Labour management

ROLE OF NURSE IN

LABOUR MANAGEMENTBy,

Ms. P.Beulah,Msc(N) II year,

OBG dept

Myles

The world health organization defines normal labour as low risk throughout, spontaneous in onset with the foetus presenting by the vertex, culminating in the mother and infant in good condition following birth.

STAGES OF LABOURLabour has been classified into 4 stages

FOURTH STAGE

THIRD STAGE

SECOND STAGE

FIRST STAGE

First stage has 3 Phases

LATENT PHASE

ACTIVE PHASE

TRANSITION PHASE

Cervix dilates from 0cm to 3-4 cm

Cervical canal shortens from 3 cm to 0.5 cm long

Lasts for about 6-8 hours.

ACTIVE PHASE

This begins when the cervix is 3-4 cm dilated and in the presence of rhythmic contractions and is complete when the cervix is fully dilated (8-10cm).

Transition phase

It is from when the cervix is from about 8cms until it is fully dilated.

Second stage

Second stageThe second stage is that of expulsion of fetus.

It begins when the cervix is fully dilated and woman feels to expel the baby.

It is complete when the baby is born.

Third stageThe third stage is that of separation and expulsion of placenta and membranes; it also involves the control of bleeding.

It lasts from the birth of the baby until the placenta and membranes have been expelled

FOURTH STAGE

Fourth stage

The fourth stage involved transition and stabilization and initial recovery from child birth normally lasts 1-4 hours after birth

Principles:- Non- interference with watchful expectancy so as to prepare the patient for natural birth.

To monitor carefully the progress of labor, maternal conditions and fetal behavior so as to delete any intrapartum complication easily.

MANAGEMENT OF FIRST STAGE

Position and mobility

Woman should be encouraged to give birth in the position they find most comfortable.

The positions used In

first stage

Semi-sitting

Sitting, Leaning Forward with Support

SIDE LYING POSITION

Kneeling over chairs

Squatting

Hands and knees

Birthing balls

MANAGEMENT OF SECOND STAGE LABOUR

Continuous electronic fetal monitoring

The device consists of simultaneous recording of fetal electro-cardiography and uterine contraction by tocography. It is not done in uncomplicated pregnancy where an intermittent auscultation with a pinard’s stethoscope or handle Doppler device is used.

If the membranes are ruptured the liquor amnii is observed to ensure that it’s clear.

An electronic fetal monitoring indicates features like,

Baseline fetal heart rate up to 110-160 b/m.

The variability of Fetal Heart Rate.

Decelerations and Acceleration of heart rate.

Preparation for birth

The room should be kept warm, well lighted with a spotlight. The equipment is kept ready, inducing drugs like uterotonic agents, vitamin k, and oxytocin etc.

Maintain aseptic techniques

The mid wife’s skill and judgment are crucial factors in minimizing maternal trauma and ensuring an optimal birth for the mother and baby. The mid wife should

observe the progress

Prevent infectionProvide physical and emotional comfort

Anticipate events Recognize the development of abnormalities.

MANAGEMENT OF

SECOND STAGE

Birth of head The perineum should be swabbed and a clean pad is kept under the women.

Encourage mother to control by gently blowing or sighing and minimize each breath in

order to minimize active pushing.

CROWNING

As the fetal head and advance and control it by supporting with one hand

or both

During the delivery of head the mid wife should support the anococcygeal region of the mother with a sterile towel in her right hand and while the left hand exerts pressure on the occiput.

SUPPORT OF PERINEUM AND FETAL HEAD

Ensure that the cord is not around the fetal head.

EPISIOTOMYWhen the perineum is fully stretched and threatens to tear especially in primi, episiotomy is done by infiltration with 10ml of 1% lignocanie.

Immediately following delivery of the head, the mucous and blood in the mouth and pharynx are to be wiped with a sterile gauze piece.

Mechanical or electrical sucker may be used. It prevents the mucus blocking the air passage.

CLEARING THE AIRWAY

The eye lids of are then wiped with sterile dry cotton swabs to minimize the contamination of conjunctival sac.

The head is grasped by both hands and gently drawn posteriorly until the anterior shoulder is released from under the pubis

Birth of shoulders

By drawing the hand, in upward direction, the shoulder is delivered out of the perineum.

Traction on the head should be gentle to avoid excessive stretching of the neck causing injury to the brachial plexus, hematoma of the neck or fracture of the clavicle.

Birth of shoulders

Delivery of the trunkAfter the delivery of the shoulders, the fore finger of each hand is inserted under the axillae and the trunk is delivered gently by lateral flexion.

Delivery of the trunk

The cord is clamped and cut about 5 cm from the

umbilicus

MANAGEMENT

OF THIRD STAGE

PRINCIPLES Ensure strict vigilance and to follow the management guidelines in practice to prevent complications.

The placental separation and its descent into the vagina are allowed to occur spontaneously.

Constant watch is needed; the mother should not be left alone.

The third stage includes separation, descent and expulsion of the placenta with its membranes.

Separation and descent of placenta

Conservative method The left hand is placed over the abdomen to detect

Any change in the level of the fundus

Sign of placental separation and decent.

The mother is asked to bear down to deliver the placenta spontaneously. Ergometrine 0.5mg or Syntometrine (5 units syntocinon + 0.5mg Ergometrine) to be given intravenouslly.

Active methodsGive Methargine 0.5 mg IM or Syntometrine (5units oxytocin+0.5mg Methargine), at the time of the anterior shoulder is free from symphysis pubis or as soon as possible thereafter.

Deliver the placenta and membranes by control cord traction by right hand, and the left hand is placed on the suprapubic region, pushing the uterus upwards.

Delivery of the placenta and membranes

An immediate and through inspection of the placentaandmembranes is done to Estimate their completeness.

Immediate new born care

Air passage should be cleared of mucus and liquor by gentle suction (mucous sucker).

Soon after the delivery of the baby, it should be placed in a tray covered with clean dry linen with the head slightly downwards (15.0).

It facilitates drainage of the mucus accumulated in the tracheo-bronchial tree by gravity.

APGAR rating at 1 minute and 5 minutes to be recorded which includes, the appearance, pulse, grimace, activity and respiration.

The presence of any abnormalities of cord is noted, and then it is covered with sterile gauze piece.

A quick check is made to detect any gross abnormality and the baby is dried and wrapped with a dry warm towel

The identification tape is tied both to the baby and the

mother.

One hour following the complete delivery of the baby, the baby should be fed

Management

of Fourth stage

Fourth Stage of Labour

First postpartum hour  Monitor vital signs and bleeding

Repair lacerations  ensure uterus is contracted (palpate uterus and monitor uterine bleeding)

A hand is placed over the funds◦To recognize the signs of placental separation

◦To note the state the uterine activity-Contraction and relaxation.

◦To detect cupping of funds

The uterus is palpated to assess the degree of contraction. The fundus should be firm at the level of umbilicus or below. The Perineal pad is observed for lochia, color, clots and amount.

The pulse, blood pressure, behavior of uterus and any abnormal vaginal bleedings is to be watched for 1 hour after delivery.

NURSING MANAGEMENT

OF LABOUR

The nurse’s responsibilities during labour include.

Assessment of all phases of each stage, providing comfort as indicated

Observe the fetal response every 10 minutes to notify occur once of any adverse changes.

Document all the findings in partogramPosition the women.

Maintain safe environmentProtect self and others with universal

precautions Maintain hygiene and administer

drugs as indicated Monitor the mother throughout labourFill in all records of the birth and condition of the body.

THANK YOU