Nursing Responsibilities in monitoring uterine contraction

The uterine contraction pattern should be evaluated every time the FHR is assessed. The contraction pattern can be evaluated using external or internal methods.

Nursing Procedure (Palpation of Uterine Contractions)
Equipment: Warm, clean hands

Procedure:

1. Explain procedure to the woman and her partner.
2. Wash hands thoroughly.
3. Locate and place one hand on the uterine fundus.
4. Use the tips of your fingers to feel changes in the uterus as it contracts.
5. At the beginning of the contraction you will feel the muscle begin to tighten.
6. Note the time the contraction begins.
7. Use your fingertips to evaluate how strong the contraction gets before the muscle begins to relax. Intensity is measured at the strongest point (the acme) of the contraction.
8. Note the time the contraction ends to determine duration.
9. Continue with your hand on the fundus through the next three contractions. Note if the uterus completely relaxes by becoming soft between contractions.
10. Note the time from the beginning of one contraction to the beginning of the following contraction to determine frequency. Frequency is documented as a range when appropriate (e.g., every 3-5 minutes, or every 2-3 minutes), unless they are occurring regularly (e.g., every 2 minutes, every 5 minutes)
11. Wash hands.
12. Chart the contraction pattern (Frequency, duration, and intensity) in the labor record. Document whether or not the uterus is fully relaxing between contractions.

Note: It is best to time several contractions consecutively before charting frequency because it is rare for contractions to be exactly "x" minutes apart. It is more common that the contraction pattern occurs every "x" to "y" minutes apart (e.g., every 3 to 5 minutes). Palpation is a method that takes place. It is best to learn to palpate contractions in conjunction with the use of EFM. In this way, you can see the contraction begin and concentrate on perceiving the tightening of the uterus with your fingertips. You can also see the acme, which lets you know when to evaluate intensity.