a. Description.

(1) Dystocia of labor refers to labor that is difficult due to mechanical and functional factors.

(2) When dystocia is present, the following factors tend to interfere with the ultimate goal of labor (dilation of the cervix and pushing the fetus through the birth canal into the outside world) which is caused by deviations of the normal interrelationships between any of the five Ps of labor.

(a) Passage-bones and soft tissue of the birth canal.

(b) Power-uterine contractions.

(c) Passenger-the fetus, its size, presentation and position, and anomalies.

(d) Placenta-position, time, and mode of expulsion.

(e) Psyche-emotional response of the woman to labor.

(3) The interrelationships of these five factors determine the pattern and progress of labor.

b. Classification of Dystocia.

(1) Pelvic dystocia. This occurs when there is a significant shortening of the internal diameters of the bony pelvis.

(2) Soft tissue dystocia. This is caused by an obstruction of the birth passage by an anatomic abnormality other than that of the bony pelvis. Those abnormalities may be tumors, injuries that prevent dilatation, and congenital anomalies (e.g., bicornate uterus).

(3) Fetal dystocia. This refers to conditions that involve the passenger (fetus) that can delay and complicate the process of labor. The conditions may be excessive size of the fetus, fetal anomaly (e.g., hydrocephalus, conjoined twins, or gross ascites), or fetal malpresentation such as a breech presentation.

(4) Uterine dystocia. This is an abnormality of the contractile pattern of the uterine muscles that prevents normal progress in labor. The contractions may be too week, too short, too irregular, or too infrequent. Labor may also be extremely forceful, rapid, or traumatic.

c. Nursing Intervention.

(1) Continue monitoring uterine contractions and the FHTs.

(2) Keep the patient informed of the progress.

(3) Instruct the patient in proper breathing techniques to decrease discomfort.

(4) Allow the patient to ventilate feelings and frustrations.

(5) Monitor the patient’s bladder status. The bladder should be kept empty to provide as much space as possible for descent of the fetal head.