Marvis is a 29-year-old G1P0 in labor at 40 weeks of gestation. She was admitted at 0200 with a history of contractions since 2200 the night before. Upon admission she denied spontaneous rupture of membranes or vaginal bleeding. She felt good fetal movement. Her vital signs and the fetal heart rate were normal. Her contractions were every 6 minutes and lasting 30 seconds. Her cervical exam was 2 cm/ 70%/-2 vertex. It is now 0600, and she has been reexamined. Her cervical exam is now 3 cm/90%/ -2 vertex. Her contractions are now every 4 to 5 minutes lasting 60 seconds. She states they are still mild. Marvis has stated that she wants a natural unmedicated birth.

1. In what stage of labor is Marvis?

2. Marvis expresses disappointment in her progress. What can the nurse do to help her at this point in her labor?

3. It is now 1000 and Marvis states the contractions have become much stronger. She now needs to utilize breathing techniques to cope with the contractions. She declines pain medication. Her cervical exam is now 5 cm /100%/0 station. In what stage of labor is Marvis at this time?

4. What nursing care is indicated at this phase of labor?

5. Marvis is now perspiring profusely and shaky. She feels she can't cope any longer. She pushes away her husband as he tries to rub her back. An increased amount of bloody show is present. She also reports a gush of fluid. Even without a cervical exam, what phase of labor is Marvis most likely in?

6. A cervical exam at 1300 confirms the transition phase as Marvis is 8 cm /100%/0 station with spontaneous rupture of membranes with clear fluid. What nursing care is indicated at this time?

7. Marvis managed to cope well through transition by going into the shower. She now reports an urge to push. A cervical exam at 1600 reveals that Marvis is still 8 cm /100%/0 station. Fetal heart rate is normal and maternal vital signs are normal. She is distraught at her lack of progress and states she can't do it anymore. What nursing care is appropriate at this time?

8. Nursing assessment reveals an abdominal mass just above the symphysis pubis. What is a likely explanation and what should be done?