Labor Watch

8/3/2019 Labor Watch

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LABOR WATCHOBJECTIVES:At the end of the lecture the students will:

Know the routines and SOPs of the different affiliatedhospitals and birthing centers.

Know their responsibilities during labour.

Assess patients needs during each phase of the firststage.

Recognize any abnormal manifestations and refer. Able to give proper health teaching to patients and

folks.


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LABOUR is described as the process by which thefetus, placenta and membranes are expelled throughthe birth canal.

NORMAL LABOUR occurs at term and is spontaneousin onset with the fetus presenting by the vertex. Theprocess is completed within 18 hours and no

complications arise.


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THREE STAGES OF LABOUR

FIRST STAGE: (Cervical Stage) The period from the

onset of true labour contractions until full cervicaldilatation and effacement is achieved. Two importantevents take place during the first stage : cervicaldilatation and effacement.


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Cervical effacement/Obliteration/Taking up. It refers to theshortening of the cervical canal from a length of about 1 to2 cm until it is paper thin. In primis, dilatation begins

when the cervix is completely effaced. In multis, dilatationand effacement takes place at the same time. Effacement isexpressed in percentage.

Cervical dilatation refers to the enlargement or wideningthe cervical canal. Uterine contraction causes dilatation bypulling the cervix over the presenting part, called the

Ferguson Reflex. The BOW and the fetal head also act as awedge in dilating the cervix. It will be noted that there isincreased amount of show as dilatation is completed sincethe last of blood tinged operculum is dislodged. Dilatationis expressed in centimeters.


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SECOND STAGE: (Expulsive Stage)This occursfrom full cervical dilatation until the birth ofthe baby. The main event of thisperiod is the birth of the baby.

THIRD STAGE: (Placental Stage). This is the periodfrom delivery of the baby to the expulsion of theplacenta.

FOURTH STAGE: (Immediate Postpartum Period).

The period from delivery of placenta until thecondition of the woman has stabilized.


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THREE PHASES OF FIRST STAGE OF LABOUR

Early

Active

Transition


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PHASES OF

FIRST STAGE

OF LABOUR

CERVICAL

DILATATION

INTERVAL DURATION TIME FRAME

Early 0-3 cm 5-30 Mins. 30-50 Seconds 12-24 Hours

Active 4-7 cm 3-5 Mins. 60 Seconds 4 12 Hours

Transition 8-10 cm 2-5 Mins. 60 - 90Seconds

10mins. -1 Hr.


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I. EARLY FIRST STAGE LABOUR


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PHYSICAL SIGNS (Early First Stage Labour)

Bloody show

Cramping

Pressure tightening

Loose stools

Backache

Flu

Resting

Contractions


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EMOTIONAL SIGNS (Early First Stage Labour)

Restless In control

Confident

Fear


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MANAGEMENT (What to do?)

Distracting

Sleep

Eat/Drink

Rest

Walk

Watch T.V./Read

Shop/Run Errands


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II. ACTIVE FIRST STAGE LABOR


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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


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Emotional Signs (Active First Stage Labour)

Serious

Full Attention

Tired

Discouraged

Losing confidence


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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


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Positions for Labour

Upright Position: gravity can help encourage the baby

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


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Squatting encourages baby to descend quickly andmakes pushing easier.

Kneeling(on something soft supported by birthpartner) 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 easepain.


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Standing and standing with bended knees, gravity willhelp baby move downward

Sitting Upright is the best position if youve beenstanding for long time and feel tired or if you had anepidural and want to remain upright and have limitedmovement.

Lying on the side if you had an epidural or if the babyis coming too quickly, this position can slow things

down.


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III. TRANSITION PHASE OF EARLY STAGE OFLABOUR


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PHYSICAL SIGNS :(Transition Phase of First Stage Labour)

Shaking

Sweating Nausea

Vomiting

Groaning Backache

Rectal pressure/urge to push

Tremble Loss of modesty

Unpleasable

Hot/cold


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EMOTIONAL SIGNS :

(Transition Phase of Stage Labour)

Cant take it anymore

Cant go on

Overwhelmed

Confused

Out of control


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MANAGEMENT (What to do?)

Support

Squat/Kneel/Lean Comfort Measures

Open up/ Release


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Students Responsibilities


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Students ResponsibilitiesHandle:

Prepare the instruments needed or open pack

Primi Set G1-G2 -2 forceps1 bandage scissors

1 needle holder

1 suture scissors

Multi Set G3 and above - 2 forceps1 bandage scissors


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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 doctorspreference


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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.


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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 assistingnurse.


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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 sterileO.S.

Observe the time of baby out.


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Students responsibilities

as soon as the baby is out:Baby Care:

While holding one of the babys legs, wipe the noseand mouth. Wipe also the body with the sterile towelprovided. Suction with rubber syringe when needed.

Once pulsation stops, clamp the umbilical cord 2cmfrom the base. Cut.

Remove the first towel and initiate Skin to Skin contactof the baby with the mother.

Cover the babys head (bonnet) and body with a cleanbaby wrap.

Place I.D. band; 1 at the left leg and 1 at the right wrist.


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Observe until the baby is able to hold and suckcorrectly 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 outercanthus.


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Handle:

Offer 2 forceps to the doctor one at a time, thenbandage scissors.

Wait until the placenta is delivered.

In delivering the placenta:

*Wait for the signs of placental separation, beforepulling 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.


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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.


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Circulating:

Help in the cleaning and transferring out of patient.

Maintain the tidiness and cleanliness of the unit.


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Thank you!!!

Documents

Labor Watch