09/09/2023
Hi. Welcome to today's lesson .My name is cecilia Chabinga ,a nurse midwife with a difference.
Today we are discussing;
MANAGEMENT OF FIRST STAGE OF LABOUR.
AIMS
-To monitor maternal well being to detect any deviation from the normal that can compromise the progress of labor.
-To monitor progress of labor in order to detect any deviation from the normal
-To monitor fetal well being to that the baby is delivered successfully or prevent any complications that can arise during first stage of labor.
ADMISSION/ENVIRONMENT
-Admit the client in labor ward for specialized midwifery care.
-Keep the room well lit for easy and visible care of nursing activities.
-Keep the room clean by doing daily dump dusting to prevent harboring of infection which can cause secondary infections such as nosocomial infections.
-keep the room warm by switching on near by heater to prevent client developing hypothermia due to prolonged exposure to cold environment.
-Keep the room quiet by eliminating noise in order to help the client to relax.
-Keep the room well ventilated by opening near by windows with caution to promote air circulation
-Keep necessary equipment near by such as fetal scope for checking fetal heart, oxygen for in case of fetal distress ,vital sign tray for monitoring vital signs
-Prepare well equipped delivery trolley in case of cervical dilatation.
PSHYCHOLOGICAL CARE
-Tell the client that client that she is in established labor to impact knowledge and gain cooperation
-Reassure the woman the fetal condition is normal in order for her to have a positive mind of having a live baby
-Explain every procedure such as vaginal examination to promote cooperation
-Involve significant others to promote sense of belonging.
-Promote nurse patient relationship to promote cooperation.
-Allow the woman to ask questions concerning her conditioned. answer appropriately to relieve any psychological tension.
OBSERVATIONS
-Measure vital signs ,these are temperature, blood pressure ,pulse and respiration to detect any deviations from the normal in order to carry out nursing interventions as these will prevent any maternal complications
-Measure the temperature 4 hourly to detect any fever that may indicate maternal infections such as malaria.
-Check pulse half hourly to detect deviation from the normal such as tachycardia which may be present in a woman with eclampsia.
-Check blood pressure 2 hourly to rule out hyperattention
-Check respirations 4 hourly to rule out maternal acidosis.
-Observe the woman reaction to labor so as to to give apriority nursing intercalations such as psychological care.
NUTRITION
-Give light diet to promote intake of food.
-Encourage intake of energy giving foods such as fruit drinks to promote energy which will enable her to go through the process of labor.
-Cannulate the client to provide parental feeding such as 5 percent dextrose as this will promote energy.
-Give attractive food to promote food in take for energy
PAIN MANAGEMENT
-Preform back rubs ,this will block pain impulse to relieve pain.
-Give pethidine 50 mg im if client is in severe pain and cervical dilatation is less than 6 cm to reduce pain.
-Give diversional therapy such as giving a book on the care of new born babies to divert the mindset from concentrating on the pain
HYGIENE
- Encourage the woman to take tab bath to promote comfort and self image esteem.
-Change soiled linen to promote hygiene.
MONITORING UTERINE CONTRACTION
-Monitor uterine contractions every after 30 minutes for duration of 10 minutes to determine the nature of uterine contraction.
-Check the number of utrine contractions in 10 minutes and how long each last in order to record them accordingly.
-If the number of contraction in 10 minutes is about 1 to 2 and each contraction last less than 20seconds,grade it as mild contraction.
-Check the number of contractions in 10 minutes and how long each last in order to grade them accordingly.
-if the number of contraction in 10 minutes are about 2 to 4and each contraction last about 20 to 40 seconds, grade as moderate
- If the contractions in 10 minutes are 4 to 5and each last 40 to 60 seconds, grade as strong contractions.
DECENT
-Monitor decent to see if the fetus is descending deeper in the pelvic cavity as well as to rule out prolonged labor.
-Assess decent by the number of fingers pressed at the pelvic brim in order to grade it accordingly.
VAGINAL EXAMINATION
-Carry out vaginal examination 4 hourly to feel the presenting part and to know cervical dilatation.
-Take note of the station and warmth to detect any abnormalities that may delay progress of labor.
-Measure cevical dilatation in in cm to determine progress in cervical dilatations this gives reflection to the progress of labor
FETAL WELLBEING
-Monitor fatal heart rate half hourly to detect deviations from the normal such as heart rate above 180 beats which may indicate fetal distress.
-Monitor amniotic fluid if membranes have ruptured, check for the color and consistence of the liquor to detect any abnormality such as presence of fresh meconium which may indicate fetal distress.
-Check for the presence of blood to rule out antepartum hemorrhage which may compromise the fatal wellbeing .
-If the membranes have ruptured, and the amniotic fluid is clear, enter the information on the partograph using a symbol C.
-if the amniotic fluid is blood stained indicate B on the partograph.
-This information will help the midwife to carry out necessary interventions such as caesarian section if needed.
MOULDING
-Check for over lapping of fetal skull bones in order to grade it accordingly.
-If the skull bones are overlapping but reduceable, on digital pressure grade it as a 2+ plus and if not reduceable on digital pressure grade it as 3+.
-Inform the doctor if the fetal skull bones is 3+ as this may indicate cephalopelvic disproportions that necessary intervention can be done such as caesarean section.
Kindly drop a comment and and let us have a conversation.
Thanks for your attention.
