Precipitous Labor: Preparing for The Fast and Furious

• Precipitous labor, or rapid labor, is onset active labor resulting in delivery in less than three hours. 
• Precipitous labor can be anxiety inducing for both staff and mothers, as there’s little time for preparation before birth. 
• This article will be helpful for L&D and ER nurses alike! Seasoned labor and delivery nurse, Hollie Dubroc, shares insight on how to approach a precipitous labor scenario that one might encounter.  

Precipitous labor has been defined as the onset of active labor to infant delivery in less than three hours.  

One-three births out of nearly 100 births are resultant of precipitous labor. 

Unfortunately, there is not a clear explanation for what causes precipitous labor in one pregnant woman compared to another. There have been identified risk factors that could heighten the risk, including: 

• Teenage pregnancy 
• Previous vaginal deliveries 
• Pre-eclampsia 
• Preterm Deliveries 
• Recreational Drug Use 
• Previous precipitous labor 

I remember when I started in labor and delivery and being amazed at my seasoned co-workers. These veterans had the ability to perform a visual assessment, make multiple observations; it appeared with that alone, they would already know so much!  

They had been in labor and delivery for decades and had an eye for when to place a patient that came in, either into a triage room or directly into a labor room.  

At the time, I recall being so eager to learn from such experienced nurses and could not wait to absorb everything they knew.  After working in labor and delivery for several years, I finally received my “Aha!” moment.  

Initially, I received a call from ER letting me know they were bringing a pregnant patient over that thought her water broke.  

As soon as the ER staff brought her through the door, I did a visual assessment, and immediately knew we needed a labor room.  

The patient delivered within the next 20 minutes and this moment in my career is still so memorable to me.  It gave me validation on how far I had come, compared to the new nurse I once was.  

Indications of Precipitous Labor

Regardless of the amount of experience under any nurse, there are and will always be some patients that do not follow textbook patterns. Sometimes basic visual assessment will lead you astray and is never an reliable independent assessment.   

When this happens, it can catch anyone off guard, so always having general knowledge on next steps, when to call fellow staff, or notify the provider is always an excellent safety net to have.  

Additional assessments may be necessary to establish if a patient is in active labor, especially in precipitous labor. 

• Acquiring fetal heart tones through an external device 
• Performing a SVE 
• Pain Assessment 
• Reviewing a quick patient history or obtaining pertinent information: 
  • Gestational age 
  • Fetal Movement 
  • Contraction pattern 
  •  Number of previous pregnancies and delivery types 
  • Current complications or previous complications 
  • Surgical/Medical history 
  • Prenatal care 
  • Prenatal Labs 
  • Discharge 
    • Fluid 
    • Blood 

Each scenario will be very independent of another. Each patient may be present closer to delivery than others. Each will respond differently, and each will progress differently.  

Developing one’s focal points for assessment and interventions will be key to providing safe patient care. Once general assessment and intake information are completed, one may choose to call the provider to notify them of patient status and await orders or call for them to attend delivery.  

Gathering Supplies for Precipitous Labor

Regarding interventions after your assessment and provider notification are completed will be next focused towards gathering necessary supplies, establishing IV access, and obtaining consent. Supplies with precipitous labors can be easily accessible if there is an established precipitous labor kit.  

Again, each patient and timeline will vary, but an established kit will decrease the time it takes to gather various items. If a complete delivery kit is utilized, it may lead to wastage of supplies that were not needed for these patients.  

The other benefit of a precipitous labor kit is mobility. If delivery is happening in the ER or the parking lot, specified kits make it much easier to transport with you to wherever you are needed.  

The Bottom Line

At any point during your provided care to the patient, simultaneously providing any patient education is ideal. Being sure to provide education on pain control options available via pharmacologic or non-pharmacological interventions.  

Continue to check on progression of patient to keep the delivery provider, nursery team, charge nurse, and patient updated. It is important to educate the patient on future pregnancies, that again according to the textbook, each labor gets quicker!  

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