Definition of normal labor, Terminology , events of labour, causes of labour, signs , stages of labour , signs and symptoms of labour, diagnosis in first stage of labour, Partograph, difference between true labour and false labour ,nursing management of first stage of labour.

1. NORMAL LABOUR AND NURSING
MANAGEMENT OF FIRST STAGE OF
LABOUR
PREPARED BY:
NEHA PARMAR
ASSISTANT PROFESSOR
DPCN
NADIAD

2. TERMINOLOGIES.
• LABOUR: series of movements that occur on the head
and the foetal trunk in the process of adaptation during
its journey through the pelvis.
• INDUCTION OF LABOUR: is the stimulation of uterine
contraction during pregnancy before labour begins on
its own to achieve a vaginal birth.
• Or it is the process or treatment that stimulates
childbirth and delivery.
• PARTOGRAPH: the graphic representation used to
assess the progress of labour and to identify when
intervention is necessary.

3. • FIRST STAGE OF LABOUR: it starts from the onset
of labour pains to the full dilatation of the cervix,
also called as “cervical stage”.
• LATENT PHASE: it is prior to active first stage of
labour and may last for 6-8 hours in primigravidae.
• ACTIVE PHASE: here the cervix undergoes rapid
dilatation. It begins when cervix 3-4 cm dilated is
complete when the cervix is fully dilated (10cm).

4. • TRANSITIONAL PHASE: is the stage when the
cervix is from around 8cm dilated until it is fully
dilated (or until the expulsive contractions
during second stage are felt by the woman)
• LIGHTENING: it is the welcome sign, occurs due
to the active pulling of the lower pole of the
uterus and widening of the symphysis pubis,
the presenting part sinks into the true pelvis
few weeks before the onset of labour in
primigravidae

5. • SHOW: there is presence of blood stained cervical
secretion with the onset of labour. Or expulsion of
cervical mucus plug , mixed with blood is called
“show”
• EFFACEMENT OF THE CERVIX: effacement is the
process of thinning out. It is measured as
percentage of shortness of cervical canal.

7. • ARTIFICIAL RUPTURE OF MEMBRANES:
amniotomy involves splitting of the amnion
and chorion to release the liquor.
• EPISIOTOMY: is a surgical incision into the
perineum to enlarge the space at the outlet,
thereby facilitating the birth of the child.

9. 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.
D.c dutta

10. CONTD..
• Labour may be defined as rhythmic contraction
& relaxation of the uterine muscles with
progressive effacement (thinning) & dilatation
(opening) of the cervix, leading to expulsion of
the products of conception.
Clausen etal, 1973
• Labour is described as the process by which the
foetus, placenta & membranes are expelled
through the birth canal.
Cassidy, 1999

11. NORMAL LABOUR (EUTOCIA):
• Labour is called normal if it fulfils the following criteria;
[1] Spontaneous in onset & at term.
[2] With vertex presentation
[3] Without undue prolongation.
[4] Natural termination with minimal aids.
[5] Without having any complications affecting the health of
the mother & /or the baby.

12. ABNORMAL LABOUR [DYSTOCIA]:
Any deviation from the definition of normal
labour is called abnormal labour. Thus a
labour in a case with presentation other than
vertex or having some complications even
with vertex presentation affecting the course
of labour or modifying the nature of
termination or adversely affecting the
maternal & or foetal prognosis is called an
abnormal labour.

13. THE THREE P’S OF NORMAL LABOUR
• The labour process involves a relationship
between the three Ps”;
• the powers,
• the passages
• the passengers

14. CONTD..
• The primary powers are the contractions and
retractions of the uterine muscle. The secondary
powers are the contractions of the abdominal
muscles and diaphragm.
• the passages are the pelvis, uterus, vagina and
the pelvic floor
• the passenger is mainly the fetus,but placenta,
membranes and liquor amnii are also passengers

15. CAUSES FOR THE ONSET OF LABOUR:
• ThE onset of labour is said to be multifactoral in
origin, i.e. hormonal, mechanical and neuronal
factorS
• Hormonal factors- The hormones responsible for
the onset of labour are oxytocin, progesterone and
prostaglandins.
Progesterone-it has a relaxant effect on the uterus.
It is first produced by the corpus luteum and then
by placenta. It inhibits uterine contractibility. When
the estrogen level increases, the progesterone level
decrease. This decreases at the end of pregnancy.

16. Contd..
Oxytocin : this hormone is released by the
posterior pituitary gland of the mother. It has a
stimulating action on the pregnant uterus. The
oxytocin released acts directly on the
myometrium and causes the uterus to contract.
Prostaglandins : the major sites of synthesis of
prostaglandins are placenta, foetal membrane,
decidual cells, and myometrium. They act on the
uterine muscles and causes it to contract

17. Contd..
• Mechanical factors : this is due to the mechanical
stimulation of the uterus and cervix:
Uterus: as pregnancy advances, its contractility
increases and it becomes more susceptible to
stimulation.
Cervix : the presence of the presenting part on the
nerve ending of the cervix causes the onset of
labour

18. Contd..
• Neuronal factors :
α and β adrenergic receptors are present in
the myometrium. When progesterone gets
withdrawn, onset of labour takes place.
• Labour is likely to be initiated by a
combination of all the above mechanisms

19. FALSE PAIN (SPURIOUS PAIN)
• it is found in primigravida than in parous
women.
• It usually appears prior to the onset of true
labour pain, by one or two weeks in primi and
by a few days in multiparea.
• The women feels pain and discomfort in the
abdomen and these are mistaken for labour
pain.

20. False pain has the following features:
• Dull in nature & usually confined to the lower
abdomen and groin
• Continuos and unrelated with hardening of uterus
Without any effect on dilation of cervix
• Usually relieved by enema and administration of
sedatives.
• Such pains are probably due to stretching of the
cervix and lower uterine segment.

21. THE PREMONITARY SIGNS OF LABOUR
• That starts from two or three weeks before
onset of true labour.
• lightening
• frequency of micturation
• cervical changes
• appearance of false pains
• Vaginal secretions may increase
• SHOW
• Membranes may rupture

22. DIFFERENCE BETWEEN TRUE LABOUR
AND FALSE LABOUR
TRUE LABOUR FALSE LABOUR
Painful uterine
contractions come at
regular intervals.
Uterine contractions
always present
 Intensity of pain progress
with advancement of
labour
Interval between pain
gradually becomes short
in true labour
Irregular intervals in false
labour
Not always present
 Intensity remains same
Remains same

23. Presence of bulging fore
waters in true labour
Pain felt in true labour is
in abdomen ,back & groin
Cervical dilatation &
effacement is present
Show is usally present
 Pain is not relived by
sedatives or enema
Absent
Pain usually felt in lower
abdomen
Absent
 Not present
Pain is usually relieved by
medication.

24. STAGES OF LABOUR
• Labour is divided into four stage
• First Stage of Labour:- The first stage of labour is
referred to as the "dilating" stage. It is the period
from the first true labour contractions to complete
dilatation of the cervix (10cm) . The forces involved
are uterine contractions.
• The first stage of labour is divided into three
phases:
– Latent (early) or prodromal.
– Active or accelerated.
– Transient or transitional

25. • Second Stage of Labor:- The second stage of
labor is referred to as the "delivery or
expulsive" stage. This is the period from
complete dilatation of the cervix to birth of
the baby. The forces involved are uterine
contractions plus intra-abdominal pressure.
• Third Stage of Labor. The third stage of labor
is referred to as the "placental" stage. This is
the period from birth of the baby until
delivery of the placenta. The forces involved
are uterine contractions and intra-abdominal
pressure.

26. • Fourth Stage of Labor.
• The fourth stage of labor is referred to as the
"recovery or stabilization" stage.
• This period begins with the delivery of the
placenta and ends when the uterus no longer
tends to relax.
• The forces involved are uterine contractions

27. PHYSIOLOGY OF NORMAL LABOUR
• During pregnancy there is marked hypertrophy
and hyperplasia of the uterine muscle and the
enlargement of uterus are more; beyond the
attachment of round ligaments.
• At term, the length of the uterus measures about
35cm including the cervix and the fundus is
much wider both transversely and
anteroposteriorly than the lower segment.
• The uterus assumes pyriform or ovoid shape.
• The cervical canal is occluded by a thick,
tenacious(sticky) mucus plug.

28. Uterine contraction in labour:
• Throughout pregnancy there is rhythmic involuntary
spasmodic uterine contractions are painless and have
no effect on dilatation of cervix.which changes with
the onset of labour; the complexity of the mechanism
of the onset has previously been described.
• While there are wide variations in frequency, intensity
& duration of contractions, they remain unusually
within normal limits & follow the following patterns
There is good synchronisation of the contraction
waves of both halves off the uterus
There is fundal dominance with gradual diminishing
contraction wave through midzone down to lower
segment which takes about 10-20 seconds
The waves of contraction follow a regular pattern

29. Intra-amniotic pressure rises beyond 20mm Hg
with the onset of true labour pains during
contraction
Good relaxation occurs in between contraction to
bring down the intra-amniotic pressure to less
than 8mmHg contractions of the fundus last
longer than that of midzone.
• During contraction, uterus becomes hard &
somewhat pushed anteriorly to make the long
axis of the uterus in line with that of pelvic axis.
• Simultaneously, the patient experience pain which
is situated more on the hypo gastric region, often
radiating to the thighs.

30. • PROBABLE CAUSES OF PAIN:
• Myometrial hypoxia during contractions (as in
angina)
• Stretching of the peritoneum over the fundus
• Stretching of the cervix during dilatation
• Compression of the nerve ganglion.
• The pair of uterine contractions is distributed
along the cutaneous nerve distribution of T10
& L1 pain of cervical dilatation & stretching is
referred to the back through the sacral plexus.

31. • TONUS: it is intrauterine pressure in between
contraction. During pregnancy ,as the uterus is
relatively in active the tonus of 2-3mmHg.
During the first stage of labour it varies from
8-10mm Hg .The factors which govern the
tonus are –
 Contractility of uterine muscles
 Intra abdominal pressure
 Over distension of uterus as in twins &
hydraminos

32. • INTENSITY: the intensity gradually increases with
advancement labour until it becomes maximum in
the stage during delivery
• DURATION: in the first stage, the contractions last
for about 30 seconds initially but gradually increase
in duration with progress in labour .Thus in the
second stage the contraction last longer than in the
first stage.
• FREQUENCY: in the early stage of labour the
contraction come at intervals of ten to fifteen
minutes .the intervals gradually shorten with
advancement of labour until in the second stage
when it comes every 2 or 3 minutes

33. Retraction: it is a phenomenon of the uterus
in labour in which the muscle fibres are
permanently shortened
 Unlike any other muscles of the body the
uterine muscles have this property to become
shortened once & for all.
 contraction is a temporary reduction in length
of the fibres which attains their full length
during relaxation

34. THE NET EFFECTS OF RETRACTION IN
NORMAL LABOUR
• Essential property in the formation of lower uterine
segment & dilatation & effacement up of the cervix.
• To maintain the advancement of the presenting part
made by the uterine contractions & to help in
ultimate expulsion of the foetus.
• To reduce the surface area of the uterus favouring
separation of placenta.
• Effective haemostasis after the separation of the
placenta

35. EVENTS IN THE FIRST STAGE OF
LABOUR

36. • UTERINE ACTION:
• FUNDAL DOMINANCE
• Each uterine contraction starts in the fundus
near one of the cornua & spreads across &
downwards. Each contraction is longest &
intense in the fundus, but the peak is reached
simultaneously over the whole uterus & fades
from all parts together. This pattern permits
the cervix to dilate & the fundus to expel the
foetus.

37. • POLARITY
• A neuromuscular harmony prevails between the
two poles or segments of uterus throughout
labour, which is termed as polarity
• During each contraction, these two poles act
harmoniously.
• The upper pole contracts stronger & retracts to
expel the foetus, lower pole contracts & slightly
& dilates to allow expulsion to occur.
• If polarity is disorganized, the progress of labour
is inhibited.

38. • CONTRACTION & RETRACTION:
• During labour the contraction does not pass off
entirely, the muscle fibres retain some of the
shortening of contraction instead of becoming
completely relaxed. This is termed as retraction,
which is a unique property of the uterine muscle.

39. • Because of this, upper segment of the uterus
becomes gradually shorter &thicker & its cavity
diminishes assisting in the progressive expulsion of
the foetus.
• FORMATION OF UPPER AND LOWER SEGMENTS:
• By the end of pregnancy, the body of the uterus has
divided into two anatomically distinct segments
upper & lower uterine segments. The upper uterine
segment is mainly concerned with contraction and
is thick & muscular. The lower segment is prepared
for distension & dilatation & is thinner. The lower
segment develops from the isthmus & is about 8 to
10 cm in length.

40. • THE RETRACTION RING
• The ridge forms between the upper and lower uterine
segments, which is known as retraction ring.
• The physiological retraction ring gradually rises as the
upper uterine segment contracts and retracts and the
lower uterine segment thins out to accommodate the
descending foetus.
• Once the cervix is fully dilated & the foetus can leave
the uterus, the retraction ring rises no further. The
retraction ring is normally not visible over the
abdomen.
• When the phenomenon is exaggerated in an
obstructed labour, the retraction ring becomes visible
above the symphysis pubis; it is termed as bandl’s ring.

41. CERVICAL EFFACEMENT/ TAKING UP OF THE CERVIX
• 'Effacement' refers to the inclusion of the cervical
canal into the lower uterine segment.
• Cervical effacement is the process by which the
muscular fibres of the cervix are pulled upward &
merges with the fibres of the lower uterine segment
• A

42. • CERVICAL DILATION
• Dilatation of the cervix is the process of
enlargement of the external cervical as from an
orifice of a few mm to an opening large enough for
the baby to pass through .
• dilatation is effected primarily by the hydrostatic
action of the amniotic fluid under the influence of
contractions, causing the membranes to serve as a
dilating wedge in the area of least resistance in the
uterus
• If the membranes have ruptured, the pressure of
the presenting part on the cervix and the lower
uterine segment has a dilating effect.

43. CONTD..
• Dilatation is clinically evaluated by measuring the
diameter of the cervical opening in centimetres,
with 0 centimetre being a closed external cervical
os and 10 centimetres being complete dilatation.
• SHOW: Because of the dilatation of the cervix,
the operculum, which formed the cervical plug
during pregnancy, is lost. This blood stained
mucoid discharge is termed as the Show. The
blood comes from the ruptured capillaries in the
parietal deciduas where the chorion has become
detached from the dilating cervix..

44. MECHANICAL FACTORS
• FORMATION OF THE FORE WATERS:
• As the lower uterine segment stretches, the chorion
becomes detached from it and the increased
intrauterine pressure causes this loosened part of
the sac of fluid to bulge downwards into the dilating
internal so, to the depth of 6-12mm.
• The fluid in front of the head is termed as fore
waters and that which surrounds the body as hind
waters. The effect of separation of fore water is to
keep the membranes intact during the first stage by
preventing the pressure applied to the hind waters
during uterine contractions from being applied to
the fore water.

45. • GENERAL FLUID PRESSURE
• While the membranes remain intact, the pressure
of the uterine contraction s exerted on the fluid
and as fluid is not compressible, the pressure is
equalized through the uterus and over the foetal
body, which is known as general fluid pressure.
• RUPTURE OF THE MEMBRANES
• The physiological moment for the membranes to
rupture is at the end of the first stage of labour
when the cervix becomes fully dilated and no
longer supports the bag of waters. Spontaneous
rupture of membranes may sometimes occur days
or hours before labour begins or during the first
stage

46. Membranes may sometimes rupture days before
labour begins or during the first stage. If for any
reason there is a badly fitting presenting part and
the fore-waters are not cut off effectively then the
membranes may rupture early.
• Ocassionally the membranes
do not rupture even in 2nd stage
and appear at the vulva as bulging sac
covering the fetal head as it is born:
This is known as the ‘Caul’.

47. • FETAL AXIS PRESSURE
• During each contraction the uterus rears
forward (becomes upright) and the force of
the fundal contraction s transmitted to the
upper pole of the uterus, down the long axis
of the foetus and is applied by the presenting
part to the cervix. This is known as foetal axis
pressure.
• It becomes more significant after rupture of
the membranes and during the second stage
of labour

48. PARTOGRAPH
• It was first devised by Friedman (1954)
• Definition
• Partograph is a composite graphical
record of cervical dilation & descent of head
against duration of labour in hours it is also
gives information about foetal & maternal
condition.
• It is been recorded on a single sheet of paper.

49. THE COMPONENTS OF A PARTOGRAPH
ARE:
Components of the partograph
• Part I : fetal condition( at top )
• Part II : progress of labour( at middle)
• Part III : maternal condition( at bottom)
• Outcome : ………………
• Patient identification
• Time-recorded at hourly interval zero time spontaneous labour
is the time of admission & for induced labour is the timr of
induction
• Foetal heart rate recorded hourly.
• State of membranes & colour of liquor: to mark of ‘I’ for intact
membranes ‘c’ for clear ‘m’ for meconium stained liquor.
• Cervical dilatation & descent of the head.

50. CONTD..
• Uterine contractions the square in the vertical
columns are shaded according to duration &
intensity.
• Drugs & fluids.
• Blood pressure –every 2 hour & pulse at every
30 minutes.
• Oxytocin – concentration in the upper box &
dose is the lower box.
• Urine analysis.
• Temperature record.

51. Cervical dilatation
• It is divided into a latent phase and an active phase
• Latent phase :
– It starts from onset of labour until the cervix reaches 3 cm diltation
– Once 3 cm diltation is reached , labour enters the active phase
– Lasts 8 hours or less
– Each lasting < 20 sceonds
– At least 2/10 min contractions
 Active phase :
– Contractions at least 3 / 10 min
– Each lasting < 40 sceonds
– The cervix should dilate at a rate of 1 cm / hour or faster

52. • Alert line ( health facility line )
• The alert line drawn from 3 cm diltation
represents the rate of diltation of 1 cm / hour
• Moving to the right or the alert line means
referral to hospital for extra vigilance
• Action line ( hospital line )
• The action line is drawn 4 hour to the right of the
alert line and parallel to it
• This is the critical line at which specific
management decisions must be made at the
hospital

54. ADVANTAGES:
• A single sheet of paper can provide details of
necessary information at a glance.
• No need to record labour event repeatedly
• It can predict deviation from normal duration of
labour early
• If facilitates handover procedure
• Introduction of partograph and the management
of labour (WHO 1944) has reduced the incidence
of prolonged in maternal morbidity perinatal
mortality & morbidity.

55. FIRST STAGE OF LABOUR (STAGE OF CERVICAL
DILATATION)
• Begins with the 1st true labour contraction and
ends with complete effacement and dilatation of
the cervix(10 cm dilatation).
• The 1st stage of labour averages about 13 ½
hours for a nullipara and about 7 ½ hours for a
multipara.
• Latent phase(early)
Dilates from 0-3 cm.
Contractions are usually every 5 to 20 minutes,
lasting 20 to 40 sec, and of mild intensity.
The contractions progress to about every 5 mts
and establish a regular pattern

56. • Active phase:
Dilates from 4 to 7 cm.
Contractions are usually every 2 to 5 mts; lasting
20 to 50 sec and of mild to moderate intensity.
After reaching the active phase, dilatation
averages 1.2cm/hr in the nullipara and 1.5 cm/hr
in the multipara.
• Transitional phase:
Dilates from 8 to 10 cm .
Contractions are every 2 to 3 mins, lasting 50 to
60 sec and of moderate to strong intensity. Some
contraction may last upto (but not exceed) 90
sec

57. • NURSING ASSESSMENT AND INTERVENTONS
• History and baseline data
• Establish baseline information
• Establish baseline maternal and fetal vital signs
• Obtain urine specimen – test the results for
glucose and protein.

58. VAGINAL EXAMINATION
• Explain the procedure. Place her in lithotomy
position.
• Conduct examination under aseptic technique.
• Evaluate :
Condition of cervix
Presentation
Position
Membranes : intact or ruptured
• Perineum

59. PREPRATION OF LABOUR ROOM AND
WOMEN
• PREPARATION OF LABOUR ROOM
• PREPARATION OF WOMEN

60. PREPARATION OF TROLLEY
• Sponge holding forceps – 2
• Dissecting forceps, toothed – 1
• Dissecting forceps, non-toothed – 1
• Scissors, straight – 1
• Small artery forceps, curved – 4
• Needle holder – 1
• Episiotomy scissors – 1
• Kidney tray – 1
• Sterile drapes
• Towel clips
• Syringe 5 cc, with needle
• Local anaesthesia
• Anti septic solution
• Gauze swabs
• Sterile pads
• Sutures and ligaments( chromic catgut no.0,1)

61. ACTIVE MANAGEMENT OF LABOUR -
1st STAGE OF LABOUR
• The main points which have to be taken care of
during the active management of first stage of
labour are as follows
• EMOTIONAL SUPPORT
• PREVENTION OF INFECTION
• CAREFUL EXAMINATION
• PERINEAL PREPARATION
• ENEMA

62. Contd..
• BLADDER
• REST & POSITION
• DIET
• VAGINAL EXAMINATION
• ABDOMINAL PALPATION
• MONITORING THE FETAL WELL –BEING

63. INDUCTION OF LABOUR
• DEFINITION: this is deliberate initiation of labour
before spontaneous onset after 28 weeks of
pregnancy
• TYPES OF INDUCTION
• Elective induction-it is the indication of labour for
the convenience of woman, the physician or the
hospital
• Indicated induction – it is the induction of labour for
the high risk pregnancies

64. • CERVICAL RIPENING:
• Maturation of the cervix starts around 5-6 weeks
prior to the labour in which the cervix start
getting dilated effaced & soft
• The methods which can be employed for ripening
of the cervix are:
• Use of prostaglandin cervical gel (cerviprime)
• Stripping of the membranes
• Oxytocin infusion
• This method for induction is chosen by assessing
the cervix with the help of bishop’s SCORE

65. BISHOP’S SCORE:
• It was introduced by Bishop in 1964.
• It is practical method of predicting the success
before induction of labour
• The score is mainly useful in multiparous
patient.
• It is done by cervical assesment as shown

66. Paramete
r
Score
Description
0 1 2 3
Cervical
position
Poste
rior
Middle
Anteri
or
–
The position of the cervix changes with menstrual cycles and also tends to
become more anterior (nearer the opening of the vagina) as labour
becomes closer.
Cervical
consisten
cy
Firm Medium Soft –
In primigravid women, the cervix is typically tougher and resistant to
stretching, much like a balloon that has not been previously inflated (it
feels like the bottom of a chin). With subsequent vaginal deliveries, the
cervix becomes less rigid and allows for easier dilation at term.
Cervical
effaceme
nt
0-30% 40-50%
60-
70%
80+%
Effacement translates to how 'thin' the cervix is. The cervix is normally
approximately three centimetres long, as it prepares for labour and labour
continues the cervix will efface till it is 'fully effaced' (paper-thin).
Cervical
dilation
Close
d
1–2 cm 3–4 cm 5+cm
Dilation is a measure of how open the cervical os is (the hole). It is usually
the most important indicator of progression through the first stage of
labour.
Fetal
station
−3 −2 −1, 0 +1, +2
Fetal station describes the position of the fetus's head in relation to the
distance from the ischial spines, which are approximately 3-4 centimetres
inside the vagina and are not usually felt. Health professionals visualise
where these spines are and use them as a reference point. Negative
numbers indicate that the head is further inside than the ischial spines and
positive numbers show that the head is below the level of the ischial

67. • METHODS OF INDUCTION
• There are mainly three methods of induction
• Medical
• Surgical
• Combined
• Medical induction –under medical induction two
drugs are discussed –
• Oxytocin induction
• Prostaglandins
• Surgical induction
• Artificial rupture of membranes
• Stripping of the membranes

68. ANALGESICS AND ANAESTHESIA
• ANALGESICS-The analgesics can be given by
subcutaneous intramuscular or intravenous
route commonly used analgesic are:
• Pethidine
• Meperidine hydrochloride (Demerol)
• MEPTAZINAL
• Pentazocin (fortwin)
• Diamorphine
• Inhalation analgesia

69. ANAETHESIA
• Regional anaesthesia - In the regional
anaesthesia, injection is given to block the
transmission of painful stimuli from the
uterus, cervix, vagina and perineum to the
local anaesthetic can be given one time or
continuously.METHOD USED:
---Para cervical block-In par cervical block, local
anaesthetic injection is given transvaginally,
near to the outer rim of the cervix when the
injection is given during labour mother
achieves the relief from the pain caused by
cervical dilatation

70. • EPIDURAL ANALGESIA
• It can be given by a single injection or by
continuous injection into the epidural space at
the second third or fourth lumbar interspaces
• the pain relief is obtained by blocking the
condition of impulses along the sensory
nerves as they enter spinal cord
• to avoid the risk of supine hypotension
mother is positioned in left lateral for the
procedure the foetal heart & blood pressure
of mother are to be examined throughout the
procedure

71. Site:

72. Position

73. • The advantages of epidural anaesthesia are:
• it gives effect pain relief & does not depress
respiratory centre of foetus
• it also enhance the woman’s rest relaxation ability
to cope.
• The disadvantages include
• the vital signs have to be monitored more
frequently and there can be lengthening of the first
and second stage of labour.
• On addition to this, mother is less able to adapt
different birth positions,
• it may cause infection

74. • SPINAL ANAESTHESIA
• It provides anaesthesia for vaginal or caesarean
delivery
• The anaesthesia is directly given into the spinal fluid
• Spinal anaesthesia has effect on the bearing down
reflex of the mother
• There is no effects on the foetal respiration but can
cause maternal headache & temporary hypotension
• It should not be given in the cases where the
mother is having infection at the puncture site
hypovolemia hypotension or hypertension CPD &
central nervous system diseases

75. • PERINEAL INFITRATION
• Perinal infiltration is done 2-5 minutes before
performing episiotomy around 10 ml of 1%
lignocaine is taken in a syringe
• The perineum on the proposed episiotomy
site is infiltrated
• One should always aspirate before infiltration
• In case of application of forceps or ventouse
perineal & labial infiltration is done

76. • FIRST STAGE OF LABOUR- LATENT PHASE (0 to
3 cm)
• NURSING DIAGNOSIS
• Deficient fluid volume related to decreased
oral intake, lack of eating, and the energy
requirement of labour.
• Anxiety related to concern for self and the
foetus.
• Acute pain related to uterine contraction or
position of the foetus

77. • FIRST STAGE OF LABOUR- ACTIVE AND TRANSITION
PHASE
• NURSING DIAGNOSIS
• Anxiety related to concern for self and foetus.
• Acute pain related to uterine contraction and nausea
and vomiting.
• Impaired urinary elimination related to epidural
anaesthesia or from pressure of the foetus.
• Ineffective coping related to discomfort
• Risk for related to rupture of membranes.
• Impaired physical mobility related to medical
intervention and discomfort.
• Ineffective breathing pattern related to pain and
fatigue.