The document discusses the nursing management of the first stage of labor. It defines labor as the series of events that expel the products of conception from the uterus through the vagina. It outlines the purposes of labor management as conducting a safe delivery and preventing complications. Nursing care during the first stage includes admission procedures, monitoring vital signs, diet/hydration, ambulation, positioning, and vaginal exams to assess cervical dilation. Non-pharmacological and pharmacological methods for pain management are also discussed. Continuous fetal monitoring and partograph recording are used to assess labor progress and detect abnormalities.

1. Definition-
Series of events that take place in the
genital organs in an effort to expel the
viable products of conception out of the
womb through the vagina into the outer
world is called labour
NURSING MANAGEMENT
OF
FIRST STAGE OF LABOUR
SUBMITTEDBY-
Ms.ITISHA ROSE PRASAD
Nursing tutor
Gov con, kanpur

2. Definition of Labour-
Series of events that take place in the
genital organs in an effort to expel
the viable products of conception out
of the womb through the vagina into
the outer world is called labour.

3. NURSING
MANAGEMENT OF
1st STAGE OF
LABOUR

4. PURPOSES
 To conduct safe and clean delivery
 To provide an adequate help and keep the
mother comfortable
 To prevent maternal and fetal complications.
 To help the mother in giving normal birth to
a healthy and live baby.

5. Conti....
 To maintain normal delivery process with
good guidance, maximum observation with
minimal assistance.
 To identify the deviation from normal and
complications in early and take corrective
measure as necessary.

6. PRINCIPLES
 Non interference with watchful
expectancy so as to prepare the mother
for natural birth
 To monitor carefully the progress of
labour, maternal conditions and fetal
behaviour so as to detect any
intrapartum complications early.

7. NURSING CARE
DURING 1st STAGE
OF LABOUR

8. HOSPITALADMISSION
• Establish rapport with the mother and
significant others.
• Explain all the procedures or routines which
will be carried out prior to performing them
• Orient the patient to the surrounding.
• Intiate the patients labour chart

9.  Review the information obtained in the exam room-
1.Obstetric history-
◦ Gravida/para
◦ Estimated day of confinement
◦ Duration of previous labour
◦ Problems with previous pregnancies/deliviers
2.General Condition-
 Rh status
 Allergies
 History of medical problems.

10. 3.Current Pregnancy-
 Onset of labour
 Frequency,duration,intensity of duration
 Membranes- ruptured or intact
 Amount and characteristics of show or
vaginal bleeding or vital signs
 Rate and location of fetal heart tones
 Any problems with this pregnancy

11. 4.Evaluate the current emotional status
5.Evaluate the preparation for labour through classes.
6.Evaluate for possible danger signs-
Increased pulse rate or temperature
Excessive vaginal bleeding
•Presence of meconium in the amniotic fluid of the
mother

12. Change in the character of uterine
contractions.
7.Perform the admission physicians orders.

13. BOWEL
According to WHO guidelines, ENEMA SHOULD
NOT BE ADMINISTERED DURING 1st Stage of
Labour.
•The patient must be evaluated if she recently has
had a recent bowel movement.

14. PERINEAL PREPARATION
(Part Preparation)
• There is no evidence to support the routine
procedure of perineal shave however the main
purpose of it is to prevent infection.
• Preparation of the perineum involving trimming,
clipping and cleaning provides for the easy viewing
of the perineum.

15. BLADDER
•The bladder should be emptied at least 4 hourly
or more frequently if it is palpable abdominally.
•Patient is encouraged to pass urine by herself as
full bladder sometimes inhibits uterine
contractions and may lead to infection.
•Bed pan is provided if needed.

16. •Privacy must be maintained and comfort must
be ensured.
•Full bladder may increase the pain, reduce
efficiency of uterine contractions, and delay
descent of the presenting part.

17.  In case of full bladder,
K 90 catheter can be
used to empty the
bladder.
K 90 CATHETAR

18. REST AND AMBULATION
• The woman should be free to walk or sit in a chair
• If the membranes are intact or ruptured, patients are
allowed to walk about.
 Ambulation can reduce the duration of labour, need
of analgesia and improve the maternal comfort

19. •Ambulation should not be allowed in case of –
 When the fetus is either small, in a footling
or ill fitting breech presentation or transverse
lie
 During rapidly progressive labour or late
first stage labour in multiparas.
 Any obstetric or medical complication
requiring the mother to be on bed.

20. POSITION
◦ A woman should assume a position that is
comfortable for her.
◦ If the membranes have ruptured and the fetus
presents problems such as transverse lie,
breech presentation or small size then the
position to be taken are –
◦ Upright, side lateral, Sitting, Semi-fowlers.

21. POSITION ON CHAIR
BIRTHING BALL

23. DIET
• There is delayed emptying of bowel in labour.
• Solid food is withheld during labour
• The best fluids for the mother to have are clear
liquids to which sugar has been added.
• Fluids (energy boosters) in the form of plain
water, ice chips or fruit juice, may be given in
the early labour.

24. DIET
 Other fluids like-
tea, coffee, jaggery water, ginger tea, basil tea,
kadha with kali mirchi, long and other.

25. INTRVENOUS INFUSION
◦An IV infusion is done in any of the following
conditions-
 A pitocin induction or augmentation.
 Maternal dehydration or exhaustion.
 Any life threatening obstetric condition like
abruption placenta, placenta previa etc.

26. INTRVENOUS INFUSION
 The usual IV solution for a woman in labour consist
of
 5% dextrose in water (D5W) :
in case of exhaustion.
 Or Ringers lactate (RL)
 D5W or NS should not be given in case diabetes
mellitus or hypertension.

27. PHARMACOLOGICAL
METHOD
 The common drug used is
INJ. BUSCOPAN
(antispasmodic) 20 mg/
ml IM, IV, subcutaneous.
 Also available as tablet 10
mg given orally.
 It is used to accelerate
labour, to reduce labour
pains, GI spasm,
Genitourinary spasm.

28.  INJ. DROTAVERINE
(anti-spasmodic) 40
mg in a 2 ml ampoule
IM, IV, given as TDS.
 It is used to relieve
smooth muscle spasm,
pain reduces the
duration of active phase
of labour by hastening
cervical dilation.

29.  INJ. EPIDOSIN(anti-
spasmodic) 4-8 mg. (each 1
ml ampoule contains 8 mg)
IM, IV.
 for oral use it is 10-20 mg
given 8-12 hours in a day.
 It is used for cervical dilatation
during 1st stage and as a
smooth muscle relaxant.

30.  INJ. Betamethasone
(glucocorticoid)
 IM- 12 mg every 12
hours* 2. It is given to
prevent respiratory distress
syndrome in preterm
infants by injecting
mothers prior to delivery to
stimulate surfactant
production in fetal lungs.

31.  CERVIPRIME GEL-
 Available as (0.5 Mg in
2.5 ml prefilled syringe)
 it is inserted into cervical
canal for pre induction
cervical softening and
dilatation in patients
with poor bishops score.

32.  The common analgesic
drug used is Pethidine
50-100 mg IM. It crosses
the placenta and is a
respiratory depressant for
the neonate.

33.  Metoclopramide 10 mg IM is commonly given
to combat vomiting due to pethidine.
 Drugs should not be given if delivery is
anticipated in 2 hours.

34. NON PHARMACOLOGICAL METHODS

35. MASSAGE

36. HYDROTHERAPY

37. HEAT/COLD PACKS

38. POSITION CHANGES

39. ELEVATION OF THE LEGS

40. ACCUPRESSURE POINTS
 Urinary Bladder 60- it
is located on the foot,
in the dint between the
tip of the external
malleolus and tendo
calcaneus helpful in
relieving heel pain
during labour.

41. ACCUPRESSURE POINTS
 Bladder 48-
 B48 is one of the vital
pressure points for
labour that is located
three chons to the side
of the sacrum, in the
middle of the gluteal
muscle of the
buttocks.

42. ACCUPRESSURE POINTS
 LI4-
 Located on the fleshy
webbing between the
thumb and the index
finger

43. ACCUPRESSURE POINTS
 Sp6-

44. CONTINOUS ELECTRONIC
FETAL MONITORING
 Fetal monitoring is done
to detect the presence of
fetal life at the time of
admission and to detect
the development of fetal
distress during labour. A
fetoscope or fetal
monitor is used to obtain
FHR.

45. VAGINAL EXAMINATION
• Dilatation of cervix in centimetres in relation to
the hours of labour is a reliable index to note the
progress of labour.

46. VAGINAL EXAMINATION
 The following things are noted in Per vaginal
examination-
 Cervical dilatation
Station of the fetal head
Colour of the liquor
Degree of moulding

47. Conti...
 To note the dilatation of cervix in centimeters.

48. • To note the station of
head ( degree of
descent) in relation to
ishial spines.

50. • Colour of the liquor (clear or meconium
stained) if the membranes are ruptured.
• Degree of the moulding of the head-
moulding occurs first at the junction of
ocipitoparietal bones and then between the
parietal bones.

51. ASSESMENT OF PROGRESS OF LABOUR
AND PARTOGRAPH RECORDING-
 Monitor the vital signs-
On admission
Every hour during early labour
Pulse is recorded every 30 minutes
Blood Pressure is recorded every 1 hour
Temperature is recorded every 2 hours.
 Urine output is recorded for volume, acetone or
protein.
 Any drug given is recorded on the partograph.

52. PARTOGRAPH
 Partograph is a
composite graphical
record of key data
(maternal and fetal)
during labour, entered
against time on the
sheet of paper.

53. PURPOSE
 To detect the abnormal progress of labour as
early as possible.
 To prevent prolonged labour
 To recognize cephalopelvic disproportion
before obstructed labour
 To assist in early decision on transfer, induction
augmentation or termination of labour.

54. Patient identification
Assessment of fetal
conditions
Progress of labour
Assesment of Maternal
Conditions
Outcome of Labour

56. IDENTIFICATION DATA

57. ASSESSMENT OF FETAL CONDITIONS-
Fetal Heart Rate-
 FHR along with its frequency and intensity
should be noted every 30 min in first stage.
 The observation should be made immediately
following uterine contractions.
 The count should be made for 60 seconds.
 Normal fetal heart rate ranges from 110 to
150 beats per minute.

59.  Membranes and liquor- plotting of the membranes
and liquor is as follows-
Intact membranes – I
Ruptured membranes- + Clear liquor C
Ruptured Membranes- + meconium stained M
Ruptured membranes- + Blood stained liquor B
Ruptured Membranes- + Absent liquor A

61. Moulding of the fetal skull- It is plotted as
follows-
 Separated bones, sutures felt easily – 0
 Bones just touching each other- +
 Overlapping bones- ++
 Severly overlapping bones- +++

63. PROGRESS OF LABOUR
Cervical Dilatation-
 The dilatation is plotted with the 0 time on the
graph and further examinations are made at least
every 4 hours,
 It is divided into two phases-
 Latent Phase
 Active Phase

64. Latent Phase-
Dilatation up to 5 cm at the rate of 1 cm/ hour in
primigravida and 1.5 cm/hour in multipara.
Normally, no. of contractions is 5 every 10 min.
Contractions occur at least twice every 10
minutes with each lasting > 20 seconds.

65. Active Phase-
Cervix should dilate at a rate of 1 cm/hour or
faster.
Contractions occur at least three times every
10 minutes each lasting > 40 seconds.

66. Alert line (Health facility Line)-
 The alert line drawn from 3 cm to 10 cm dilatation
represents the rate of dilatation of 1 cm/hour. Moving
to the right of the alert line means the patient should
be referred to the hospital
 When the progress of labour is normal and
satisfactory, plotting of cervical dilatation remains on
the alert line or to the left of it.

67. Action Line-
 The action line is drawn 4 hours to the right
of the alert line and parallel to it.
 This is the critical line at which specific
management decisions must be at the higher
level of health care facility.

69. ◦ Uterine contactions-
 The number of contractions in 10 minutes and
duration of each contraction in seconds are
recorded in the partograph.
 Partograph is charted for every 30 minutes as-
Mild- contractions duration less than 20
seconds
Moderate- contractions between 20 and 40
seconds
Strong- Contractions more than 40 seconds

70. ◦ Uterine contactions-
 Contractions in 10 min.-
contraction < 20 sec.
Contraction < 40 sec
Contraction > 40 sec.

72. ASSESSMENT OF MATERNAL
CONDITIONS
◦ Assess maternal condition regularly by
monitoring
◦ Drugs, IV fluids
◦ Pulse, Blood Pressure.
◦ Temperature
◦ Urine volume, analysis for protein and
acetone.