Subsequent management of labour
If an expectant mother is given some idea in simple language before the labor begins, of what to expect in each states of labour, she is likely to be more co-operative. Patient should never be left alone. Further management include
All observations made must be recorded.
a. General appearance: The effect of labor on the woman is she taking the labour pain easy or is it making her distress.
b. Vital signs: Blood pressure 1-2hrly Pulse, Respiration.
Hourly early labor 15-30mins in late labour. Infection Ketosis, haemorrhage ruptured uterus. Temperature – 4 hourly. Abnormalities in the observation should be reported. Volume of pulse is important as thready pulse may indicate pre-eclampsia.
c. Fetal heart Rate; Hourly in graph form rhythm, rate and volume are noted. Normal beat is between 120-160 beats per minute and drop of 20 beats below or above should be reported. Fetal heart is not auscultated during contractions because it can alter the normal rate.
d. Contraction. Characteristics of contraction –streng th durationand pregnancy
If ruptured or still intact. If ruptured – Liquor a mni volume, colour etc time of rupture, colour, and Odour. Color should be clear or pale amber with slightly fleshy odour. Rule out cord prolapse.
Contraction: Strength, Duration, frequency. E.g. whencontraction is 1-10min it should be weak at first then becoming more frequent and strong and for longer duration.
Descent of the head: This is one of the ways of determiningthe progress of labour. That is the head engaged or not or if getting engaged if not engaged at the beginning of labour. If head is persistently high it should be reported to the Doctor. It is done in fifth of the head per symphysis public.
Feeding: During early labour the patient can be given smalleasily digestible food with plenty of glucose drink, milk, tea or fruit. 5% Dextrose can be given intravenously if patient can not take orally or ill patients e.g. Pre-elampsia. Accurate fluid chart should be kept.
Bowel and Bladder: Full bladder and bowel can lead touterine inertia and delay in engagement of the head. Midwife must encourage the woman to pass urine every two hours and all must be tested. Enema may be repeated if necessary but not towards the end of first stage of labour. Bed pan should be used during late stage of labour.
Rest and sleep: The midwife must ensure adequate rest andsleep during labour. Drugs are given to relieve pain and induce sleep e.g. pethidine 100mg. Pethilorfan 2mls intramuscularly in early labour.
Comfort: Non-medical method-proper position, damp coolcloth on forehead detraction – music, TV, pictures, breathing exercises and relaxation. The midwife should pay attention to the woman’s toileting by washing the face, and hands, change perineal pad and clothing when necessary – medication – may be used in a safe way.
Posture: patient should be on lateral position as this reducesthe risk of compression on the vena cava which occurs in supine position in some women. Upright position facilitates engagement of the head. The woman is allowed to walk about if the membranes are in tact and head engaged. When membranes rupture she should lie on bed because of the risk of cord prolapse.
When membrane ruptures in labor put patient on bed and check the vulva by opening the labia for cord prolapse. Also note the colour odour and volume. Vaginal examination could be done, Note the cervical dilatation and level of the head.
Relief of pain in labour: Objective is to provide maximumrelief while maintain maximum safety for the woman and fetus. May be achieved through and conpharmexcotogic approach or combination of both.
Contraction should be increasing in frequency, strength and duration.
There should be a progressive decent of the head over a period of time.
V.E. is performed to determine & effacement. The cervical OS should be dilating progressively. And the labor pain should not distress the woman.
Station of the head in relating with the Ischial spines.
Just before the end of the first stage of labour, the delivery room must be got ready. The delivery trolley must be set ready under strict aseptic technique. They are set from the drum or packs which are used with basic requirement.