapeutic rest with analgesia or sedation and IV hydration. Cephalopelvic disproportion is managed by cesarean birth, and occiput posterior back labor eases with hands-and-knees or side-lying positions and sacral counterpressure. The nurse encourages walking and voiding about every 2 hours, monitors the fetal heart rate, and watches for chorioamnionitis, exhaustion and postpartum hemorrhage. Precipitous labor, birth in under 3 hours, is the opposite problem: never leave the client alone.