Role of nurse in Labour

1. ROLE OF NURSE
IN
LABOUR MANAGEMENT
By,
Ms. P.Beulah,
Msc(N) II year,
OBG dept

2. 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.

3. STAGES OF LABOUR
Labour has been classified
into 4 stages
FOURTH STAGE
THIRD STAGE
SECOND STAGE
FIRST STAGE

5. First stage has 3 Phases
LATENT PHASE
ACTIVE PHASE
TRANSITION PHASE

7. 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.

8. ACTIVE PHASE

9. 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).

10. Transition phase
It is from when the
cervix is from about
8cms until it is fully
dilated.

11. Second stage

12. 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.

13. Third stage
The third stage is
that of separation and
expulsion of placenta
and membranes; it
also involves the
control of bleeding.

14. It lasts from the
birth of the baby
until the placenta
and membranes
have been
expelled

16. FOURTH STAGE

17. Fourth stage
The fourth stage
involved transition
and stabilization and
initial recovery from
child birth normally
lasts 1-4 hours after
birth

18. Principles:-
Non- interference
with watchful
expectancy so as to
prepare the patient
for natural birth.

19. To monitor carefully
the progress of labor,
maternal conditions
and fetal behavior so
as to delete any
intrapartum
complication easily.

20. MANAGEMENT OF
FIRST STAGE

21. Position and
mobility
Woman should be
encouraged to give
birth in the position
they find most
comfortable.

22. The positions
used
In
first stage

23. Semi-sitting

24. Sitting, Leaning Forward with
Support

25. SIDE LYING POSITION

26. Kneeling over chairs

27. Squatting

28. Hands and knees

29. Birthing balls

30. MANAGEMENT OF
SECOND STAGE LABOUR

31. Continuous electronic fetal
monitoring

32. 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 pinard’s
stethoscope or handle
Doppler device is used.

33. If the membranes are ruptured
the liquor amnii is observed to
ensure that it’s 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.

34. 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.

35. Maintain aseptic techniques

36. The mid wife’s 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

37. Prevent infection
Provide physical and
emotional comfort
Anticipate events
Recognize the
development of
abnormalities.

38. MANAGEMENT
OF
SECOND STAGE

39. Birth of head
The perineum
should be swabbed
and a clean pad is
kept under the
women.

40. Encourage mother to control
by gently blowing or sighing
and minimize each breath in
order to minimize active
pushing.

41. CROWNING
As the fetal head and advance and
control it by supporting with one hand
or both

42. 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.

43. SUPPORT OF PERINEUM AND
FETAL HEAD

45. Ensure that the cord is not
around the fetal head.

46. EPISIOTOMY
When the
perineum is
fully stretched
and threatens
to tear
especially in
primi,
episiotomy is
done by
infiltration with
10ml of 1%
lignocanie.

47. Immediately following
delivery of the head,
the mucous and blood
in the mouth and
pharynx are to be
wiped with a sterile
gauze piece.

49. Mechanical or
electrical sucker
may be used. It
prevents the mucus
blocking the air
passage.

50. CLEARING THE AIRWAY

51. The eye lids of are
then wiped with
sterile dry cotton
swabs to minimize
the contamination
of conjunctival sac.

52. The head is grasped
by both hands and
gently drawn
posteriorly until the
anterior shoulder is
released from under
the pubis

54. Birth of shoulders
By drawing the hand,
in upward direction,
the shoulder is
delivered out of the
perineum.

55. 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.

56. Birth of shoulders

57. 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.

58. Delivery of the trunk

59. The cord is clamped and cut
about 5 cm from the
umbilicus

60. MANAGEMENT
OF
THIRD STAGE

62. 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.

63. The third stage includes separation,
descent and expulsion of the placenta
with its membranes.

64. Separation and descent of placenta

65. 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.

66. 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.

67. 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.

68. Deliver the placenta and
membranes by control cord
traction by right hand, and the
left hand is placed on the
suprapubic region, pushing the
uterus upwards.

69. Delivery of the placenta
and membranes

70. An immediate and
through
inspection
of the placenta
and
membranes is
done to
Estimate their
completeness.

71. Immediate new born
care

72. Air passage should be cleared of
mucus and liquor by gentle
suction (mucous sucker).

73. Soon after the delivery of the baby, it
should be placed in a tray covered
with clean dry linen with the head
slightly downwards (15.0).

74. It facilitates
drainage of the
mucus
accumulated in the
tracheo-bronchial
tree by gravity.

75. APGAR rating at 1 minute and 5
minutes to be recorded which
includes, the appearance, pulse,
grimace, activity and respiration.

76. The presence of any
abnormalities of cord is
noted, and then it is
covered with sterile gauze
piece.

77. A quick check is made to detect any
gross abnormality and the baby is
dried and wrapped with a dry warm
towel

78. The identification tape is tied
both to the baby and the
mother.

79. One hour following the
complete delivery of the
baby, the baby should be
fed

80. Management
of
Fourth stage

81. Fourth Stage of Labour
First postpartum hour
Monitor vital signs and
bleeding
Repair lacerations ensure
uterus is contracted (palpate
uterus and monitor uterine
bleeding)

82. A hand is placed over the
funds
◦To recognize the signs of
placental separation
◦To note the state the
uterine activity-Contraction
and relaxation.
◦To detect cupping of funds

83. The uterus is palpated to
assess the degree of
contraction. The fundus
should be firm at the level
of umbilicus or below. The
Perineal pad is observed
for lochia, color, clots and
amount.

84. The pulse, blood
pressure, behavior of
uterus and any
abnormal vaginal
bleedings is to be
watched for 1 hour
after delivery.

85. NURSING MANAGEMENT
OF LABOUR

86. The nurse’s responsibilities during
labour include.
Assessment of all phases of each
stage, providing comfort as indicated
Observe the fetal response every 10
minutes to notify occur once of any
adverse changes.
Document all the findings in
partogram
Position the women.

87. Maintain safe environment
Protect self and others with
universal precautions
Maintain hygiene and administer
drugs as indicated
Monitor the mother throughout
labour
Fill in all records of the birth
and condition of the body.