ROLE OF NURSE IN LABOUR MANAGEMENT By, Ms. P.Beulah, Msc(N) II year, OBG dept
Myles The world health organization defines normal labour as low risk throughout, spontaneous in onset with the foetus presenting by the vertex, culminating in the mother and infant in good condition following birth.
STAGES OF LABOUR Labour has been classified into 4 stages FOURTH STAGE THIRD STAGE SECOND STAGE FIRST STAGE
First stage has 3 Phases LATENT PHASE ACTIVE PHASE TRANSITION PHASE
Cervix dilates from 0cm to 3-4 cm Cervical canal shortens from 3 cm to 0.5 cm long Lasts for about 6-8 hours.
This begins when the cervix is 3-4 cm dilated and in the presence of rhythmic contractions and is complete when the cervix is fully dilated (8-10cm).
Transition phase It is from when the cervix is from about 8cms until it is fully dilated.
Second stage The second stage is that of expulsion of fetus. It begins when the cervix is fully dilated and woman feels to expel the baby. It is complete when the baby is born.
Third stage The third stage is that of separation and expulsion of placenta and membranes; it also involves the control of bleeding.
It lasts from the birth of the baby until the placenta and membranes have been expelled
Fourth stage The fourth stage involved transition and stabilization and initial recovery from child birth normally lasts 1-4 hours after birth
Principles:- Non- interference with watchful expectancy so as to prepare the patient for natural birth.
To monitor carefully the progress of labor, maternal conditions and fetal behavior so as to delete any intrapartum complication easily.
MANAGEMENT OF FIRST STAGE
Position and mobility Woman should be encouraged to give birth in the position they find most comfortable.
The positions used In first stage
Sitting, Leaning Forward with Support
SIDE LYING POSITION
Kneeling over chairs
Hands and knees
MANAGEMENT OF SECOND STAGE LABOUR
Continuous electronic fetal monitoring
The device consists of simultaneous recording of fetal electro-cardiography and uterine contraction by tocography. It is not done in uncomplicated pregnancy where an intermittent auscultation with a pinards stethoscope or handle Doppler device is used.
If the membranes are ruptured the liquor amnii is observed to ensure that its clear. An electronic fetal monitoring indicates features like, Baseline fetal heart rate up to 110-160 b/m. The variability of Fetal Heart Rate. Decelerations and Acceleration of heart rate.
Preparation for birth The room should be kept warm, well lighted with a spotlight. The equipment is kept ready, inducing drugs like uterotonic agents, vitamin k, and oxytocin etc.
Maintain aseptic techniques
The mid wifes skill and judgment are crucial factors in minimizing maternal trauma and ensuring an optimal birth for the mother and baby. The mid wife should observe the progress
Prevent infection Provide physical and emotional comfort Anticipate events Recognize the development of abnormalities.
MANAGEMENT OF SECOND STAGE
Birth of head The perineum should be swabbed and a clean pad is kept under the women.
Encourage mother to control by gently blowing or sighing and minimize each breath in order to minimize active pushing.
CROWNING As the fetal head and advance and control it by supporting with one hand or both
During the delivery of head the mid wife should support the anococcygeal region of the mother with a sterile towel in her right hand and while the left hand exerts pressure on the occiput.
SUPPORT OF PERINEUM AND FETAL HEAD
Ensure that the cord is not around the fetal head.
EPISIOTOMY When the perineum is fully stretched and threatens to tear especially in primi, episiotomy is done by infiltration with 10ml of 1% lignocanie.
Immediately following delivery of the head, the mucous and blood in the mouth and pharynx are to be wiped with a sterile gauze piece.
Mechanical or electrical sucker may be used. It prevents the mucus blocking the air passage.
CLEARING THE AIRWAY
The eye lids of are then wiped with sterile dry cotton swabs to minimize the contamination of conjunctival sac.
The head is grasped by both hands and gently drawn posteriorly until the anterior shoulder is released from under the pubis
Birth of shoulders By drawing the hand, in upward direction, the shoulder is delivered out of the perineum.
Traction on the head should be gentle to avoid excessive stretching of the neck causing injury to the brachial plexus, hematoma of the neck or fracture of the clavicle.
Birth of shoulders
Delivery of the trunk After the delivery of the shoulders, the fore finger of each hand is inserted under the axillae and the trunk is delivered gently by lateral flexion.
Delivery of the trunk
The cord is clamped and cut about 5 cm from the umbilicus
MANAGEMENT OF THIRD STAGE
PRINCIPLES Ensure strict vigilance and to follow the management guidelines in practice to prevent complications. The placental separation and its descent into the vagina are allowed to occur spontaneously. Constant watch is needed; the mother should not be left alone.
The third stage includes separation, descent and expulsion of the placenta with its membranes.
Separation and descent of placenta
Conservative method The left hand is placed over the abdomen to detect Any change in the level of the fundus Sign of placental separation and decent.
The mother is asked to bear down to deliver the placenta spontaneously. Ergometrine 0.5mg or Syntometrine (5 units syntocinon + 0.5mg Ergometrine) to be given intravenouslly.
Active methods Give Methargine 0.5 mg IM or Syntometrine (5units oxytocin+0.5mg Methargine), at the time of the anterior shoulder is free from symphysis pubis or as soon as possible thereafter.
Deliver the placenta and membranes by control cord traction by