Professional Documents
Culture Documents
labour
Prepared by:
Nirsuba Gurung
Assistant Lecturer
MSON
Nursing care of women in first
stage of labour
General :
◦ Clean and safe environment
◦ Use of aseptic technique
◦ Trimming of vaginal hair
◦ Constant observation
◦ Communication/emotional support
Position
Bending in back ,Sitting in low chair or
bed leaning forward –help in
engagement
Upright and walking helps in fetal
descent
Lateral facilitate kidney function and
promote blood circulation to fetus
Diet
In the latent phase of labour allow diet as
desired and encourage oral
hydration(Uterine muscle contraction
requires glucose and, if depleted, muscle
inertia may occur. Eating and drinking in
early labour has not been shown to
significantly affect labour progress, or cause
adverse maternal or infant )
Allow a light, low fat, low roughage diet in
labour for women at low risk for
anaesthesia(Hunger and thirst can lead to
ketonuria, which may increase the length of
• Women at risk for having a general
anaesthetic should have sips of clear
fluid only.
Consider administration
of intravenous fluids for:
- Women at risk of
dehydration
- Fasting women
Bladder
Encourage women to pass urine every
two hourly
If women is not able to pass urine for
six hour and bladder is found full as
suprapubic bulging ,sterile catheter
should insert to passed the urine
from bladder
Bowel
Enema should not be given at the end
of the first stage of labour
Emptying the rectum prevents soiling
of the perineum in second stage of
labour
Rest and sleep
Mild sedation and analgesic
Ensure adequate sleep
Pain management
Position
Ambulation
Small feeding
Back massage
Breathing technique
Warm bath and shower
buscopan, morphine
Provide comfort and
assistance
Assist in daily care
Praise and reassure her
Give detail of progress of labour
Teaching bearing down or
pushing effort
Medication
Epidocin–for cervical dilation and
effacement
Infection control measures
Proper recording
To note progress of labour
Complications of obstructed
labour
and ruptured uterus contribute
up to 30% of maternal deaths in
some areas.
Proper use of partogram has proved
so useful in reduction of both
maternal and perinatal mortalities and
Advantage
1. A single sheet of paper can provide
details of necessary information at a
glance
2. No need to record labour event
repeatedly
3. Gives clear picture of normality and
abnormality in loabour
4. It can predict deviation from duration
of labour ,so appropriate stepscould
betaken in time
5. It facilitate handover procedure
of staff
6. Save working time of staff
against writing labour notes in
long hand
7. Educational value for all staff
RECOMMENDATIONS ON THE USE OF
PARTOGRAM
1. Latent phase
◦ Contractions at least 2 in 10, lasting ≥ 20 sec
2. Active phase
◦ Contractions at least 1 in 10, lasting ≥ 20 sec
3. SRM but no contractions
◦ When oxytocin is started or when labour
commences
4. Inductions
◦ At ARM ± oxytocin
◦ When induction is medical start when labour
commences (see 1 and 2) or membranes rapture.
DESIRED UTERINE CONTRACTIONS
Vaginal examination 4 8 4
Descent of head 4 8 4
Contractions ½ 4 2
Fetal heart beats ½ 4 1
Temperature, PR, BP, urine 4 4 4
TIMING OBSERVATIONS IN LATENT
PHASE AND ACTIVE PHASE
Variable
Late
membranes and liquor
intact membranes
……………………………………….I
ruptured membranes + clear liquor
…………………….C
ruptured membranes +
meconium- stained liquor
……..M
ruptured membranes + blood –
stained liquor
…………B
ruptured membranes + absent
liquor…………………....A
Molding the fetal skull bones
Molding is an important indication of how
adequately the pelvis can accommodate the fetal
head. Increasing molding with the head high in the
pelvis is an ominous sign of Cephalopelvic
disproportion.
separated bones . sutures felt easily……….O
bones just touching each other……………..+
overlapping bones …………… …………...++
severely overlapping bones ( notable ) ……..+++
Part 2 – progress of labour
. Cervical dilatation
Descent of the fetal head
Uterine contractions
this section of the paragraph has as its central
feature a graph of cervical dilation against time
it is divided into a latent phase and an active
phase
latent phase :