GENERAL MANAGEMENT OF FIRST STAGE OF LABOUR

REQUIREMENTS #

• A Trolley containing:
  1. Watch with a second hand
  2. Ball pen
  3. Observation chart/Partograph/WHO Labour chart (manual/ electronic)
  4. Chair
  5. Foetal stethoscope(pinnard)/ Electronic foetal monitor
  6. Ultrasound gel
  7. Tissue
  8. Linen (for draping)
  9. Kidney dish
  10. Rubber apron
  11. Hand sanitizers
• Vaginal Examination tray
  1. Gallipot containing diluted antiseptic lotion
  2. Sterile cotton wool swab
  3. Sterile gloves
  4. Perineal pad

STEPS #

1. Explain procedures to client (refer steps)
2. Ask client to empty bladder and provide privacy
3. Take accurate labour history (time of onset of labour, present of show or state of membrane etc.)
4. Assemble all items at the bedside
5. Put on rubber apron and perform hand hygiene
6. Assist client to adopt a dorsal position in bed
7. Perform a quick head to toe examination and note any deviation
8. Check vital signs every 4 hourly and record appropriately
9. Perform hand hygiene and wear sterile gloves  
10. Perform vaginal examination every 4 hourly; noting dilatation of cervix, state of membranes, moulding, position of presenting part, descent and adequacy of pelvis
11. Remove gloves and perform hand hygiene
12. Perform abdominal palpation and auscultate foetal heart rate
13. Time contractions, noting duration, frequency and intensity for 10 minutes
14. Monitor foetal heart rate, contractions and maternal pulse every 30 minutes and record appropriately
15. Evaluate the degree of pain and manage as such
16. Ensure client is well hydrated; by encouraging her to take nourishing fluid if indicated or intravenous fluid when necessary
17. Encourage the client to empty her bladder every 2 hours or pass urethral catheter when necessary
18. Test urine for protein and sugar every 2 hours
19. Allow client to adapt to preferred position if not contraindicated
20. Encourage client to rest in between contractions as much as possible
21. Assist client to maintain cleanliness and ensure Infection Prevention Control measures throughout
22. Allow preferred choice of companion to give necessary support to client
23. Address client’s concerns and keep her informed about progress of labour
24. Record all findings into the partograph/WHO labour care chart
25. Report any deviations from normal as soon as possible to the officer in-charge