[35] Management of Labour Flashcards
What is the primary aim of intrapartum care?
To deliver a healthy baby to a healthy mother
When does the preparation of the mother for the process of parturition begin?
Well before the onset of labour
What is it important for the mother and her partner to understand regarding labour?
What happens during the various stages of labour
How should the mother be prepared for labour during antenatal classes?
Should be introduced to strategies for dealing with pain in labour, including mental preparation with controlled respiration
How can antenatal classes help the mother with life with a baby?
Should include instructions about neonatal care and breastfeeding
When should the mother be advised to come to hospital (or call the midwife in the event of a home birth) with labour?
- Contractions are at regular 10-15 minute intervals
- When there is show
- Membranes rupture
What should the mother be encouraged to do if she is in early labour?
Take a shower and empty her bowels and bladder
What should be done on admission of women in labour?
Examination
What should be included in the examination at the start of labour?
- Full general examination
- Obstetric examination of the abdomen
- Vaginal examination
What should be included in full general examination at the start of labour?
- Temperature
- Pulse
- RR
- BP
- State of dehydration
- Urine testing
What should the urine be tested for at the start of labour?
- Glucose
- Ketones
- Protein
What should be included in obstetric examination of the abdomen at the start of labour?
- Inspection
- Palpation
- Auscultation of fetal heartbeat
What should be palpated in the abdominal examination at start of labour?
- Fetal lie
- Presentation
- Position
- Station of presenting part
How can the fetal heartbeat be auscultated at the start of labour?
Using stethoscope or Doptone device
How can infection be prevented when doing the vaginal examination at the beginning of labour?
- Clean vagina and introitus before starting
- Use aseptic technique, using sterile gloves and antiseptic cream
- Once examination has started, fingers should not be withdrawn from vagina until examination is complete
What factors need to be noted at the examination at the beginning of labour?
- Cervical factors
- Membrane factors
- Fetal factors
What should be noted about the cervix from the examination at the start of labour?
- Position
- Consistency
- Effacement
- Dilatation of cervix
What should be noted about the membranes from the examination at the start of labour?
If they are in tact or ruptured, and if ruptured, the colour and quantity of amniotic fluid
What should be noted about the fetus from the examination at the start of labour?
- Presentation
- Position of presenting part
- Relationship of presenting part to level of ischial spines
What are the guiding principles of the management of first stage of labour?
- Observation of the progress of labour, and intervention if its slow
- Monitoring of fetal and maternal condition
- Pain relief during labour and emotional support for the mother
- Adequate hydration and nutrition throughout labour
How is observation of the progress of labour done?
Using the partogram
How is monitoring of the fetal and maternal condition done?
Partogram
What needs to be balanced when considering hydration and nutrition throughout labour?
The risk of needing a C-section vs providing hydration and nutrition
What should be done when there is a likelihood that the mother will need operative delivery under general anaesthesia?
Avoid oral intake of a significant level during the first stage of labour
