MANAGEMENT OF FIRST STAGE OF LABOR IN ENGLISH

                                                      

                   MANAGEMENT OF FIRST STAGE OF LABOR IN ENGLISH

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MANAGEMENT OF FIRST STAGE OF LABOR-

 

Management of labor starts even before onset of first stage of labor. Labor events have great psychological, emotional and social impact to the woman and her family. She experiences stress, physical pain and fear of dangers. The caregiver should be tactful, sensitive and respectful to her. 

Preparation for delivery: Shaving of the vulva is done. The vulva and the perineum are washed liberally with soap and water and then with antiseptic solution. The woman should take a shower or bath, wear laundered gown and stay mobile. Throughout labor she is given continued encouragement and emotional support. A well equipped Labor trolley should be kept ready

Vaginal examination : The examination is done with the patient lying in dorsal position. Explain the purpose of the procedure to the client. Hands and forearms should be washed with soap and running water, a scrubbing brush be used for the finger nails. Wear sterile gloves. Vulva should once more be swabbed from before backward with antiseptic lotion first from outside than from inside.

Gloved middle and index fingers of the right hand smeared liberally with antiseptic cream are introduced into the vagina after separating the labia by two fingers

of the left hand. Complete examination should be done before fingers are withdrawn. Vaginal examination should be kept as minimum as possible to avoid risks of infection.

The following informations are to be noted and recorded carefully (Using Partograph):

Ø  Degree of cervical dilatation in centimeters. It is marked with a cross (×) on the partograph at 4 cm dilatation.

Ø  Alert line starts at 4 cm of cervical dilatation and continued to the point of full dilatation (10 cm) at the rate of 1 cm/h.

Ø  Action line  is drawn parallel and 4 hours to the right of the alert line.

Ø  Degree of effacement of cervix 

Ø  Status of membranes and if ruptured—color of the liquor. This is recorded as—I: membranes intact; R: membranes ruptured; C: liquor clear; M: liquor meconium stained; B: liquor blood stained.

Ø  Presenting part and its position by noting the fontanels and sagittal suture in relation to the quadrants of the pelvis.

Ø  Station of the head in relation to ischial spines. The level of ischial spines is the halfway between the pelvic inlet and outlet. This level is known as station zero (0).

Ø  Walk around- Generally, If the membranes are intact,a woman in early normal labor may not be confined to bed. While in bed she may take the position most comfortable to her. She should avoid dorsal supine position to avoid aortocaval compression.

Ø  An enema with soap and water or glycerin  suppository is traditionally given in early stage. This may be given if the rectum feels loaded on vaginal examination.

Ø  food is withheld during active labor. Fluids in the form of plain water, ice chips or fruit juice may be given in early labor.

Ø  Patient is encouraged to pass urine by herself as full bladder often inhibits uterine contraction and may lead to infection. If the woman cannot go to the toilet, she is given a bed pan.

Ø  Pulse is recorded every 30 minutes and is marked with a dot (.) in the partograph.

Ø  Blood pressure is recorded at every 1 hours and is marked with arrows (   ) 

Ø  Temperature is recorded at every 2 hours.

Ø  Urine output is recorded for volume, protein or acetone.

Ø  Any drug (oxytocin or other) when given is recorded in the partograph.

Ø  Abdominal palpation—Uterine contractions as regard the frequency, intensity and duration are assessed. The number of contractions in 10 minutes and duration of each contraction in seconds are recorded in the partograph

Ø  Pelvic grip: Gradual disappearance of poles of the head (sinciput and occiput) which were felt previously,

Ø  Fetal heart rate (FHR) along with its rhythm and intensity should be noted every half hour in the first stage and every 15 minutes in second stage or following rupture of the membranes. The observation should be made immediately following uterine contraction. The count should be made for 60 seconds.

Ø  Continue to monitor and provide psychological support