Def

ini
ti
on

I
ntrapart
um isaperiodofcarer
eceiv
edduri
nglabouranddel
i
veryorchil
dbi
rt
h.
Specif
ical
ly
,itbegi
nswiththeonsetofl
aborandendsatthecomplet
ionofthe
thi
rdstageoflabor
.

I
ndi
cat
ions

Someoft
hei
ndi
cat
ionst
haty
ou'
reatt
hei
ntr
apar
tum st
agear
e

 hav
ingst
rongandr
egul
arcont
ract
ions;

t
heseCont
ract
ionshel
ppusht
hebabyoutoft
heut
erus.

 f
eel
i
ngpai
niny
ourbel
l
yandl
owerback;

t
hecauseofthisi
sDuringlabor
,themostcommonsourceofbackpai
nis
f
rom t
hebaby'sheadexert
ingpressur
eonthel
owerback,whi
chhappens
whenthebaby
'sheadisdownandf aci
ngfor
war
d

 hav
ingbl
oodymucusdi
schar
ge;
and

 l
ast
ly,
yourwat
erbr
eaks

St
agesofI
NTRAPARTUM car
e

Nextwemov
eont
otheSt
agesofI
NTRAPARTUM car
eandt
heyar
easf
oll
ows:

Ont
he1stst
age:

ont
hel
atentphase

1Al
l
owpati
entt
obeconti
nuall
yactiv
e.Uprightmaternalposi
ti
onsar
erecommendedfor
womenonthefi
rstst
ageoflabor.Pati
entswithoutpregnancycompl
icat
ionscanst
il
l
wal
kar
oundandmakenecessarybir
thpreparat
ions.

2Assess pat
ient
’s psy
chol
ogi
calr
eadi
ness.Pr
ovi
de cont
inuous mat
ernalsuppor
t
3Conducthealt
ht eachi
ngonbr east
feedi
ng,newbor
ncare,andef
fect
ivebear
ingdown
becauseduringthistime,pat
ient’
sanxiet
yiscontr
oll
edandshei sabletofocuson
nurse’
sinst
ruct
ions.

4.
Ensur
ethatbi
rt
hingcompani
onofchoi
cei
spr
esental
lthr
oughoutt
hecour
seofl
abor
.

ont
heact
ivephase

1.
Monit
ormater
nalv
italsi
gnsandf
etalhear
trat
eev
ery2hour
s,ordependi
ngont
he
doct
or’
sor
der
.

2.
Inf
ormt
hedur
ati
onoff
ir
stst
ageofl
abour-

Womenshoul dbei nfor

medt hatast
andarddurati
onofthel
atentf
ir
ststagehas
notbeenestabl
ishedandcanv ar
ywidel
yfrom onewomant oanot
her.However
,
thedurat
ionofacti
v efi
rstst
ageusuall
ydoesnotextendbey
ond12hour sinf
ir
st
l
abors.

3 Encourage pat
ientt
o be cont
inuall
y acti
veto maximize the ef
fectofut
eri
ne
cont
ract
ions.Upri
ghtmat
ernal
posi
tionsarerecommendediftol
erat
ed.

4.
Assistpati
enti
nassumingherposi
ti
onofcomfor
t.Forthosewhocan’tst
ayupr
ight
,
l
eft
-si
delyingisr
ecommendedtoavoi
ddisr
upt
ioni
nfetal
oxy genat
ion.

5.
Anti
cipatepati
entneedssuchasspongi
ngfacewit
hcool
clot
h,keepi
ngbedcl
eanand
dr
y,pr
ov i
dingicechi
psorli
pbalmtopromotecomfort
.

6.
Det
ermi
newhenpat
ientl
astv
oidedbecauseaf
ullbl
addercanhi
nderf
astl
abor
pr
ogr
ess.

Di
git
alv
agi
nalexami
nat
ion-

Di
git
alv
agi
nalexami
nat
ionati
nter
val
soff
ourhour
sisr
ecommendedf
orr
out
ine
 assessmentofact
ivef
ir
stst
ageofl
abouri
nlow-
ri
skwomen.

Manualt
echni
quesf
orpai
nmanagement
-

Manualt echni
ques,such as massage orapplicat
ion ofwarm packs,are
recommendedf orheal
thypregnantwomenrequesti
ngpainrel
i
efdur
inglabour
,
dependi
ngonawoman’ spreferences.

nexti
str
ansi
ti
onphase

1I
nfor
m pat
ientonpr
ogr
essofherl
abor
.

2Assi
stpat
ientwi
thpant
-bl
owbr
eat
hing.

3Monitormaternalv
italsi
gnsandf et
alhear
trat
eevery30minutes-1hour
,or
dependingonthedoctor’
sorder
.Contr
act
ionmonit
ori
ngisal
soconti
nued.

3When per inealbul

ging is not
iceabl
e,pr eparefor del
i
very.Check room
temperaturesomewhere25-280Candf reeofai rdr
aft
s.Thenurseshouldalso
notif
y staff and prepare necessary suppli
es and equipment
,i ncl
uding
resusci
tati
onmachine.Last
ly,
perf
orm handwashinganddoublegl
ovi
ng.

he2ndst
Ont age:

1Pr
ovi
deaqui
etenv
ironmentf
ort
hepat
ientt
oconcent
rat
eonbear
ingdown.

2Pr
ovi
deposi
ti
vef
eedbackast
hepat
ientpushes.

3Repeatdoctor’sinst
ructions.Atthis phase,t
he pat
ientbarely hear
sthe
conversat
ionaroundther oom becauseallherener
gyandt hought
sar ebei
ng
di
rectedtowar
dgi vi
ngbir
th.

4Takenot
eofthet
imeofdel
iv
eryandpr
oceedt
oini
ti
ateessent
ialnewbor
ncar
e.
Delay
edcordcl
ampi
ngi
srecommended.
 5Assi
sti
nrest
ri
cti
veepi
siot
omyf
orpat
ient
swhohadv
agi
nal
bir
ths.

6Bi
rt
hposi
ti
on-

Encour
agi
ngt headopti
onofabir
thposi
ti
onoft
hei
ndi
vi
dualwoman’
schoi
ce,
i
ncludi
ngupr
ightposi
ti
ons,
isr
ecommended.

7Met
hodofpushi
ng-

Women int he expul

sive phase ofthe second st
age ofl
abourshoul
d be
encour
agedandsupportedtofoll
owtheirownurgetopush.

Topusheffect
ivel
y,womenwoul dneedt ot
akeadeepbr eat
handhol di
tinthei
r
l
ungs,putthei
rchinontheirchest,andpullt
heirl
egstowardt hei
rchestwhi l
e
bear
ingdown.Thesamei nst
ructi
onsapplyift
heyaresquatt
ing.Womenuset he
samemusclestopushoutababyast heydotopushoutabowel mov ement.

8Techni
quesf
orpr
event
ingper
inealt
rauma-

Forwomeni nthesecondst ageoflabour

,techni
questoreduceper
inealt
rauma
andfacil
it
atespontaneousbir
th,
suchasper i
nealmassage,war
m compressand
ahands-onguardingoft heperi
neum,arerecommended,basedonawoman’ s
pref
erencesandavailabl
eopti
ons.

he3rdst
Ont age:

1Coachi
nrel
axat
ionf
ordel
i
ver
yofpl
acent
a.

2Congr
atul
ateondel
i
ver
yofbaby
.

3Encour
ageski
n-t
o-ski
ncont
actt
ofaci
l
itat
ebondi
ngandear
lybr
east
feedi
ng.

4ut
erot
oni
cs–

Theuseofut
erot
oni
csfortheprev
ent
ionofpostpar
tum haemor
rhage.
Butbef
ore
weuseuter
otoni
csweneedtocheckthemother
'sv
ital
signsfi
rst
.

al
so Oxy
toci
nist
he r
ecommended ut
erot
oni
c dr
ug f
ort
he pr
event
ion of
 post
par
tum haemor
rhage.

5Del
ayedumbi
li
calcor
dcl
ampi
ng-

Delayed umbi
l
icalcor
d clampi
ng,notearli
erthan 1 minute af
terbi
rt
h,is
recommendedforimpr
ovedmater
nalandi
nfantheal
thandnutr
it
ionout
comes.

Possi
bleCompl
icat
ionsdur
ingI
ntr
apar
tum

Thenextdi
scussi
onwi
l
lbeaboutt
hepossi
blecompl
icat
ionsdur
ingi
ntr
apar
tum and
theyar
easfol
lows:

Labort
hatdoesnotpr
ogr
ess-

Someti
mescontr
act
ionsweaken,t
hecer
vixdoesnotdi
lat
eenoughorinatimel
y
manner
,ort
heinf
ant
'sdescenti
nthebi
rt
hcanaldoesnotproceedsmoot
hly
.

Per
inealt
ear
s-

A woman'sv agi
naandt hesurroundingtissuesarelikel
yt otearduri
ngthe
deli
ver
yprocess.Someti
mest hesetearshealont hei
rown.I fatearismore
seri
ousorthewomanhashadanepi siotomy ,
whichisasurgicalcutbet
weenthe
vagi
naandanus,herpr
oviderwi
llhel
prepairthetearusi
ngsti
t ches.

Abnor
malhear
trat
eoft
hebaby-

Manyt i
mes,anabnor
malheartrat
eduri
nglabordoesnotmeanthatt
herei
sa
probl
em.Ahealthcar
eprovi
derwil
lli
kel
yaskthewomant oswi
tchposi
ti
onsto
helpt
heinf
antgetmorebl
oodflow.

Wat
erbr
eaki
ngear
ly–
Laborusuall
ystar
tsoni
tsownwi t
hin24hour
softhewoman' swaterbreaki
ng.If
not,t
hepr ovi
derwil
lli
kelyi
nducelabor
.Ifapregnantwoman'swat erbreaks
befor
e34weeksofpr egnancy
,thewomanwi l
lbemoni toredint hehospit
al.
Inf
ecti
oncanbecomeamaj orconcerni
fthewoman' swaterbreaksearlyand
l
abordoesnotbeginonitsown.

Shoul
derdy
stoci
a-

Inthi
ssit
uat
ion,t
hei
nfant
'
sheadhascomeoutoft
hev
agi
na,butoneoft
he
shoul
der
sbecomesst
uck.

Excessi
vebl
eedi
ng–

I
fdel i
veryr
esultsi
nt ear
st otheuter
us,oriftheut
erusdoesnotcont
ractt
o
del
i
vert heplacent
a,heavybleedi
ngcanr esul
t.Wor
ldwi
de,suchbl
eedi
ngisa
l
eadingcauseofmat er
naldeat
h.