NORMAL LABOUR , FIRST AND SECOND STAGE OF LABOUR. PPT.

NORMAL LABOUR AND
DELIVERY
MR. SAKALA
JULY 2017 INTAKE - LIAS

NORMAL LABOUR
• Normal labour refers to labour that occurs at
term and is spontaneous in onset with the
fetus presenting by vertex, in which there is
regular uterine contractions associated with
effacement and dilatation of the cervix.

ONSET OF LABOR
• There are three classical signs by which the
onset of labor is diagnosed.
• Any one of the signs is enough to diagnose the
onset of labor - it is not necessary to get all
three signs.

1.Painful Uterine Contractions: The onset of
labour is characterized by painful,
intermittent, involuntary and co-ordinated
uterine contractions which cannot be relieved
by medicines or rest.

• Some women get uterine contractions in late
pregnancy which they often mistake for onset
of labor.
• But the contractions are usually not regular,
does not increase gradually in intensity and
are relieved by medicines or rest.
• These are 'false labor pains‘.

• Braxton Hicks contractions occur throughout
pregnancy and are not related to labor pains.
2.Expulsion of Show or Mucus Plug: During
pregnancy, the cervix which is the mouth of
the uterus is filled with dense mucus that seals
it to some extent.

• As the cervix begins to thin out and open to
allow the baby to be born, this mucus is
expelled through the vagina.
• There is also some amount of bleeding from
blood vessels that rupture when the cervix
dilates.
• These present at the vaginal opening as blood
stained mucus.

• This blood stained mucus is called 'show'or
'mucus plug'. The mucus plug may consist of
thin or thick mucus.
• It may be just bloodstained in some women,
resulting in brownish vaginal discharge. But in
others , there may be frank bleeding at the
time of expulsion of the mucus plug.

3.Rupture of Membranes: In many women, the onset of
labor is signified by the rupture of the bag of waters
(rupture of membranes) without any prior abdominal
pain.
• The rupture of the membranes may occur with a
sudden gush of waters, or with only a thin trickle that
is barely enough to soak the underwears.

• Usually, leakage of water is more in the lying
down position.
• Standing or sitting up causes the head of the
fetus to plug the mouth of the uterus and
prevents outflow of the amniotic fluids
(waters).

True Labor
• Contractions become stronger, longer and
closer together
• Bag of waters may break (shortens); call your
health care provider

• Cervix progressively effaces (shortens) and
dilates (opens)
• Increase in mucus and bloody show may be
present

• Walking increases intensity
• Discomfort in back and abdomen
• Contractions don't go away after rest or
activity

False Labor
• Contractions may be uncomfortable
• Contractions usually don't get closer together
or last longer
• Contractions are usually not regular
• Cervix shows little or no dilation or effacement
• Change in activity, either resting or moving
around, may stop contractions

• Position change may stop contractions
• Discomfort usually only in abdomen

STAGES OF NORMAL LABOUR
• Labor is divided into three stages, though a
fourth stage has also been instituted recently
and is discussed under immediate care of
woman after delivery of placenta:
• Stage I : Stage I lasts from the onset of labor
to full dilation of the cervix. In a primigravida,
this stage lasts for about 10 to 12 hours.

• In a woman who has delivered earlier, it lasts
from 6 to 8 hours.

The First Stage is again divided into three
phases:
• Phase I: This is the longest and least painful
phase of the entire duration of labor.
• It starts from the time when the cervix first
starts to dilate to the time when the cervix is 4
cm dilated.

• It is also called the 'Latent phase' of labor or
the 'Early phase' of labor.
• It can last for days and can occur with only the
mildest discomfort to the pregnant woman.

• Phase II: This is a more active phase of labor.
The cervix dilates from 4 cm to 8 cm during
this phase.
• The contractions are more painful , of longer
duration and come more regularly.
• It is also called the 'middle phase ' of labor.

• Phase III: During this phase, the cervix dilates
from 8 cm to 10 cm .
• At 10 cm, the cervix is fully dilated and the
baby's head can come out of the uterus safely
and easily.
• This phase is also called the 'transition phase'
of labor since it marks the transition of the
First stage of labor to the Second stage.

• Stage II : Stage II lasts from the full dilatation
of the cervix to the expulsion of the baby. In a
first pregnancy, it lasts for about 1 hour, in
subsequent pregnancies, it lasts for about ½
hour.
• This stage (Second stage) is a stage when the
baby's head is travelling down the vaginal
canal to be delivered.

• The contractions are very painful and run into
each other, appearing to produce almost
continuous pain.

• Stage III : Stage III lasts from the birth of the
baby to the expulsion of the placenta and the
membranes.
• It lasts for about 15 - 20 minutes in both first
and later pregnancies.

• The third stage is comparatively less painful
and is characterized by a gush of bleeding at
the time the placenta separates from the
uterus.

MANAGEMENT OF NORMAL LABOUR
Admission of a woman in labour
Objectives:
• To confirm if patient is in labour
• Reassure the patient and allay anxiety.
• Detect any abnormality and take appropriate
action.

Requirements
• Trolley should be prepared as follows.
Top shelf
• Vaginal delivery pack containing 2 gallipots,
with cotton wool swabs, episiotomy scissor,
umbilical cord scissor, vaginal pad, pair of
sterile gloves.

• Bottom shelf
• Clean sheets
• Mackingtosh with draw sheets
• Receiver for used swabs
• Sphygmomanoter and stethoscope

• Bottle of savlon 1:2000 for swabbing
• Thermometer
• Fetal stethoscope
• Multistic reagents

• Gallipot with clean cotton wool
• Gallipot with clean water
• Soap and towel.

PROCEDURE
• Greet the woman and welcome her into the
ward.
• Introduce yourself in a friendly manner and
reassure the woman.
• Quickly assess the general condition of the
woman and stable go ahead with the
admission procedure.

• Review the antenatal card noting the past
obstetric history, medical history, any thing
unusual about the present pregnancy and
relevant data.
• If patient is unbooked, a full history should be
taken
• Labour history - Obtain details concerning the
present labour

Inquire about the following:
• Time and onset of regular uterine contractions.
• History of any show.
• Any vaginal bleeding observed.
• Any danger signals such as severe headache,
blurred vision, dizziness, fever.
• If the membranes have rupture and at what
time did the they rupture.

• Note the color of liquor
Vital signs
• Check the temperature, pulse, respiration and
blood pressure.

• Urinalysis - obtain urine for urinalysis and test
especially looking for presence of albumin,
sugar or acetone, measure the amount and
record

• Head to toe examination - carry out the head
to toe examination as previously described
taking note abnormalities such as anaemia,
oedema, varicose veins, lymphadenopathy
and any vaginal discharge or vulval sores.

Abdominal examination
• inspection
• Size of abdomen in relation to calculated
gestational age.
• Shape and contour of the abdomen
• Any scars or skin changes
• Uterine contractions-type, frequency and duration.
• Fetal movements and activity

• Palpation
• Estimate the height of the uterine fundus
• Leopard palpation
• Pelvic palpation

Auscultation
• Check the foetal heart rate noting the volume,
rhythm, etc.
• After physical examination, then perform
vaginal examination

Vaginal examination
• This is a sterile procedure
Objectives
• To confirm that the woman is in labour.
• To form baseline data for subsequent
examinations.
• To detect any abnormalities and to make
appropriate interventions.

• To rule out cord prolapse when the
membranes rupture.
• To confirm the presentation
• To assess the labour before giving analgesics
such as pethidine.

During vaginal examination note the following;
• Vagina-should feel warm and moist.
• Hot or dry vagina may be a sign of obstructed
labour.

• Cervix-is it effaced or not. Is it thick or thin, is
it well applied to the presenting part. Is it
oedematous and then estimate cervical
dilatation in cm.

• Membranes- are they intact or ruptured, do
they bulge with a contraction, if ruptured,
note the color of liquor, any meconium in
liquor.
• If meconium present in liquor note if fresh or
dry.
• Note if the liquor is offensive and take note of
the time of rupture of membranes.

• Umbilical cord-Feel for the umbilical cord and
if absent that indicates that there is no cord
presentation or prolapse.
• If the cord is felt and the membranes are
intact, it is called cord presentation or funic
presentation

• If cord is felt and membranes are ruptured, it
is called cord prolapse.
• During vaginal examination, confirm the;
• The presentation and degree of flexion.

The presenting part
• Presence of caput succedaneum and degree.
• Note if moulding is present and assess the
degree of moulding such as o, +1, +2, +3

• Assess for station of the presenting part.
• Finally carry out pelvic examination to rule
CPD.
• If the woman is in active labour-os 4cm and
above, open the partogram

Management of first stage of labour
Medical management
Lab work
• Lab work mainly done if it was not done
antenatally and client has complaints.

The following lab work is usually done;
Blood slide for mps to detect any malaria.
Hb/HCT to detect any anaemia which is
common in pregnancy.
• Grouping and Cross Match in case of need for
Blood Transfusion.
• Rhesus factor in case of rhesus incompatibility.

• Urinalysis is done mainly to exclude
abnormalities such as presence of proteins in
urine which can be an indication of pre-
eclampsia.
Drugs are given only if ordered and only in
special conditions such as HIV/
AIDS, Hypertensive patient.

Nursing management
Aim
To ensure that the woman gives birth normally
by monitoring the maternal well-being, foetal
wellbeing and progress of labour and that the
maternal-fetal status is within normal limits.

Maternal well being
Room
Clean room to reduce chances of infection.
• Warm to promote comfort to the mother and
prevent hypothermia to the new born baby.
Quiet to promote rest.
Well ventilated to promote free circulation of
air.

The following equipment should be in the
room:
• The tpr tray, blood pressure machine
• Stethoscope, electronic foetal monitor or
foetoscope, flashlight or penlight, oxygen
machine, IV pole.

Position
Lateral position is preferable if woman wishes
to lie down.
• Lateral position is preferable as it prevents
compression of the inferior vena cava which
may cause supine hypotension.

The woman should be encouraged to adopt
lateral position.
Upright position should be encouraged as well
as this position facilitates uterine contractions
and promote good progress of labour.

• The client should never lie in recumbent
position as this can lead to supine hypotension.
• With Supine hypotension, the woman will
usually complain of vertigo, dizziness and finally
she can faint.
• Recumbent position will also result into
reduction of placental blood flow and this will
compromise the well being of the fetus.

Observations
Blood pressure
This is done to rule out
preeclampsia/eclampsia
• The normal levels of blood pressure during
labour should range as follows: 90/60-140/90
mmHg.

• Measures reflecting an increase by 30mmHg
in systolic and 15mmHg in diastolic above the
antepaturm base line data are an abnormal
and should be investigated.

Assess and record blood pressure on
admission and at least hourly during the active
phase and more frequently if blood pressure
elevated.
The blood pressure should not be taken when
patient is in supine position because of the
risk of supine hypotensive syndrome and this
may give false reading.

• Blood pressure should not be assessed during
contractions as this may cause a false
elevation.

Temperature:
The temperature should be assessed initially
as base line data and every 4 hours thereafter.
If the membranes are ruptured and the
temperature is elevated, it should be observed
1 to 2 hourly.
Temperature is mainly done to rule out
infection such as malaria, UTI, URTI, GITI,
obstructed labour etc.

Pulse and respirations
• The pulse and respirations are assessed
initially as baseline data and every 4hours.
• The pulse is assessed to detect any deviation
from normal such as tachycardia and
bradycardia.

• Normal range of pulse is 60-90 beats/minute
and respirations 16-24 breaths/minute.
Increased respiration and pulse may be
attributed to anxiety, excitement and pain.
When tachycardia is associated with elevated
temperature, it is a good indication of
infection.

• Other observations include the general
condition of the client, how the client is
responding to labour.

Nutrition and hydration
The client is encouraged to take enough
calories
fluids to replenish energy expenditure and
promote efficient uterine contractions and
general well being of the woman.

• The client is encouraged to take foods and fluids
orally and or commencing her on intravenous
fluids such as 5% dextrose.
• This will help prevent maternal distress atonic
uterus.
• The client should be encouraged to eat light
food that can not cause constipation and make
rectum full as these can delay the progress of
labour.

• Ensure that the woman has enough to eat
when able to as this will generally promote
the wellbeing of the woman in labour.

Emotional support (Psychological care)
• Emotional support encompasses such factors
as acceptance, understanding, and continuous
uninterrupted physical presence of the nurse,
encouragement and praise.
• All the above components of supportive role
have a major impact on the outcome of
labour.

• Make the client and her family welcome,
comfortable and acceptable to allay anxiety.
Create good client- nurse relationship as this
tends to relieve the tension and stress the
woman may be feeling.

• Work in a calm and friendly manner to avoid
alarming the woman as cold, abrupt or
irritable nurse will make woman feel defensive
and more apprehensive especially that this
woman is from muselepete.
• The nurse should spend as much time as
possible with the client to establish a positive
relationship.

• The nurse should identify what the client
needs to know and share information with the
client.
• The nurse should teach the woman on what is
expected such as when to start pushing,
contraction patterns, timing the contractions
and changes through out labour that indicate
the progress such as cervical dilatation, decent,
effacement and station.

• Divertional therapy may be encouraged in the
early phase of labour such as playing cards,
listening to music or watching television.
Explain every procedure done to the woman such
as vaginal examination, fetal heart rate to allay
anxiety.
Tell the woman the progress of labour, her
wellbeing and wellbeing of the fetus every after
each examination.
This will allay apprehension the woman may have.

Hygiene
Basic hygiene should not be overlooked in the
excitement for labour.
keep the woman clean and dry
If perspiring, change her gown frequently to
keep her dry and comfortable.
Cold moist wash cloth can be placed on her
forehead or used to wipe her face and hands
to refleshen the client.

Keep the bed dry especially if the woman is
having large amounts of blood show or
membranes have ruptured and she is leaking
amniotic fluid.
Oral hygiene in the form of mouth wash should
be encouraged to help her feel refreshed.
Ice chips can be given to keep her mouth moist.

Pain management
 If the woman is tense and in pain, a soothing
backrub will be done as this may help to relax
the woman.
Encourage woman to use ice packs or hot
packs as this may relieve pain.
Encourage woman to relax her muscles during
contractions by taking slow-paced breathing.
Pain killers such as pethidine in case of severe
backache can be given.

• However care should be taken as pethidine
can cause fetal distress.
• It is recommended to give pethidine only
when the cervical dilatation is less than 6cm.

Elimination/bladder care
• Encourage woman to void every after 2 hours
to avoid retention of urine as a distended
bladder can cause discomfort to the client and
may delay the progress of labour.
• If membranes are intact or ruptured and the
presenting part is well engaged into the pelvis,
the woman can be encouraged to get up to go
to the bathroom to void on the toilet as the
chances of cord prolapse in this case are slim.

• If membranes are ruptured and head is not
engaged, woman should remain in bed and
bedpan should be given to her for use as
chances of cord prolapse in this case are
increased.
• If the woman is unable to void and it is obvious
by observation or palpation that the
• bladder is full, in and out catheterization may
be necessary.

Activities/Rest
If the membranes are intact and the head is
well engaged, she can be allowed to walk up
and down as this promotes the progress of
labour.
Allow woman to rest if she wishes by
promoting a quiet room and dry bed to make
her comfortable.

FOETAL WELBEING
• Fetal well being during labour is very
important and the following nursing
intervention should be carried out;
 Foetal heart rate should be done every 30
minutes.
 This is mainly done to rule out any deviation
from normal such as foetal distress.

• The fetal heart rate should be within a normal
range of 120-160beats/minute.
 The heart rate should be regular.
• When taking the fetal heart note the rhythm
in which the heart beat should be coupled and
steady.

 Heart beat volume should be strong as weak
heart beat volume may indicate fetal distress.
 The heart rate should remain stead or
accelerate during contractions.
 Avoid taking heart rate during contractions as
this can give a misleading heart rate.

• Note if there is any diminished or ceasation of
foetal movement to rule out intra uterine
• foetal death or excessive foetal movement to
rule out foetal distress.
• Check for any passage of fresh meconium as
this can be an indication of foetal distress.

• Check the degree of moulding as this may
endanger the life of the foetal and cause head
injury.
• Carry out abdominal palpation every 4 hours
to determine the lie, position, presentation of
the fetus as abnormal lie, position and
presentation put a fetus at high risk of foetal
death or injuries.

• Watch for the signs of distress such fetal heart
rate above or below the normal range of 120-
160b/m.
• Passage of fresh meconium and excessive fetal
movement.

PROGRESS OF LABOUR
Abdominal palpation
 This is done every after 4hours to determine
the position, lie , descent and presentation of
the fetus.

Uterine contractions
• The frequency, duration and intensity of
uterine contractions have to be done every
15-30 minutes.

Vaginal examination
• Done every 4 hours to assess for the following:
cervical dilatation, cervical position, cervical
effacement, cervical consistency, foetal
station, presenting part and noting if
membranes intact or not.
• These assessments are the basis for
determining labour progress.

Partograph
• This will be used when the woman is in an
active labour with a cervical dilatation of 4cm
and above and all the necessary information
will be entered.

Second stage of labour
• The second stage of labor starts at the end of
the first stage when the cervix is fully dilated
to 10 cm.
• This stage is characterized by some specific
dynamics in both the mother and the baby.

Mechanism of labour
• These are series of adaptations that the fetus
makes as it moves through the maternal bony
pelvis during the process of labour and birth.
• Mechanism of labour is influenced by size and
position of the fetus, the powers of labour, the
size and shape of the maternal pelvis and the
mother’s position and these can be
summarised as the 4Ps.

• Student4Ps stand for:
• ………………………..
• ………………………..
• ………………………..
• ……………………….
• s to complete the 4Ps

MANAGEMENT OF SECOND STAGE OF
LABOUR
• Toward the end of the first stage of labour, the
midwife should make preparation for the
conduct of the second stage of labour.

Requirement:
• Room which is clean and warm {26degree
Celsius}
• Privacy
• Resuscitaire
• Trolley-top shelf {should be sterile}
A sterile delivery pack containing:
• 1 bowl with cotton wool and gauze swabs
• 1 Gallipot for putting 1:200 hibitane or savlon

• 1 cord clamp
• 2 receivers
• 2 artery forceps
• 1 cord scissors
• 2 maternity pads
• 1 episiotomy scissors
• 15cc or 10cc syringe with green top needles G21.
• 1 urinary gatheter
• 2 sterile dressing towels

Trolley-bottom shelf
• Injection of syntometrine 1ml, or oxytocin 10
units
• Syringes 2cc, 5cc, 10cc. and needles.
• Lignocaine plain 1% or 2%
• Water for injection

• Receiver for used swabs etc.
• Sterile groves
• Fetal stethoscope
• Packet of maternity pads
• Extra linen
• Bottle of hibitane or savlon 1:200

• Baby wrapper, label, neonatal form
• Resuscitaire must always be ready at all times
to resuscitate the baby
Procedure {2 midwives should be in
attendance}

• Ask the patient to pass urine or pass a
catheter if she fails to pass urine in order to
prevent delay in 2nd
and 3rd
stage of labour.
• The patient should be given instruction on
how to push.
• The midwife conducting the delivery now
washes and dries her hands, opens the outer
part of the delivery pack.

• s/he now puts on {gown if available} sterile
gloves and completes the preparation of the
sterile part of the trolley.
• The second midwife is responsible for
monitoring fetal and maternal well-being, as
well as the efficiency of the uterine
contraction.

• Observation in second stage should be done
every five minutes.
• s/he is also responsible to see that the mother
maintains a good position and gives clear
helpful instructions.

• The attending midwife stands on the patient’s
right side.
• The perineum is swabbed with antiseptic solution.
• The advance of the fetal head should be carefully
watched and controlled in a downward direction
with the left Hand.
• Meanwhile using the right hand the perineum
and anus are covered with the sterile pad.
• At this time, the decision as to whether or not to
perform an episiotomy is made.

• The patient should only push when she has a
contraction.
• The fetal head is delivered slowly to prevent
trauma of the head and perineal tears.
• The head is crowned and the brow, face and
chin are born by a movement of extension.

• During this phase the mother is asked to
‘pant’.
• Now follows a short resting phase during
which the midwife checks to see if the cord is
around the baby’s neck.

• If it is loose, it can be slipped over the
shoulders.
• If tight, then apply 2 artery forceps about
3cms apart, hold a swab over the cord, cut
and unwind.
• Clean the baby’s eyes with sterile swabs, and
clear baby’s airway.

Delivery of the shoulders
• Allow the shoulder to rotate into the anterior
posterior diameter of the pelvic outlet.
• If spontaneous rotation fails to occur then
assist the shoulders to rotate.
• Place one hand on each side of the baby’s
head and apply gentle downward traction.

• The anterior shoulder should slip under the
symphysis pubis, once the anterior shoulder is
free carry the baby upward toward the
mother’s abdomen.
• During this manoeuvre the posterior shoulder
can escape over the perineum.
• With the same manoeuvre the rest of the
baby’s body is born by lateral flexion.

• Dry the baby and put it on the mother’s
abdomen.
• Clamp the cord by applying 2 artery forceps
about 3cms apart, hold a swab over the cord,
and cut the umbilical cord.
• Note the time of the baby’s birth. Assess the
baby’s condition especially his respirations. Give
an apgar score at one minute and again at five
minutes.

• Show the baby to the mother for identification
{especially the sex}.
• Leave the baby in skin to skin contact on the
mother’s abdomen or chest covered by a
clean, dry towel/cloth or wrap the baby
warmly to prevent hypothermia.

• Palpate the mother’s abdomen to exclude a
second baby.
• The assistant midwife gives i/m syntometrine
1ml or 10 units oxytocin within 1 minute of
the delivery of the baby.

• Place the identity band on the baby’s wrist.
• The following information should be put
identity band-name, file no. date and time of
birth, apgar score, sex.
• Initiate breastfeeding as soon as possible {this
promotes mother/baby bonding also stimulates
the production of oxytocin from the posterior
pituitary gland which in turn causes contraction
of the uterine muscle.}

• Wrap the baby in a towel to reduce heat loss,
then give him to his mother and encourage
her to suckle him immediately; or give him to
the mother without wrapping him and cover
them both up together.

THIRD STAGE OF LABOUR
• Period from delivery of the baby up to delivery
of the placenta

MANAGEMENT OF THIRD STAGE OF LABOUR
• The mother must never be left alone during
third stage of labour.
• Tell the woman and her support person what
is going to be done.

ACTIVE MANAGEMENT OF THIRD STAGE
• As noted above: give 10 units of oxytocin e.g
sytometrine 1ml or Ergometrine 0.5mg
intramusculary within 1 minute of the baby’s
birth.
• The mother should be in the dorsal position
with the sterile receiver under the vulva.
• Empty the bladder if not already done.
• Clamp the cord near the vulva with an artery
forceps

• The right hand grasps the forceps and cord
• Wait for the uterus to contract.
• Place the other hand {left hand} above the
level of the symphysis pubis, with the palm
facing toward the mother’s umbilicus and
gently apply pressure to the uterus in an
upward an backward direction.

• At the same time, firmly apply traction to the
cord, in a down ward direction, using the hand
that is grasping the forceps.

• Apply steady tension by pulling the cord firmly
and maintaining upward pressure on the
uterus.
• Jerky movement and force must be avoided} if
the manoeuvre is not immediately successful,
stop pulling and wait for the next contraction
and repeat.

• When the placenta appears at the vulva grasp
it with both hands and rotate it in order to
‘rope’ the membranes-this assists the
complete delivery of the membranes.
• If the placenta does not advance, it can be
delivered with gentle upward and downward
motion.

• Once the placenta and membranes are
delivered, then massage the uterus in order to
‘rub up’ a contraction and expel any blood
clots.
• Make sure the uterus is well contracted.
• Remove the placenta, membranes and clots in
the receiver.

• The uterine fundus rises up to the level of the
umbilicus, becomes hard, round and
ballotable
• The cord elongates in the receiver and does
not recedes on supra-public pressure
• A small gush of blood

Delivery of the placenta
• Once the placenta has separated it is delivered
by maternal efforts.
• An artery forceps is clamped on the cord near
the vulva.

• When the placenta appears at the vulva grasp
it with both hands and rotate it in order to
‘rope’ the membranes-this assist the complete
delivery of the membranes.
• If the placenta does not advance it can be
delivered with gentle upward and downward
Motion.

• Once the placenta and membranes are
delivered then massage the uterus in order to
‘rub up’ a contraction and expel any blood
clots.
Make sure the uterus is well Contracted.
• Remove the placenta, membranes and clots in
the receiver.

IMMEDIATE CARE AFTER DELIVERY OF
PLACENTA
• This care is given in the first hour after delivery
and is mainly referred as the four stage.
• Clean and dry the buttocks, remove the wet
linen and secure the perineal pad.
• Change the linen, leave the patient clean,
warm and comfortable.
• Give a warm drink, and if necessary some
analgesic for relief of ‘after pains’

• Take the following vitals immediately and
these should return to prelabour values within
one hour.
• Vital signs are usually assessed every 15
minutes during the immediate post partum
period.

• Massage the uterine fundus to prevent
haemorrhage.
• Maintain fluid balance and nutrition by giving
patient warm during or light diet if woman is
in stable condition.

• Encourage woman to void to promote
contraction of the uterus and prevent
haemorrhage.
• The woman can be given analgesics for after
pain such as panadol.

• Observe the type of lochia to detect any active
bleeding.
• Change any soiled linen/cloths
• Keep the woman clean especially perineal
hygiene.

• Give psychological care to the woman to allay
anxiety.
• Allow the woman to verbalize about her delivery
and baby.
• Allow the woman to be with the baby if both the
baby and the mother are in good condition.
• Keep patient warm and keep room quite to
promote rest as woman may be tired during
labour process she underwent.

NORMAL LABOUR , FIRST AND SECOND STAGE OF LABOUR. PPT.

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NORMAL LABOUR , FIRST AND SECOND STAGE OF LABOUR. PPT.