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Chapter: Maternal and Child Health Nursing : Management of Labor

Management of patient in labour

The successful management of labour depends on good supervision during pregnancy to rule out abnormalities and threat if detected.

Management of Labor

Introduction

 

The successful management of labour depends on good supervision during pregnancy to rule out abnormalities and threat if detected. A good midwife must realize that she is dealing with two lives and she must try her possible best to preserve these lives. Her attitude toward the woman is most important as her approach can reduce the woman’s anxiety considerably.

 

Their relationship should be that of woman-centered care that assesses the needs and expectation of individual in labour and plan care to meet her specific needs and expectation.

 

Management of patient in labour

Basic Principles of Management

 

·              Understanding and meeting the woman’s psychological needs

 

·              Provide efficient bedside care

 

·              Maintain cleanliness, antisepsis and asepsis during labor

 

·              Restrain from unnecessary interference

 

·              To cope with emergencies

 

Admission of patient in labor

 

When a patient comes into the labor ward she must be treated politely and kindly.

 

·              She must be welcomed in a friendly manner. She must be reassured and midwife must gain her confidence, especially the primigravida who are usually tense and frightened of the unknown.

 

·              Time to record all the strange procedures and must be properly explained to the patient.

 

·              The relatives must be treated with courtesy. Offer them seats, and tell them when to check on the patient.

 

·              If the woman has gone far in labour she should go straight to the delivery room if not some enquiries are made to ascertain whether she is in true labour. There are two types of patients. The booked and the unbooked.

 

·              If the patient in booked, her card is obtained and studied carefully in case there are special instructions to how she should be managed in labour. And if she is unbooked she has to be booked and enquires are made regarding previous labour, weight of the baby, instrumental delivery, still birth etc. also any abnormal condition in the present pregnancy e.g. pre-Eclampsia anaemia, diabetes, cardiac disease, rhesus negative factor blood type and group, allergy to food. In all cases take the history of the present labour;

 

o     Time the labor began

 

o     Frequency and strength of the contractions.

 

o     If she has had any show.

 

o     If membranes are ruptured or intact, if ruptured the time it ruptured and the colour and the amount of liquor aminii

 

o     She should be asked if she has eating within six hours time and type of food she ate. All these should be recorded. To plan appropriate care, the health status is determined, by gathering base time information to assess health conditions, stage of labor and to rule out complications.

 

General Examination

 

·              Urine Test: Albumin, sugar, Acetone, if albumin is present a mid-stream specimen is obtain?

 

·              Status of membranes and vaginal bleeding. Elimination pattern, hydration.

 

·              Psychosocial Assessment – Prenatal education, respo nse to labour, self confidence.

 

Abdominal Examination

·              Inspection: Shape, size, scars (if any ask for the reason)

 

·              Palpation: Fundal height, lie, presentation position, engagement of the head.

 

·              Auscultation: Fetal heart, Rate, volume regularity.

 

·              Strength duration and frequency of contractions.

 

Vaginal examination

 

This should be done as frequently as necessary (4-6hrs). Asepsis must be kept during the procedure because of the danger of introducing infection. It is the only certain method of determining cervical dilatation.

 

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Maternal and Child Health Nursing : Management of Labor : Management of patient in labour |


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