OBJECTIVES: At the end of the lecture the students will: Know the routines and SOPs of the different

t affiliated hospitals and birthing centers. Know their responsibilities during labour. Assess patients needs during each phase of the first stage. Recognize any abnormal manifestations and refer. Able to give proper health teaching to patients and folks.

LABOR WATCH

 LABOUR is described as the process by which the

fetus, placenta and membranes are expelled through the birth canal. NORMAL LABOUR occurs at term and is spontaneous in onset with the fetus presenting by the vertex. The process is completed within 18 hours and no complications arise.

THREE STAGES OF LABOUR

FIRST STAGE: (Cervical Stage) The period from the

onset of true labour contractions until full cervical dilatation and effacement is achieved. Two important events take place during the first stage : cervical dilatation and effacement.

 Cervical effacement/Obliteration/Taking up. It refers to the

shortening of the cervical canal from a length of about 1 to 2 cm until it is paper thin. In primis, dilatation begins when the cervix is completely effaced. In multis, dilatation and effacement takes place at the same time. Effacement is expressed in percentage. Cervical dilatation refers to the enlargement or widening the cervical canal. Uterine contraction causes dilatation by pulling the cervix over the presenting part, called the Ferguson Reflex. The BOW and the fetal head also act as a wedge in dilating the cervix. It will be noted that there is increased amount of show as dilatation is completed since the last of blood tinged operculum is dislodged. Dilatation is expressed in centimeters.

 SECOND STAGE: (Expulsive Stage)This occurs

from full cervical dilatation until the birth of the baby. The main event of this period is the birth of the baby. THIRD STAGE: (Placental Stage). This is the period from delivery of the baby to the expulsion of the placenta. FOURTH STAGE: (Immediate Postpartum Period). The period from delivery of placenta until the condition of the woman has stabilized.

THREE PHASES OF FIRST STAGE OF LABOUR

Early Active Transition

PHASES OF FIRST STAGE OF LABOUR Early Active Transition

CERVICAL DILATATION 0-3 cm 4-7 cm 8-10 cm

INTERVAL

DURATION

TIME FRAME

5-30 Mins. 3-5 Mins. 2-5 Mins.

30-50 Seconds 60 Seconds 60 - 90 Seconds

12-24 Hours 4 12 Hours 10mins. -1 Hr.

I. EARLY FIRST STAGE LABOUR

PHYSICAL SIGNS (Early First Stage Labour)

Bloody show Cramping Pressure tightening Loose stools

Backache Flu Resting Contractions

EMOTIONAL SIGNS (Early First Stage Labour)

Restless

In control
Confident Fear

MANAGEMENT (What to do?)

Distracting Sleep Eat/Drink Rest Walk Watch T.V./Read Shop/Run Errands

II. ACTIVE FIRST STAGE LABOR

Physical Signs (Active First Stage Labour)

Contractions demand full attention Retreat in wards Irritable Walk become slow Leg pains Water might break Less aware of surroundings Bleed more Nauseated Backache

Emotional Signs (Active First Stage Labour)

Serious Full Attention Tired Discouraged Losing confidence

MANAGEMENT (What to do?)

Manage Pain: Relax Breath Rock Visualization Music Massage Groan
Dim lights Shower

Freedom of movement
Hot/cold packs Conserve Energy

Let Labour Take over

Change positions

Positions for Labour

Upright Position: gravity can help encourage the baby

to move down into mothers pelvis and to keep her as active as possible.

 Squatting encourages baby to descend quickly and

makes pushing easier. Kneeling(on something soft supported by birth partner) and; Leaning/Resting your hand (on birthing ball or bed) can help stretch your pelvic ligament or the slight rocking movement back and forward may help to ease pain.

 Standing and standing with bended knees, gravity will

help baby move downward Sitting Upright is the best position if youve been standing for long time and feel tired or if you had an epidural and want to remain upright and have limited movement. Lying on the side if you had an epidural or if the baby is coming too quickly, this position can slow things down.

III. TRANSITION PHASE OF EARLY STAGE OF LABOUR

PHYSICAL SIGNS :
(Transition Phase of First Stage Labour)
Shaking Sweating Rectal pressure/urge to push Tremble

Nausea
Vomiting Groaning

Loss of modesty
Unpleasable Hot/cold

Backache

EMOTIONAL SIGNS : (Transition Phase of Stage Labour)

Cant take it anymore Cant go on Overwhelmed Confused Out of control

MANAGEMENT (What to do?)

Support Squat/Kneel/Lean

Comfort Measures
Open up/ Release

Students Responsibilities

Students Responsibilities Handle:

Prepare the instruments needed or open pack

Primi Set G1-G2 -2 forceps 1 bandage scissors 1 needle holder 1 suture scissors Multi Set G3 and above - 2 forceps 1 bandage scissors

 Don gloves
Drape the patient after perineal prep has been done Arrange the instruments

Fill the syringe with anesthesia

Open the suture and cut 1/3 by 2/3 or per doctors

preference

Assist:
Position patient at D.R. table.

Adjust light
Provide O.S., syringe, xylocaine 2%, rubber ear syringe

and suture to the sterile pack. Provide D.R. chair to the doctor if needed. Check and regulate IVF. Check FHB and BP Provide the needs of Handle Record the time of birth and the delivery of placenta.

Circulating:
Adjust Kelly pad when needed.

Remove O.B. Pad/ Adult Diaper

Do perineal preparation aseptically Gather relevant information from the patient.

Prepare I.D. band for the baby.

Work and provide the needs of baby care Record the time of baby out together with the assisting

nurse.

Baby Care:
Prepare the crib or Basinet

Open light/ Heat lamp

Check suction machine and attached suction tip (NGT

F8) Gather needed materials from folks e.g. baby dress, wrap, diaper and adult diaper for the mother. Don gloves Stand at the side of the patient while holding 1 sterile O.S. Observe the time of baby out.

Students responsibilities as soon as the baby is out: Baby Care:

While holding one of the babys legs, wipe the nose

and mouth. Wipe also the body with the sterile towel provided. Suction with rubber syringe when needed. Once pulsation stops, clamp the umbilical cord 2cm from the base. Cut. Remove the first towel and initiate Skin to Skin contact of the baby with the mother. Cover the babys head (bonnet) and body with a clean baby wrap. Place I.D. band; 1 at the left leg and 1 at the right wrist.

 Observe until the baby is able to hold and suck

correctly at the mothers breasts. Inject Vitamin K at the left vastus lateralis and Hepa B vaccine at the right vastus lateralis. Measure head, chest, abdominal circumference and length of the baby. Check weight and temperature by anal route. Apply ophthalmic ointment from inner to outer canthus.

Handle:
Offer 2 forceps to the doctor one at a time, then

bandage scissors. Wait until the placenta is delivered. In delivering the placenta: *Wait for the signs of placental separation, before pulling the cord. Assist the doctor while doing episiorrhaphy. Do final perineal cleaning and flushing. Transfer the patient out of D.R. via stretcher after adult diaper has been fixed.

Assist:
Inject Oxytocin 10 units I.M. to the mother. Check BP after the placenta is out.

Check for uterine contraction

Apply ice pack per doctors order.

Circulating:
Help in the cleaning and transferring out of patient. Maintain the tidiness and cleanliness of the unit.

Thank you!!!