Second stage - Management of patient in labour

Second stage

Objectives

1.           To prevent infection of the genital tract by careful attention to asepsis and antisepsis.

2.           To ensure that the child is born alive with no injuries.

3.           To prevent injury to the perineum.

Physiology of the second phase(refer to Module Two Unit One) Signs of Second stage of labor

The following signs and symptoms will be observed when a woman reaches the second phrase of labor

1.           On vaginal Examination: OS fully dilated

2.           Expulsive uterine contractions

3.           Trickling of blood Repture of membranes

4.           Tenseness between coccyx and anus Vulva gapes.

5.           Anus pouts gapes

6.           Urge to push

7.           Presenting part is visible

8.           Perineum stretches and bulges.

Active management

Patient should be transferred to the second stage room or lie on her bed in the first stage room. She should not be left alone.

Vaginal examination is done to confirm full dilatation of the cervix. Patient can lie in any position she finds most comfortable for her. If membranes are intact it should be ruptured artificially using a pair of cockers or artery forceps. Observations and recordings continues and more frequently between contractions (1) Uterine contractions (ii) Descent of the presenting part (iii) maternal pulse 5 – 15 minutes –intervals. Fetal hea rt rate every 5 minutes. Any irregularity must be reported. As oxygenation to the fetus may be less due to compression of head or cord.

Bladder must be kept emptied by catheterization at the end of firststage or at the beginning of second stage, if the bladder is full as this can cause delay in the engagement of the head and post partum haemorrhage in third stage. Only a sip of glucose drink is allowed if the second stage is getting prolonged and the woman’s condition permits it, because of danger of vomiting. The hands and the face could be sponged with cold water. Two nurses should do a delivery at a time. One clean nurse and one assistant. Head should be delivered slowly to prevent injuries to the perineum. The woman should be discouraged from active pushing until the head is visible. She can practice breathing exercise – Rhythmic, eas y breathing, avoid shallow panting, very deep breathing and prolong breath – holding. She should feel free to express herself – cry, shout, etc. it helps her to cope.

Position: Depend on maternal & fetal conditions, motherpreference, the environment, Midwife’s confidence. Positions include: Dorsal, Left lateral, Squatting, Kneeling, or standing, the birthing chair.