MANAGEMENT OF FIRST

STAGE OF LABOUR
 Definition : labor

 LABOR
Series of event that take place in the genital organ in and effort to expel out the viable product of conception foetus
placenta and membrane out of the womb through the vegina into to outer world is called labour.
 NORMAL LABOR (EUTOCIA)
Labour is called normal if it fullfils the following critaria ….
Spontaneous in onset and at term
With vertex presentation
Without undue prolongation
Natural termination with minimal aids
Without having any complications mother and baby

ABNORMAL LABOR(DYSTOCIA)
Any deviation from normal labor is called abnormal labor. It includes all cases of non-vertex presentations and all
vertex presentations with complications affecting the course of labor or maternal or fetal prognosis.
Cause of onset of labour

Fetal cortisol theory

Oxytocin theory

Progesterone withdrawal theory

Prostaglandins theory

Estrogen theory
 II Mechanical factors
 Uterine distension theory Like any hollow organ in the body, when the uterus in distended to a certain limit, it
starts to contract to evacuate its contents. This explains the pre term labour in case of multiple pregnancy and
polyhydramnios.
 Stretch of the lower uterine segment : By the presenting part near term.
CLINICAL PICTURE OF LABOUR Prodromal (pre-labour) stage The following clinical manifestations may
occur in the last weeks of pregnancy.
 1. Shelfing It is falling forwards of the uterine fundus making the upper abdomen looks like a shelf during
standing position. This is due to engagement of the head which brings the foetus perpendicular to the pelvic
inlet in the direction of pelvic axis.
 2. Lightening It is the relief of upper abdominal pressure symptoms as dyspnoea, dyspepsia and palpitations
due to: Ni Descent in the fundal level after engagement of the head and Shelfing of the uterus.
 3. Pelvic pressure symptoms With engagement of the presenting part the following symptoms may occur : 1.
Frequency of micturition 2. Rectal tenesm 3. Difficulty in walking.
 4. Veginal discharge pink , clear. And bloody show in few day before labour.
5.False labour pain
Difference between the true labour pain and false labour pain
STAGE OF LABOUR
First Stage of Labor.
The first stage of labor is referred to as the "dilating" stage. It is the period from the first true labor contractions to complete dilatation of the
cervix (10cm) The forces involved are uterine contractions.
1 The first stage of labor is divided into three phases :
● Latent (early) or prodromal.
● Active or accelerated.
● Transient or transitional
 Latent phase.
1. Cervical Dilatation 1-4 cm
2. Contraction repeat 15-30 min.
3. Remain 15-30 sec
4. Mother talk active
5. Duration primi 4-6hr , multipara 4-8hr.
 Active phase
1. Cervical Dilatation 5- 7 cm
2. Contraction repeat 3-5 min.
3. Remain 45-60 sec.
4. Mother Restless
5. Duration primi 4 hr , multipara 2hr.
Transient phase
Cervical Dilatation 8- 10 cm
Contraction repeat 2- 3 min.
Remain 60 – 90 sec.
 Duration primi , multipara both 30 min. – 2hr
 Ideal contraction 3 contraction in 10 minutes
Second Stage of Labor.
The second stage of labor is referred to as the “delivery or
expulsive” stage. This is the period from complete dilatation of the
cervix to birth of the baby. The forces involved are uterine
contractions plus intra-abdominal pressure.
Third Stage of Labor. The third stage of labor is referred to as the
“placental” stage. This is the period from birth of the baby until
delivery of the placenta. The forces involved are uterine contractions
and intra abdominal pressure. Fourth Stage of Labor.
 Fourth Stage Of Labor is referred to as the “recovery or
stabilization” stage. This period begins with the delivery of the
placenta and ends when the uterus no longer tends to relax. The
forces involved are uterine contraction
FIRST
► STAGE OF LABOUR
EVENTS IN FIRST STAGE OF LABOR
Following are The main events or physiological changes which help to
prepare the birth canal in the first stage of labour.
● Contraction and Retraction of Uterine Muscules
● Formation of Upper and Lower Segment
● Development of Retraction Ring
● Dilatation and effacement of the cervix
● General Fluid Pressure
● Rupture of Membranes
● Fetal Axis Pressure
1. Contraction and Retraction of Uterine Muscles
Uterine contractions are involuntary movements which are palpable and painful. these
contractions are recurring with rhythmic and regular intervals.
Natures of the Uterine Contractionsare
● Painful Uterine Contraction
● Fundal Dominance
● Raised intra- amniotic pressure
● Retraction
● Polarity

a. Painful Uterine Contraction

The contractions are intermittent and regularintervals whichare painful. During contractions are
not within the control of the patient and confines even when the patient is unconscious or under
sedation.
Uterine contraction reference is made to the following characteristics
● Frequency: Contraction occur intermittently through out labour. They begin at 20-30 m
apart and become closer together until, at the height of the expulsive efforts, they are as
frequent as every 2-3m.
● Regularity : Contractions occur more and more regularly as labour becomes well
established.
● Duration : The length of the time a contraction lasts increases from 30s to between
60-90s near full dilatation of the cervix. Then the duration becomes about 60 s until
delivery of the fetus is accomplished.
● Intensity: The strength of the contraction also increases as labor from weak
contraction noted early in labor strong expulsive Contraction (intra uterine pressure
measured , at 50-75 mm Hg) .
.Fundal Dominance
Each contractions begins in the region of the Ostia where of the pacemaker of the contractions are probably situated
and waves of contraction spread through midzone to lower uterine segment. The contractions being stronger and
longer in the fundus than the lower segment of Contraction are weaker in the lower pole and passes off first.

The nature of uterine contraction is essential for the stretching and thinning of the lower segment and dilatation of the
cervix and decent of foetus into the pelvis.
 Raised intra - amniotic pressure
 There is some intra amniotic pressure during pregnancy, which measures 3 to 5 mm of Hg. During contraction
it increases up to 40 to 50 mm of Hg in the first stage and 80 to 100mmHg in the second stage of labour.
 In between uterine contractions, the resting tone varies within 6 to 10 mmHg. Good relaxation occurs between
contractions to bring down the intra- amniotic pressure to less than 8 mm of Hg.
 Polarity
During each contraction two poles of uterus act harmoniously. The upper pole of the uterus contracts strongly and
retracts to expel the fetus towards the lower pole and the lower pole contracts slightly and help cervix to dilate in
response to the forces of contraction of upper segment or to accommodate the descending fetus from upper pole
and lower pole allow expelling the fetus.
Formation of upper and lower uterine segments :
By the end of pregnancy, uterus is divided into two segments, i.e. upper and lower segments. The upper
segment, which is formed from the body of the fundus, is thick and muscular. The lower segment, which is
formed from the isthmus and cervix, progressively thins out. There is the formation of physiological ring,
called as 'retraction ring'or 'bandl's ring', which forms at the ridge between upper and lower uterine segment
Development of Retraction Ring:
A distinct ridge develops at the junction of the two segments
during labour pain, which is known as the retraction ring. The
contraction and retraction of the upper segment cause the uterine
thicker, shorter or smaller, so it attempts to push the fetus out
into the birth canal according to the activity of upper segment,
the lower segment tend to distend, stretch and thinner and
thinner. During this process, a distinct ridge is produced at the
junction of the two segments, which is called retraction ring or
physiological ring and moves up to the level of symphysis pubis
as the lower pubis as the lower segment is distened and it
perfectly normal if doesn't move beyond the symphysis pubis.
.Show Presentation
Show-There is presense of blood stained cervical secretion with the onset of labour. The bleeding comes from the
separation of membranes from lower uterine.
With the onset of labor , there is profuse cervical secretion . Simultaneously there is slight oozing of blood from
rupture of capillary vessels of the cervix and form the raw decidual surface caused by separation of the
membranes due to stretching of the lower uterine segment . Expulsion of cervical mucus plug mixed with blood is
called ‘show’.
5.Effacement and dilatation of the cervix
During the first stage of labor, the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the
birth canal. In figures A and B, the cervix is tightly closed. In figure C, the cervix is 60% effaced and 1 to 2 cm
dilated. In figure D, the cervix is 90% effaced and 4 to 5 cm dilated. The cervix must be 100% effaced and 10 cm
dilated before a vaginal delivery.
 6.FORMATION OF ‘BAG OF WATER ‘
 This is almost Due to stretching of the lower uterine
segment , the membranes are detached easily because of
its loose attachment to the poorly formed decidua .
 With the dilatation of the cervical canal , the lower
pole of the fetal membranes becomes unsupported and
tend to bulge into the cervical canal . As it contains
liquor which has passed below the presenting part , it’s
called BAG OF WATER ‘During uterine contraction
with consequent rise of intra amniotic pressure , this bag
becomes tense and convex . After the contractions
pass off , the bulging may disappear completel a certain
sign of onset labor . in some cases the membranes are
so well applied to the head that the finding may not be
detected .
 General fluid pressure
 Will the membranes remain intact the pressure of the uterine contraction is exerted the fluid and fluid is not
compressible the pressure is equalized throughout the uterus and over the fetal body is known as general
fluid pressure.
 8.Rupture of membrane at the end of first stage of labour when the service become fully dilated and no
longer support the bag of for water the uterine contraction are also applying increases force at this time the
membrane may be remain in that until full dilation of cervix of the first stage of labour. it may also refer
picture at any time after the onset of labour
 9.Fetal Axis pressure during each contraction the uterus rises forward and the force of the fundal
contraction is transmitted to the upper pole of the fittest downward the long axis of the foetus and applied
by the presenting part of cervix.
►MANAGEMENT TO FIRST STAGE OF LABOUR
 Emotional support, physical care and clinical skills are equally important to ensure a satisfactory outcome for
mother and the baby.
 Purposes
● To conduct safe and clean delivery.
● To provide an adequate help and maintain comfortable to mother in labour.
● To prevent maternal and fetal complication eg .Maternal and fetal distress, postpartum hemorrhage and injuries
etc.
● To give a healthy, live and a normal birth of a baby.
● To maintain normal delivery process with good guidance, maximum observation with minimal assistance.
● To identify the deviation from normal and complications in early and take corrective measures as necessary.

 MANAGEMENT OF THE FIRST STAGE OF LABOUR

● Nursing Management
● Preparation of room for delivery
● Preparation of equipments for delivery
● Maintain record or documentation of labour
► NURSING CARE DURING THE FIRST STAGE OF LABOR
 Hospital Admission :
After a physician or nurse has evaluated the patient, an admission order is written. At this point, the duties as
a practical nurse are as follows :
Establish a rapport with the woman and significant others.
2. Explain all procedures or routines, which will be carried outpriorto performing them. These include:
● NPO except ice chips while in labor.
● . Activities allowed and disallowed according to ward policies (i.e. bathroom privileges).
● Use of fetal monitors.
● Progress reports.
● Visitation policies.
● Where patient's personal belongings will be maintained.
3. Orient the patient to the surroundings
4. Initiate the patient's labor chart.
 (i) OBSTETRIC HISTORY
● Gravida/para.
● Estimated date of confinement (EDC) or due date.
● Duration of previous labors.
● Problems with previous pregnancies/deliveries.
(ii) General condition
● Rh status. ● Allergies. ● History of medical problems.
(iii) Current pregnancy
● Onset of labor (contractions regular, 5 minutes or less). ● Frequency, duration, and intensity of contractions. ● Membranes-
ruptured or intact. ● Amount and character of show or vaginal bleeding. Vital signs. ● Rate, location of fetal heart tones. ● Plans to
bottle or breast feed. ● Any problems with this pregnancy. 6)evaluate the current emotional status.
7) Evaluate the preparation for labour through classes
8) Evaluate for possible danger signs
● Increase pulse and temperature
● Excessive vaginal bleeding.
● Presence of meconium (fetal feces).in the amniotic fluid of a mother a vertex position.
● Alteration in fetal heart tones (FHT's) above160 orbelow 120.
● Obvious change in the character ofuterine contractions.
9) Perform the admission physician's orders to include but not limited to the following:
● Administer and maintain intravenous fluids-per physician's order. This is usually done on all patients.
● Draw lab work-CBC, serologic testing, type and screen,or per.
Perineal Preparation :
Shaving of pubic hair to prevent infection of perineal episiotomy/lacerations is rarely done anymore. There must be a
physician's order to perform this task .
Cleansing Enema
1. A cleansing enema may range from "mini-" or "Fleets" to a full, soap - enema. Giving an enema is no longer
considered routine. There must be a physician's order to perform this task.
2. The patient must be evaluated to determine if she has had a recent bowel movement.
3. If a cleansing enema is given, it is usually a small fleet.
4. Some physicians consider giving fleets to :
● Prevent fecal contamination of the perineum during delivery.
● Cleanse the bowel. This provides more room for fetal passage.
● Stimulate uterine contractions.
5) Some physicians consider not giving fleets because the following factors may be present or begin :
● Vaginal bleeding.
● Premature labor.
● Presenting part not engaged.
● Abnormalpresentation-breech or transverse.
● Already rapid movinglabor.
● Advanced labor.
● Membranes are ruptured or danger of prolapsed cord.
● Results of enema may produce unmanagable amounts of loose stool at delivery.
 D ) Check the Uterine Contractions
 1. The purpose of this evaluation is to assess the ability of the uterus to dilate the cervix, help in determining the
progress of labor, help to detect abnormalities of uterine contractions (such as lack of uterine relaxation), and help to
evaluate any signs of fetal distress.
 2. This evaluation will help to in identifying the frequency (how often in minutes contractions occur), intensity (streng
of contractions when palpitations are identified as mild, moderate, or strong [severe]), and duration (how long the
contractions lasts in seconds).
 3. When palpating for contractions, place your hand over the fundal area of the patient's uterus. Contractions can be fe
by the fingers before the patient actually becomes aware of them.
 F. Fetal Monitoring
 1) Fetal monitoring is done to detect presence of fetal life at time of admission and to detect development of fetal
distress during labor. A fetoscope or fetal monitor may be used to obtain FHR. Normal fetal heart rate ranges from 120
to 160 beats per minute (BPM). The rate may increase or decrease by 30 BPM during a contraction. It should return to
the baseline immediately after the contraction. A continued fetal heart rate of greater than or less than 30 BPM from the
normal baseline after contractions may be indicative of fetal distress as defined by: ● Fetal tachycardia-FHR sustained a
greater than 160 BPM. ● Fetal bradycardia-FHR sustained at less than 120 BPM. 14
 2) Fetal distress may be indicated by FHR, between contractions that are consistently abnormal. Any variations should
be reported immediately.
 3) The FHRs should be checked and recorded on admission, every 15 minutes during the first stage of labor, every 5
minutes during the second stage of labor, and immediately after rupture of membranes. This helps to identify the
location of the prolapsed cord.
 4) Candidates for continuous fetal monitoring includes a patient with a multiple pregnancy, patient with obstetric
complications, a patient receiving oxytocin infusions,any high risk patient,a patient with meconium stained aminotic
fluid, or any patient whose pregnancy is not progressing normally.
 5) Most medical facilities are using continuous fetal monitoring during labor.Alternative birth center soffen intermittent
monitoring.
 6) Methods of fetal monitoring. A transducer is placed on the abdomen over the uterus for external monitoring electrode
is attached to the presenting part of the fetus, but NOT placed on the sutures,fontanels,face. for internal monitoring.
 G) Vital signs.
● On admission
● Every avar during early labour
● Blood pressure pulse and respiration rate (R) every 30 min. Active transition stage of labour to include the temperature every hour.
● Blood pressure and ,P, and R every 15 min. while on Pitocin, oxytocin to include the temp.every hr.
● More frequently if complications arise
H) Patient Should Void .
You should offer the patient an opportunity to void every 2 hours during labor. The discomfort of contractions often causes
the patient to be unaware that her bladder is full. A full bladder may impede the progress of labo r.
 Patient is NPO During Labor.
The patient may have ice chips to prevent drying and chapping of the lips. Vaseline may be applied to her lips to prevent
chapping. Gastric emptying time is prolonged once labor is established. The administration of analgesics also prolongs
gastric emptying. The patient may vomit and aspirate since her stomach contents may not be absorbed. Being unaware of
when possible complications could arise could necessitate an emergency C-section with general anesthesia.
Positioning During Labor
Assist the patient in turning from side to side. Elevate the head of the bed 30 degrees; this makes it easier for the patient to
breath. Try to keep the patient off her back to prevent spine hypotensive syndrome. This syndrome results in 15 pressure of
the enlarged uterus on the vena cava, reduces blood supply to the heart, decreases blood pressure, and reduces blood
circulation to the uterus and across the placenta to the fetus. The patient may complain of being nauseated and feeling cool
and clammy. The best position for the patient is on her left side since this increases fetal circulation.
 Prevention of Infection.
Handwashing is essential before and after performing any procedure. Fresh, clean scrub suits should be worn in the
delivery area. Unauthorized persons should not be allowed in the area. A patient with infections should be separated
from other patients.
 I.Vaginal Exams.
Only the physician or a trained nurse performs this exam. It is done to evaluate cervical effacement, cervical
dilatation, status of membranes, and station of presenting part. Care must be taken to perform good perineal
cleansing before and after the procedure (vaginal exam). Once membranes rupture, the exam should be limited even
further to prevent the risk of infection. for vaginal palpation Cervical dilatation, effacement, aminotic mambranes in
the presenting part.
 Artificial Rupture of Membranes.
Rupture of the membranes is done by the physician to induce or hasten labor. Apply an internal fetal monitor lead or
a uterine catheter
 The FHTs should be checked immediately following rupture.
Determining fetal distress is secondary to compression of the cord. The cord may be displaced by the sudden "gush"
of waters, which may yield a prolapsed cord. Fluids should be carefully examined for meconium if the fetus is in the
vertex presentation, (that is, head first). You should check for: Slight green color -- called light meconium. Green to
dark color -- called moderate meconium. Dark green with chucks of meconium -- called heavy meconium.
Record the following information:
Time of the procedure (rupture of membranes). Amount of fluid expelled (small, moderate, or large). Color -- clear or
meconium stained (extent of staining -- light, moderate, or heavy). Fetal heart rate immediately after the procedure
and five minutes after the procedure. Instrument used, if other than an amnihood, to provide a slow, controlled
release of fluid. Other instruments may be a fetal scalp electrode or spinal needle.
Emotional Support
First phase - laten. Offer support and explanations. Instruct or reinforce breathing techniques (breathe slowly and
deeply and use deep chest or abdominal breathing). Remind the patient to not push down during the first stage since
it could causes cervical edema. It could also cause cervical lacerations and fetal hypoxia.
 Second phase -active. Continue to give support, offer encouragement, and give explanations. Include significant
other in these procedures. Reinforce breathing and relaxation techniques. Accelerated shallow panting may be
used, and also, effleurage (stroking movement used in massage, usually of the abdomen).
 Third phase - transition. Encouragement is especially important now since the patient is most likely losing control
at this point. She may be nauseated and vomit. Assist the patient to turn on her side or to sit up to prevent
aspiration. Wipe her face and mouth with a cool cloth. Be aware that the patient may want to be left alone, but
don't leave; stay and support her. Remind the patient that this is the shortest stage and that the baby will be born
soon. Encourage her to concentrate on relaxation and breathing techniques. Use more intensive breathing
techniques ,
 Preparation of the Delivery Room.
Preparation is usually done by the paraprofessional on duty if the scrub technicians are not employed. Strict aseptic
technique is maintained. The room is prepared while the patient is in the first stage of labor. The local SOP will
determine how soon before anticipated delivery the room can be set up. It is usually 2 to 12 hours if the tables are
covered and rooms are closed.
 PAIN RELIEF
Non- Pharmacological Approaches To Relieve Labour Pain.
This approach to pain include a wide variety techniques to prevent suffering from enhancing physical ,psycho
emotional and spiritual component to care.
. Method
● Continuous labour support
● Hydrotherapy
● Movement and positioning
● Touch and massage
● Acupuncture
● Hypnosis
● Transcutaneous electric nerve stimulation
● Aromatherapy
● Heat and cold
● Childbirth education
● Self-help techniques such as patterned breathing and relaxation
● Music and Audio analgesia.
Effective Pain Relief Techniques/Comfort Measures for Labor :
Message
● Counter pressure
● Pressure on hand feet and lips
● Hydrotherapy
● Breathing patterns
● Heat and cold pack
● Position change
● Relaxation technique
● Music , focal point photos etc
● Aromatherapy
● Fluid and light food
● Birth dual ● Pressure point

GOALS OF NURSING MEASURES TO MINIMISE DISCOMFORT DURING THE

CHILDBIRTH
Nursing measure utilised to minimum minimise discomfort during the childbirth
A.) Give frequent explanation of patient
1) Explain to the patient what she is to expect, especially if she did not attend childbirth classes.
2) Give simple and straightforward answers.
3) Inform the patient of all progress. Do not give specific times for progress.
4) Emphasize that pain diminishes between contractions. Encourage the patient to relax. Have her close her eyes and sleep.
5) Ease panic associated with pain. Remind the patient of safety measures required for the baby and encourage concentration
B. Provide Comfort Measures.
1)Ensure that there is clean and dry bedding and a clean gown.
2) Inform the patient of frequent oral hygiene, especially after vomiting. This includes brushing the teeth and using mouthwash.
3) Provide ice chips.
4) Provide a cool cloth for the patient's face, if necessary.
5) Give back rubs or pressure, especially over the lower sacrum area.
6) Position the patient as needed. The side lying position is recommended.
Lying on the left side is preferred because it increases placental flow. Place pillows behind the patient's back and between her legs
as necessary.
7) Provide for a quiet room. Dim the lights if possible to encourage relaxation.
8) Have the patient void every 2 hours; assist as needed.

C. Encourage the Use of Psychoprophylaxis

Relaxation techniques concentration. include breathing during contraction on the focal point and if
effleurage.rhythmic stroking techniques used during childbirth. The pelvic tilt and abdominal exercises are the
exercises to be used.

d. Analgesic Medications During Labor

1) Fetus : What the patient in labor receives crosses the placenta and goes to the fetus. The fetus becomes sedated as
a result of the medication. It may cause respiratory distress in the fetus if it is not worn off by the time of delivery.
Medication is not usually given if the fetus is premature due to problems they have detoxifying the drug due to the
immature system.
 2 Mother : The medication will make the patient sleepy or drowsy. When given during the active phase, it may
cause appropriate maternal relaxation that results in more rapid dilatation. It is not generally given during the
latent phase (less than 4 cm dilatation) because it may interrupt a regular contraction pattern. It is not generally
given in the transitional phase (greater than 8 cm dilatation) as delivery time cannot be predicted exactly and the
infant may be born under the full impact of the medication.
 3 labor and delivery process : Medications may slow labor down and space contractions further apart. In
addition, it may speed the labor due to the relaxed state of the patient.
CLASSIFICATION OF DRUGS USED FOR CHILDBIRTH
a. Analgesics (Narcotics and Nonnarcotics). Analgesics refer to a technique or medication that reduces or
eliminates pain. A narcotic analgesic produces the same amount of CNS depression. It includes
● Demerol-narcotic.
● Morphine-narcotic.
● Stadol-nonnarcotic.
● Nubain-narcotic.
● Nisentil-narcotic
 b. Anesthetic : Anesthetic refers to a technique or medication that partially or completely eliminates sensation or
feeling. There are two types of nerve blocking anesthetics, local and regional.
 Local anesthetics : produces only in the area where injected. It is used in the superficial nerves of the perineum
to make or repair episiotomy lidocaine 1% drug normally used and is short acting. local anesthetics are used
frequently for delivery.
 Regional anaesthetic : include paracervical block pudendal block, sandal block( lower spinal ) and cradle for
lumbar epidural.
 General Anesthesia : General anaesthesia produce loss of sensation and loss of consciousness it is indicated for
uncomplicated vaginal delivery it is used in cases of fetal distress requiring immediate delivery and used for c
section when is Paya spinal anaesthesia is contraindicated.
Nursing Care Given To The Obstetric Patient Receiving Anesthesia :
a. Continue monitoring the labor patterns, fetal heart rate, blood pressure, and pulse.
b. Observe closely for side effects, most frequently maternal hypotension and fetal bradycardia.
c. Provide emotional support for the patient and her partner.
d. Maintain appropriate emergency equipment for maternal hypertension for fetal bradycardia the equipment include
oxygen with face mask suction airway and IV fluids.
e. Monitor blader status at least every 2 hours if the bladder is distended a physician order may be required for in and out
catheterization.
 Nursing Care For Maternal Hypotension In The Obstetric Patient
1) Position the patient on her left side. This relieves uterine pressure on the inferior vena cava and iliac veins and it increases
oxygen supply to the fetus.
2) Administer oxygen per facemask, usually at 5 to 8 liters/minutes, as ordered.
3) Elevate the patient's llegs.
4) Stay with the patient, do not leave her unattended.
5) Notify the Charge Nurse or physician immediately
III Preparation of equipments for delivery
. The equipments needed for delivery should be pre sterilized and should keep ready or in working condition and readily accessible.
Keep ready the needed materials for baby the mother including resuscitation sets, oxygen, suction machine and warm, dry clothes
as well as needed medicines.
Equipments for delivery
● Delivery set
● Episiotomy set
● Equipments with medicine which are to be available in the ward tray.
● Equipments and materials needed for baby.
● Resuscitation set (Neonatal)
● Equipments needed for home delivery.
● Maintain records or documentation of labour.
● Maintain records or documentation of labour.
VI. Maintain records or documentation of labour
Throughout the first stage of labour, the midwife must keep meticulosis records of all events of the woman's physical
and psychological condition and the condition of the fetus. While observing the progress of labour, she be alert for
signs of second stage of labour. A comprehensive record of the progress of the labour must evident. Vital parameters,
treatments and nursing care be clearly documented.
PARTOGRAPH
The partograph is used to plot following parameters for the progress of labour; Cervical dilatation, descent of the fetal
head, and uterine contractions. It is also used for monitoring fetal conditions with the following parameters: fetal heart
rate, membranes and liquor and moulding of fetal skull. partograph can be used to monitor maternal condition: pulse,
blood pressure, temperature, urine, drugs, IV fluids, and oxytocin. Vaginal examination is generally done every 2-4
hours. Uterine activity and the heart rate of fetus is assessed every 15 minutes. The findings are recorded on the graph.
The benefits of using the partograph are:
● Effective means of recording progress of labour.
● A partograph chat must only be started when a woman in labour
● It saves the timing of the staff, which can be wasted in long writings.
● If progress of labour is satisfactory the plotting of cervical dilator tation will remain on or to the left of the alert line.
● The latent phase 0-3 cm dilation is accompanied by gradual shortning of the cervix.
● The active phase 3 to 10 cm validation should progress at the rate of at least one centimetre per hour.
● During the first stage of labour, monitoring of mother and fetus is very important to assure the well being of both. There
are some significant factors which should be considered during this period.
● Assessing decent of head a cyst in detecting the of labour
● Vaginal examination should be performed in frequently as disease compatible with safe practice
● When the Roman arrives in the Latin face the time of admission is zero time
● Urine testing of the mother is done for glucose, proteins and ketones.
● Vitalsigns of the mother area assessed at regular intervals. Pulse rate can be increased during this stage. Increased
metabolism may lead to increase in respiration. During contractions, blood pressure also increases.
● One should look for bladder distention. A distended bladder can cause obstruction in labour. So, the bladder must
emptied every 2-3 hours.Mother may feel tired and exhausted. Her general condition should be monitored to look for signs
of fatigue.
● Gastric emptying is prolonged during this period. So, hydration should be maintained by fluids
SUMMARY
Terminology, onset of labour and clinical picture of labour , stage of labour, event of labour in 1st stage manegement of labour
Nursing care during 1st stage of labour Such as drugs position, pain relief measures, Partograph.
Assignment of pain relief measures and position