This File Explain more about Admission of woman in Labor and it's Management, this is very useful in Labor Ward and other people who like reading information

1. ADMISSION OF A
WOMAN IN LABOUR

2. Broad objectives
•To equip nurse midwives with knowledge, skills
and appropriate attitude during the admission of a
woman in labour.

3. SPECIFIC OBJECTIVES
1. Describe relevant history to be obtained
from a woman in labour, during admission.
2. Explain the physical examination to be
conducted during the admission of a woman
in labour
3. Describe the interpretation of the
information gathered on history taking and
physical exam of a woman in labour.

4. INTRODUCTION
•Labour refers to the normal physiological process
by which the fetus, placenta and membranes are
expelled through the birth canal.
•Traditionally, labour is considered a continuous
process that ranges from first, second and third
stages and can also be described as latent, active
and transitional phases

5. INTRODUCTION
• Despite labour being a normal physiological
process, birth is probably one of the most
dangerous event in the life of every person and
giving birth is extremely hazardous to the woman
in labour.
• It is therefore very important for a midwife to be
skilled, smiling, friendly and understanding when
welcoming and admitting the woman in labour.

6. HISTORY TAKING
•Welcome client
•Greet, offer a seat or allow the client to lie on a
couch if in severe pain
•Introduce self; instructors and your roles
•Do rapid assessment to rule out danger signs like;
per vaginal bleeding,
draining of liqour,
severe headache
Convulsions
Blurred vision, dizziness, severe oedema etc

7. •Review the health passport book and check on the
following
•Validate personal particulars like; name, age,
address, NOK
•Past Obstetric history; parity, past pregnancy
problems
•Present; gravidity, LMP and EDD
•Surgical history; previous C/ S scar, uterine
surgeries or other genital surgeries
•Past medical history; HTN, DM, Epilepsy, Asthma
etc

8. History taking
•Take personal particulars e.g.
- Name for identification
- Address for follow up and cultural practices in
her area.
- Next of kin for support and donating of blood if
need be
- Age helps to assess the risks associated with early
pregnancy or grandmultiparity
•Gravidity and parity to assess the risks e.g. PPH in
multiparas
•Chief complaint, onset of labour, hx of contractions,
show

9. History taking ct…
•LMP and Gestation will help to know if its
preterm/term/post term fetus.
•Past pregnancy problems helps to determine past
experiences of the woman thereby allaying present
anxiety
•Past & present medical; obstetric & gynae hx to
rule out risk factors.
•Social economic; family; Past surgical hx
• Noting time of admission in labour helps to assess
duration of labour and guide in critical decision.

10. History taking cont ….
• Knowing whether labour was induced or
spontaneously helps to determine the type of
labour that she will have and the well being of the
fetus and the uterus.
• NB Induced labour is dangerous because it can
cause ruptured uterus and fetal distress.
• Onset of labour (regular, painful contraction)- it
will help to determine if labour is progressing and
if it is prolonged.
• Membranes ruptured will help to determine if the
woman is in true labour or not and to determine
the risk for cord prolapse and infections

11. History taking ct…
• History of food taken helps to know if she has
eaten since she will need energy for labour, her
uterus also needs energy for contractions.
• Sleep: if she did not sleep the woman will be
tired and helps the midwife anticipate difficult
labour.
• Home made medication:
• Any abnormal experiences like reduced or lack of
fetal movements

12. History taking ct…
•If it's a referral: indicate time the woman was
referred from the place of referral and time of
arrival for legal purposes.
•If you are the one referring, indicate time for
referral and time the ambulance came to pick the
woman.
•Do lab investigations like HB, proteinuria if
necessary

13. PHYSICAL EXAMINATION
•NB Examination should be thorough and accurate
and the information should be carefully recorded.
•The midwife should explain carefully all the
procedures to the woman
•The midwife should always tell the truth
•Ensure privacy all the time and ensure adequate
covering
•Throughout the admission of a woman in labour,
cleanliness and strict aseptic measures must be
observed.

14. OBSERVATIONS OF GENERAL
APPEARANCE
•Observe the woman's physical and psychological,
status: height, gait, size of the feet, pendulous
abdomen, physical health, sweating, hydration, and
nutrition status, signs of anaemia, oedema, anxiety,
distressed etc
•Anaemia - causes weak contractions, bleeding.
•Oedema and its location gives alert to
preeclampsia.
•Height has an effect on the pelvis of the mother ie
women with height of less than 150cm are
considered at risk of small pelvis

15. PHYSICAL EXAMINATION
•NB Encourage the woman to empty the bladder
before starting the examination; Full bladder
interferes with uterine contractions and descent of
the presenting part
•In addition full bladder may cause severe bleeding
after delivery
•NB if the woman can not void on her own due to
pressure of the fetal head the midwife should
catheterize the urinary bladder to drain the urine

16. PHYSICAL EXAMINATION
•Do the general physical examination:
Check vital signs ;(Temperature, pulse,
respirations and blood pressure, weight) record and
interpret the findings
Perform Head to toe examination
Do laboratory investigations when necessary.

17. PHYSICAL EXAMINATION CT…
Inspection: size, shape, any scars, linear nigra, striae
gravidarum, bladder distention, fetal movements .
Palpation:
•Fundal height in relation to gestation by dates use
tape measure & finger breadths; liver and spleen
•Pelvic palpation to determine the presentation:
what is lying in the pelvic e.g. cephalic (favourable)
or buttocks (breech).
•Descent; This is how much of the head has gone
into the pelvis

18. Abdominal Examination ct..
If head palpable abdominally, is 5/5. (floating)
Lateral palpation is done to determine lie (either
longitudinal or transverse) and Position of the fetus:
anterior or posterior position
•Fundal palpation: to rule out another fetal head i.e in
twin pregnancy

19. Abdominal examination ct…
•Assess the uterine contractions for frequency,
duration & strength
•NB Contractions are timed in 10 minutes and may
be categorized as mild, moderate or severe basing
on duration
•Auscultaion: Fetal heart- record number of
beats/minutes and compare with maternal pulse
Normal fetal heart ranges from 120-160 beats/ min

20. Perform a vaginal examination
Indications for VE during admission
1.To determine whether the woman is in true labour
on admission (cervical dilatation and effacement)
2. To establish the baseline for assessment of the
progress of labour for subsequent examinations.
3. To determine the presentation and position of
presenting part to the cervix.
4. To determine the station of the presenting part.
5. To assess if there is moulding and caput of the
presenting part and if so, how much.

21. 6. To Determine the state of membranes and exclude
cord prolapse when membranes rupture especially when
the head is not engaged.
7. To assess the pelvis and determine if it is adequate
for the vaginal delivery
NB avoid doing digital VE if the woman has history of
vaginal bleeding during pregnancy and/or where vaginal
bleeding is present before or during labour because it
can be due to placenta praevia/abruptio
Only do VE when it is necessary basing on indications.

22. Preparation for performing vaginal
exam
1. Rule out all contraindications
2. Ensure privacy both visual and audio
3. Prepare her physically and psychologically.
4. Explain the procedure to the patient, what, how,
where and when.
Encourage her to relax and breathe deeply to
prevent some discomforts and to promote
cooperation leading to accurate findings.
5. Ensure empty bladder.

23. Preparation for performing vaginal
exam ct…
6. Gather the equipment required for the procedure:
- a ball containing antiseptic solution
- a ball containing cotton swabs (6)
- Receiver for used swabs
- Sterile gloves
- Surgical gloves
- Sterile perineal pad
- Source of light
7. Put on IP attire; apron, mask to ensure asepsis

24. Vaginal Inspection- check for:
- Bleeding/show
- Liquor; note colour, amount and odour
-Varicose veins
- Oedema of the vulva
- Scars on the perineum due to previous tears/
episiotomy
- Cleanliness of the vulva.
- Vulva sores and warts.

25. Procedure for Vaginal examination
•Clean the vulva with chlorohexidine using 6 swab
techniques
•Gently insert the 2 fingers into the woman's vagina
and check for;
Muscle tone of the vaginal wall.
Soft tissues in the vagina - should be soft and
warm
Check the cervix for thinness or thickness.
Check the cervix for dilatation and effacement
(taking up).

26. VAGINAL EXAMINATION ct…
Check the application of the head to the cervix
(head stimulates the cervical nerves for dilatation)
Check to feel the membranes, if ruptured or not
Feel the cord for prolapse or presentation
Confirm the presentation: cephalic, breech
Position of sutures and fontanel (AP)
Caput (swellings on the head of the baby), mild,
moderate or severe or no caput.
Moulding –overlapping of the fetal bones

27. VAGINAL EXAMINATION ct…
Fetal station; level of the fetal head in relation to
the ischial spines:
whether above, each centimeter above spines
shown as station -1; -2; -3; -4; -5.
When the fetal head is in line with the ischial
spines ;Station 0
Below the ischial spines +1; +2; +3; +4, +5
NB Compare descent of head abdominally to station
of head vaginally.
•Perform pelvic assessment and interpret the
findings

28. RATIONALE FOR PELVIC
ASSESSMENT
NB Pelvic assessment is very important because it
helps to;
•Detect abnormalities of the bony pelvis,
•Measure diameters of the pelvis, inlet, cavity and
outlet
•Helps the midwife to predict the mode of delivery

29. Pelvic assessment
Identify the following:
•Sacropromontory
•Shape of the brim
•Sacrum
•Ischial spines
•Sacrospinous ligaments
•Subpubic arch
•Intertuberous diameter

30. NORMALLY;
•Sacropromontory-should not be tipped
•Shape of the brim should be difficult to follow or
round
•Sacrum should be curved
•Sacrospinous ligaments should be flexible
•Ischial spines –not prominent but palpable
Subpubic arch-greater than 90 degrees
- Intertuberous diameter- more than 8.5cm
-

31. Pelvic assessment
Diagonal or internal conjugate:
•Extends from the inferior margin of the symphysis
pubis to the centre of the sacral promontory and
should measure 12 cm more
•The tip of the middle finger feels for the centre of
the sacral promontory. The site where the bottom of
the pubic arch meets the hand is marked or noted.
•If the hand measures less than 12cm the sacral
promontory should not be reached in the average
sized pelvis.

32. Pelvic assessment ct…
Shape of brim; Try to follow the brim, in an
average sized pelvis the brim should not be easily
followed.
Curve of sacrum:The middle finger runs gently
down the curve of the sacrum.
•Narrow sacrum indicates narrow pelvic cavity
Coccyx: The end of the coccyx is pressed gently
•It should be slightly mobile bot not prominent
•Fixed and projecting coccyx indicates narrow
anterior-posterior diameter of the outlet.

33. Pelvic assessment ct…
Ischial spines:
•Ischial spines are gently palpated with the tips of the
fingers. Should not be easily palpable and should
not be prominent
•If prominent, they can cause delay or obstruction in
second stage of labour.
Sub-pubic arch:
•Turn the fingers horizontally and press them gently
upwards against the lower border of the arch.

34. Pelvic assessment ct…
sub pubic arch ct …
•Should accommodate 2 fingers with an angle of
about 90º. Less than 80º indicates reduced
transverse diameter of outlet leading to difficult
delivery of the head through the pelvic outlet leading
to trauma.

35. Pelvic assessment ct…
Bituberous/intertuberous Diameter:
•Remove the fingers from the vaginal orifice. Make
the hand into a fist and place the knuckles between
the ischial tuberosities.
•Width of 4 knuckles should fit comfortably
between the ischial tuberosities and is considered
to be than 8.5 cm

36. Interpretation of findings
•Findings should be interpreted and conclusion about
pelvis should be made whether it feels adequate or
inadequate for vaginal delivery
Impression:
•Primigravida/multigravida in active phase of labour
•Primigravid/multigravida not in labour

37. Examples of Midwifery diagnosis based on
findings
•Altered comfort, pain, related to uterine
contractions……….
•Altered coping mechanism
•Risk for infection

38. Example of Plan of Care
•The woman may be admitted in labour ward or first
stage waiting room depending on the stage of
labour hence plan of care may be
•Admit a woman in labour ward (care of a woman in
labour topic to follow).
•Monitor fetal condition ie : heart rate ½ hourly and
colour of liqour hourly.

39. •Monitor Maternal condition: Bp, RR & pulse rate
hourly and Temp 2 hourly
•Remember to document the findings
Implement the care
•Fetal heart rate monitored, check strength and
regularity.
EVALUATE THE CARE
Indicate if labour is progressing or not

40. INDIVIDUALASSIGNMENT
•Read and make notes on possible problem
that can be identified from a labouring
woman during admission

41. REFERENCE
Ministry of Health; Obstetric Life Skills Training
Manual For Malawi.(2000). Malawi.
Ministry of Health; Participants Integrated Maternal
and Neonatal Care Manual. (2009). Malawi.
Sellers, P. M., et. Al. (2006). A Textbook and
Reference foe Midwives in Southern Africa. (8th
ed.).Lansdowine, Juta .