Role of nurse on management in

labor

DEFINITION

Labor is a process by which the fetus, Placenta and membranes are expelled through birth canal.

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 in to outer world is called labour.

STAGE OF LABOUR

FIRST STAGE:- It starts from onset of true labor pain and ends with full dilatation of cervix. It’s average duration 12hrs in primigravida and 6hrs in multipara.

SECOND STAGE:- It starts from the full dilatation of cervix and ends with expulsion of fetus from the birth canal.

THIRD STAGE:- It begins after expulsion of fetus and ends with expulsion of the Placenta & membrane.

FOURTH STAGE:- It is the stage of observation for at least one hour after expulsion.

MANAGEMENT OF FIRST STAGE LABOUR

Enema

Perineal shave

Food & Fluids by mouth

Intravenous infusion

Position & Ambulation

Medication

Monitoring Maternal physiological changes

Vital sign

Renal system

GI changes

Haematological changes

Monitoring Of Fetal Wellbeing

Evaluation Of Maternal Wellbeing

Vital sign

Bladder care

Urine test

Hydration

Bodily Care Of Progress Of Labour

Back rub

Abdominal rub

Effleurage

EVALUTION OF PROGRESS OF LABOUR:

Partogram –

Partogram is a graphic recording of the salient features of labour status. In the management of women in labour partogram serves to validate the normal progress of labour and to facilitate early identification of deviations from normal pattern.

Maternal vital signsUterine contractionsFetal heart rateVaginal examination findingsFluid balance Urine analysisDrugs administered

MANAGEMENT OF SECOND STAGE OF LABOUR:

Vital Sign

Bladder care

Hydration & General condition

Maternal pushing effort

Analgesia & Anaesthesia

Perineal integrity

Episiotomy

Evaluation of progress of labor

Contraction Pain

Length of Second Stage

Descend & Station

Progress through the mechanism labor

PREPARATION FOR THE DELIVERY:Location of the delivery Position for the deliveryGeneral preparationCONDUCTION OF DELIVERY:Clamping and cutting the Umbilical cordImmediate care of the Newborn

MANAGEMENT OF THIRD STAGE OF LABOUR:

Delivery of the Placenta & Membrane.

Sign of placental separation

•Fresh blood loss

•Lengthening of the cord

•Fundus becomes rounder,smaller & more mobile in the abdomen

Expectant management

Assisted expulsion

•Controlled cord traction

•Expression by fundal pressure

Use of Oxytocic agent.

Examination of Placenta & Membrane.

Immediate care to mother & baby.

MANAGEMENT OF FOURTH STAGE LABOUR:

Evaluation & Inspection

•Evaluation of Uterus

•Inspection of Cervix

•Repair

•Perineal Cleansing & Positioning Of Leg

Continuing Case Monitoring:

Vital sign check

Palpation of the fundus of uterus for contractility

Massage of uterus and expression of clots

Measurement of fundus

Inspection of the perineum

Inspection of bladder

Inspection and change of perineal pad

THANK YOU

Mrs. Kalyani RathLecturer, KINS