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.
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
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.
·
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.
·
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.
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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