Labor – First Stage
Management
Dr. S. Kalavathi
Professor
RMCON, AU.
Introduction
Labor is a unique experience in women’s life
Labor events have got great psychological, emotional
and social impact to the woman and her family
By utilizing the knowledge of physiological changes
during pregnancy, we can give appropriate care to the
mothers in labor
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General Considerations
Labor pain is real . Mother experiences pain, stress
and fear of unknown/danger
Mother is sensitive. Caregivers need to be tactful,
sensitive and respect her
Mother can choose her birth companion
Continuous emotional support can reduce the need
for analgesia & operative delivery
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General Considerations [Cont..]
Privacy must be maintained
Keep her informed and explain her
Provide environment to her so that she can give birth
with dignity
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Aims of management of Normal Labor
Maximal observation with minimal active intervention
To maintain normalcy and to detect any deviation
from normal at the earliest possible moment
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Admission of the Mother
Quick assessment
Care according to the stage of labour
Make her feel comfortable by reassurance and
welcome attitude
Admission bath
Dress, Jewels, nailpolish, artificial dentures, lenses
etc
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Antisepsis & Asepsis
Strict asepsis and antisepsis should be maintained
Shaving or hair clipping of the vulva
Shower or bath & wear laundered gown
Perineal care
Strict aseptic technique precautions to be taken
during vaginal examinations and during conduction of
delivery
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Vaginal examinations in labor
Vaginal examination is done on admission by a senior
doctor -to confirm the onset of labor, to confirm the
presenting part & its position & Pelvic adequacy
(Primi)
This findings serve as a baseline data
Frequent PV should be avoided
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Vaginal examinations in labor [Cont..]
Even if the proper aseptic techniques are followed
there is chance of introducing the infection, specially
after the rupture of membranes
It can be done every 4 hourly in normal labor to
assess the progress of labor
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Vaginal examinations in labor [Cont..]
Indications
At the onset of labor
Repeated at 3 to 4 hourly
Following rupture of membranes to exclude cord
prolapse
To confirm the onset of second stage of labor
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Management of First Stage
Principles
Noninterference 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 detect any
intrapartum complication early
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Management of First Stage
General Care
Admission of the mother
Confirm the stage in which she is – care accordingly
Reassure & welcome her
Constant supervision
Avoid supine position in bed to avoid vena caval
congestion
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Management of First Stage
Bowel Care
Traditionally an enema with soap and water or glycerine
suppository is given early in labor
Enema reduce the load in the rectum & contamination in
second stage
Studies have proved that enema does not shortens the 2 nd
stage or the rate of infection
Giving enema – Follow the Institution Policy
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Management of First Stage [Cont..]
Rest and Ambulation
Mother can be ambulated in first stage if
The membranes are intact
Not given any analgesia
Ambulation can reduce the duration of labor and
the need of analgesis & improve the maternal
comfort
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Management of First Stage [Cont..]
Diet
Emptying of the stomach is delayed in labor
Gastric content pH is low
Fluids (Juices, water) may be given in early labor
Intravenous infusion may be started where any intervention
is anticipated or patient is under regional anesthesia
Food is withheld in active labor
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Management of First Stage [Cont..]
Bladder Care
Encourage her to empty the bladder by herself frequently
[Full bladder inhibits uterine contractions and may lead to
infection]
If women can not go to the toilet, bedpan to be provided
Maintain privacy
If fails to urinate on her own, catheterize following aseptic
precautions
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Management of First Stage [Cont..]
Relief of Pain
Pain relief is an important aspect in care of mother in
labour
Pain relief can be achieved by either Pharmacological or
Non Pharmacological methods (Will be taken as a separate
topic)
Proper explanation, reassurance, relaxation, back massage
etc. are useful in relief of pain
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Management of First Stage [Cont..]
Relief of Pain (Cont..)
Common analgesic drug used is Pethidine 50 to 100mg IM –
in well established labour
Can be repeated after 4 hours
Pethidine crosses the placenta, causes respiratory depression
to the neonates
Pethidine should not be given if delivery is anticipated
within 2 hours .
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Management of First Stage [Cont..]
Observation
Maintain partograph
Maternal Vitals – Pulse, Respiration, BP, Temperature
Observe the tongue periodically for hydration
Foetal wellbeing – FHR
Uterine contractions – duration & interval
Urine output
Descend of presenting part – by abdominal palpation, pelvic grip, PV
examination & shifting of maximal intensity of FHS
Management of First Stage [Cont..]
Assessment of Fetal Wellbeing
Check the FHR – Rate, rhythm, and intensity
Counted every half an hour in early labour ; Every 15 minutes in late
labour; and every 5 minutes in second stage of labour
Count FHR for full 1 minute; The observation immediately following
uterine contractions is valuable
Normal FRH – 110 to 160 beats per minute
Continuous Electronic Fetal Monitoring –
is done in high risk pregnancies
Clinical Fetal Monitoring
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Clinical Fetal Monitoring
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Management of First Stage [Cont..]
Assessment of Progress of Labor
Pain – duration and interval. As the labour advances, the
duration increases and the interval decreases
Station of the head – can be assessed by abdominal
palpation & PV examination
Cervical dilatation & effacement. After latent phase, in
Primi – 1 cm/hour & in Multi – 1.5 cm/hour is the rate of
dilatation.
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Management of First Stage [Cont..]
Preperation for Second Stage of Labor
The mother may be anxious of labour, because of pain
and fear of unknown, Fear of outcome of labour etc.
Physical Preperation of the mother
Psychological preparation of the mother
Preperation of delivery tray, resuscitation tray etc.
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Evidence of Maternal Distress
Anxious look with sunken eyes
Rising pulse rate of 100 per minute or more
Dehydration, dry tongue
Hot, dry vagina often with offensive discharge
Acetone smell in breath
Scanty high colored urine with presence of acetone
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Summary & Conclusion
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Thank You…
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