🚧 Under construction — VoTechWorks is being built. A free tech program — complimentary, as our commitment to get America working.
voTechWorksGrade 13 · a vocational technology learning center, by urbanicity
newSchoolWorks.com › VoTechWorks › Health & Personal Services › Practical Nursing (LPN) › Maternal/Child Nursing › Lesson 4
HLT-LPN37-04 · Lesson 4 · 20 clock hours · demo

Intrapartum Nursing: Labor, Delivery, and Fetal Monitoring

Objective. Students describe the stages and phases of labor, perform Leopold maneuvers on a simulation model, and interpret fetal heart rate monitor strips identifying reassuring versus non-reassuring patterns.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Intrapartum Nursing: Labor, Delivery, and Fetal Monitoring

Intrapartum care covers the period from the onset of true labor through delivery of the placenta. As an LPN, you work under the supervision of an RN or provider, but you are often the first to notice changes in the laboring patient's status. Knowing the stages of labor, how to assess fetal position, and how to read a fetal heart rate (FHR) strip are core competencies that directly protect mother and baby.

Stages and Phases of Labor

First Stage begins with the onset of regular contractions and ends with complete cervical dilation (10 cm). It has three phases:

Second Stage runs from complete dilation to birth of the baby. The patient pushes with contractions. This stage can last minutes to several hours depending on parity and epidural use.

Third Stage covers delivery of the placenta, usually within 30 minutes of birth. Signs of placental separation include a gush of blood, the umbilical cord lengthening, and the uterus becoming firm and globular.

Fourth Stage is the first one to two hours after delivery. The nurse monitors for postpartum hemorrhage, uterine atony, and maternal vital sign stability.

Leopold Maneuvers

Leopold maneuvers are a four-step systematic abdominal palpation technique used to determine fetal lie, presentation, position, and engagement.

Document fetal position using obstetric notation: presenting part (O = occiput, S = sacrum, M = mentum), side of maternal pelvis (L or R), and anterior/posterior/transverse relationship (A, P, or T). For example, LOA = Left Occiput Anterior, the most favorable position for delivery.

Safety point: Always explain the procedure to the patient, warm your hands, and use gentle, steady pressure. Stop if the patient reports pain. Confirm findings with ultrasound or provider order as needed.

Fetal Heart Rate Monitoring

Electronic fetal monitoring (EFM) produces a continuous strip showing FHR on the upper channel and uterine contractions on the lower channel.

Baseline FHR: Normal range is 110–160 beats per minute (bpm), assessed over a 10-minute window excluding accelerations and decelerations.

Variability: Reflects the interplay of the sympathetic and parasympathetic nervous systems. Moderate variability (6–25 bpm fluctuation) is reassuring. Absent or minimal variability can indicate fetal hypoxia, sleep cycles, medications, or prematurity.

Accelerations: An abrupt rise in FHR of ≥15 bpm above baseline lasting ≥15 seconds (in fetuses ≥32 weeks). Accelerations are reassuring—they indicate an intact, reactive autonomic nervous system.

Decelerations:

Reassuring vs. Non-Reassuring Patterns

A reassuring (Category I) strip shows: baseline 110–160 bpm, moderate variability, no late or variable decelerations, and accelerations present or absent.

A non-reassuring (Category II or III) strip may show: late decelerations, significant variable decelerations, absent variability, or a sinusoidal pattern.

Priority LPN actions for non-reassuring patterns:

1. Reposition the patient (left lateral position offloads vena cava and improves placental blood flow).

2. Administer supplemental oxygen by face mask per facility protocol and provider order.

3. Increase IV fluid rate if ordered to improve circulating volume.

4. Discontinue oxytocin if infusing and notify the RN/provider immediately.

5. Document your findings and the time you notified the team.

Assessing Contractions

Assess contractions for frequency (start of one to start of the next, in minutes), duration (beginning to end of one contraction, in seconds), and intensity (mild = uterus indents easily; moderate = some resistance; strong = uterine wall feels like forehead). Report contractions lasting more than 90 seconds or intervals shorter than 2 minutes, as these can compromise fetal oxygenation.

SBAR Communication

When an abnormal finding is identified, report it using SBAR: Situation (what is happening), Background (relevant history), Assessment (your clinical finding), Recommendation (what you think needs to happen). Clear, timely communication is a patient safety priority in intrapartum care.

Key terms10

IntrapartumThe period from the onset of true labor through delivery of the placenta; the time during which childbirth occurs.
Leopold ManeuversA four-step systematic abdominal palpation technique used to assess fetal lie, presentation, position, and degree of engagement in the pelvis.
Baseline Fetal Heart RateThe average fetal heart rate during a 10-minute period, excluding accelerations and decelerations; normal range is 110–160 bpm.
VariabilityFluctuations in the baseline fetal heart rate from beat to beat; moderate variability (6–25 bpm) is a reassuring sign of an intact fetal autonomic nervous system.
Late DecelerationA gradual decrease in fetal heart rate that begins after the peak of a uterine contraction and returns to baseline after the contraction ends; associated with uteroplacental insufficiency and considered non-reassuring.
Variable DecelerationAn abrupt decrease in fetal heart rate of ≥15 bpm lasting ≥15 seconds with variable timing relative to contractions; caused by umbilical cord compression and may be non-reassuring when severe or persistent.
Early DecelerationA gradual, uniform decrease in fetal heart rate that mirrors a uterine contraction, caused by fetal head compression; considered benign and reassuring.
Uteroplacental InsufficiencyInadequate blood flow and oxygen exchange through the placenta to the fetus, often reflected on the fetal monitor as late decelerations.
SBARA standardized communication framework: Situation, Background, Assessment, Recommendation; used to convey critical patient information clearly to other healthcare team members.
Cervical EffacementThe thinning and shortening of the cervix during labor, expressed as a percentage from 0% (uneffaced) to 100% (fully effaced).
In class: Instructor demonstrates Leopold maneuvers on a birthing simulator; students then perform all four maneuvers on the simulator in pairs and document fetal position using correct obstetric notation, with instructor observing each pair. · Review six printed fetal heart rate monitor strips, classify baseline rate, variability, accelerations, and decelerations (early, late, variable) for each strip, and state one priority LPN action for the two non-reassuring strips. · Step through a staged intrapartum simulation: receive shift report, assess a patient in active labor (vital signs, contraction frequency/duration/intensity, cervical dilation from report, fetal heart rate strip), document findings on a labor flow sheet, and report abnormal finding via SBAR.
Materials: Birthing simulator/pelvis model, Leopold maneuvers reference card, printed fetal heart rate monitor strips (variety of patterns), labor flow-sheet forms, electronic fetal monitor (demo unit or training software), maternal-newborn textbook, NCLEX-PN test plan (Reduction of Risk Potential; Physiological Adaptation)
Check: Correct performance of all four Leopold maneuvers on three consecutive simulator attempts as rated by instructor skills checklist (pass = correct technique on ≥ 3 of 4 maneuvers per attempt); ≥ 78% accuracy classifying monitor strip patterns; SBAR report complete per checklist.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Physiological Adaptation
1. A laboring patient's cervix is 8 cm dilated and contractions are lasting 75 seconds every 3 minutes. Which phase of labor is she in?
Reduction of Risk Potential
2. During Leopold Maneuver 1, the nurse palpates a firm, round, ballottable mass in the fundus. What does this finding most likely indicate?
Physiological Adaptation
3. The fetal heart rate strip shows a baseline of 140 bpm with moderate variability and accelerations. No decelerations are present. How should the LPN classify this pattern?
Reduction of Risk Potential
4. Late decelerations appear on the fetal monitor. Which action should the LPN perform FIRST?
Physiological Adaptation
5. A student nurse asks how early decelerations differ from late decelerations. Which response by the LPN instructor is most accurate?
Reduction of Risk Potential
6. The LPN notes contractions lasting 100 seconds with only a 90-second interval between them. What is the priority concern?
Physiological Adaptation
7. Using obstetric notation, the fetal occiput is on the patient's right side and is directed toward the posterior of the maternal pelvis. How is this position documented?
Reduction of Risk Potential
8. When completing an SBAR report about a non-reassuring fetal heart rate strip, which element of SBAR does the statement 'The fetal monitor is showing repetitive late decelerations with minimal variability' represent?
Record this lesson on my transcript. Sign in with your key and enrollment email to record lessons (enroll free if you have no key). This page stays open to read and practise.
← Previous lessonProgram planNext lesson →