Management of 1st Stage of Labor

Subject: Midwifery II (Theory)

Overview

The management of the first stage of labor comprises both initial and general care. General care of the mother in the first stage of labor involves environmental care, i.e. physical surroundings should protect from damage and be clean and free of infection, emotional support, reassurance, and physical comfort such as back rubbing. In the same way, infection prevention Thus, throughout the antenatal period, physically prepare the ladies about personal hygiene, diet, and treating anemia. If necessary, a vaginal examination is performed on a regular basis. It is also critical to examine if the equipment is in working order and if emergency supplies such as an anesthetic and a laryngoscope are available and in good working order.

Initial care

  • Make the women and their families feel welcome and at ease.
  • Create a positive relationship.
  • Keep an eye on the mother's vital signs and the fetus's heart rate.
  • Educate the woman and her support person on the birthing environment.
  • Examine the client's emotional and physical well-being.
  • Examine the course of labor and the fetal status.
  • Inform the midwife about your discovery.
  • Provide the client with coping strategies, if applicable.
  • Encourage ambulation whenever possible.
  • If necessary, teach breathing techniques.
  • Examine voiding and other fluids.
  • Examine the amniotic membrane and fluid.
  • Participate in the care of the supporter.

General care

1. Environment

  • The physical environment should safeguard against damage and be clean and free of infection.
  • Maintain a comfortable position for the mother.
  • The mindset of the workers is far more essential than the actual environment.
  • There should be enough light.
  • Help with going to the bathroom

2. Emotional support

  • As a result of labor pain and the new surroundings at the hospital, the mother becomes restless and exerted.
    provide reassurance in addition to physical comforts, such as back stroking
  • Encourage the mother to practice deep breathing exercises during contractions.
  • Keep your privacy and confidentiality

3. Prevention of Infection

  • During labor, both the mother and the fetus are vulnerable to infection.
  • Take extra care when dealing with hepatitis B and HIV/AIDS.
  • Thus, throughout the antenatal period, physically prepare the ladies about personal hygiene, diet, and treating anemia.
  • Handwashing before and after the mother's inspection
  • Always utilize sterilized equipment and employ an aseptic technique when using gloves.

4. Diet

  • During labor, the patient requires enough nutrition and fluids.
  • Early on, tea, biscuits, soup, and fruit can be served.
  • In the final stage, a liquid diet is administered.
  • Avoid eating solid foods.
  • I/O diagramming is required.

5. Position and Posture

  • Can sit in a relaxed position
  • In between contractions, try to relax.
  • To avoid vena cava compression, a lateral posture is preferable.

6. Monitor Vital Signs

  • Vital signs should be checked every two hours or as needed.
  • A pulse rate of greater than 100 beats per minute indicates infection or bleeding.
  • Hypertension is indicated by a blood pressure of 140/90mm Hg.

7. Assess Uterine Contraction

  • The strength, length, and frequency of uterine contractions should be recorded hourly during the latent period and half an hourly throughout the active and transitional phases.
  • Always take notes with your touch on the patient's uterine fundus.
  • Women's reactions cannot be used to judge.
  • Contraction types include mild, moderate, and severe.

8. Observe the Fetal Heart Rate

  • Evaluate the fetal heart rate every half hour in the first stage of labor and every 15 minutes in the second stage of labor following membrane rupture.
  • To identify variation, count for the full 1 minute.
  • The usual range is 120-160b/min.
  • Doppler or fetoscope auscultation is used to evaluate.

9. Intravenous Fluid

  • When symptoms of dehydration are present, I/V fluid is administered.
  • Keep a fluid balance.

10. Care of Bowel and Bladder

  • Encourage the patient to pee every 1-2 hours.
  • If required, catheterization should be performed.
  • An empty bladder allows the presenting part to descend and prevents labor from being delayed.
  • Due to improved intestinal mobility, bowel movement during labor is reduced.

11. Vaginal Examination

  • If necessary, it is done regularly; otherwise, it is done every 4 hours or more frequently if there is a risk.
  • Dilatation of the cervix; a degree of dilation of the cervix in cm in relation to hours of labor is a valid measure of labor progress.
  • To determine the location of the head and the degree of bending.

12. Observe the Membrane Rupture

  • Whether the membrane ruptures
  • If the amnio has ruptured, look at the color of the liquor amnio.

13. Preparation for Childbirth

  • The first stage of labor concludes with complete cervical dilatation.
    instructing on pounding down or pushing effort
  • Birth normally occurs within minutes of complete dilation for a multiparous mother, with only one push afterward.
  • However, the nulliparous woman normally pushes for 1-2 hours before giving birth.
  • When a multiparous woman is 6-7 cm dilated, the nurse will start preparing for delivery because advancement through the last few cm of dilation can take anywhere from minutes to hours.
  • When the presenting component begins to descend the perineum between contractions during the second stage of labor, the nulliparous mother should be transferred.

14. Preparation for Delivery

  • Scrubbing tools, cleaning agents, masks, and safety glasses should all be provided.
  • Handwashing facilities should be available during the delivery process.
  • Gloves and a gown for a doctor, nurse, or midwife.
  • A sterile drape and towel for draping the ladies, as well as a sterile instrument, are arranged for ease of use on a sterile table.
  • There are supplies for clean vulva [antiseptic solution, sterile water].
  • A delivery area should be warm and dust-free.
  • Infant identification or tag material, as well as infant blankets, should be planned ahead of time.
  • Material for caring for an infant's eyes
  • Check to see that the equipment is in functioning order.
  • Supplies such as emergency equipment, anesthetic, and a laryngoscope are available and in good working order.
  • Women's records are up to date and ready to be used during delivery.
Things to remember
  • The management of the first stage of labor comprises both initial and general care.
  • General care of the mother in the first stage of labor involves environmental care, i.e. physical surroundings should protect from damage and be clean and free of infection, emotional support, reassurance, and physical comfort such as back rubbing.
  • In the same way, infection prevention Thus, throughout the antenatal period, physically prepare the ladies about personal hygiene, diet, and treating anemia.
  • The mother's position and posture should be maintained, and a comfortable position should be provided.
  • Keep track of vital signs. 2 hourly or as needed, and also analyze the nature of uterine contractions in terms of strength, duration, and frequency should be recorded hourly during the latent period and half an hour throughout the active and transitional phases.
    Monitor the fetal heart rate and deliver intravenous fluid to keep the fluid balance.
  • Care of the bowel and bladder is critical at this stage; encourage the patient to pass urine every 1-2 hours or catheterization should be performed if necessary.
  • If necessary, vaginal examinations are performed on a regular basis; otherwise, they are performed every 4 hours or more frequently if the patient is at risk.
  • It is equally critical to prepare for delivery. Check to see if the equipment is in functioning order, as well as the emergency equipment, anesthetic, and so on.
Questions and Answers

Management of 1st Stage of Labor

  • Initial Care
    • Make the woman, her family, and yourself feel at home.
    • Establish a good connection.
    • Keep an eye on the fetal heart rate and mother vital indicators.
    • Introduce the woman to the delivery surroundings and her support person.
    • Evaluate the client's physical and mental health.
    • Analyze the fetal condition and labor progress.
    • Inform the midwife about the discovery.
    • Provide the customer with advice on coping techniques.
    • Encourage walking if you can.
    • Teach breathing exercises if necessary.
    • Evaluate urination and other fluids.
    • Evaluate the fluid and membrane of the amniotic sac.
    • Include the supporter in the care.
  • General Care
    • Environment
      • Physical surrounding should protect from injury and be clean and free from infection.
      • Keep the mother in a comfortable position.
      • The attitude of the staff is much more important than physical surrounding.
      • Light should be adequate.
      • Assist while going the bathroom.
  • Emotional support
    • Important because the mother becomes agitated and exhausted from the childbirth pain and the unfamiliar hospital surroundings.
    • Along with aiding in bodily comfort, such as back rubbing, offer certainty.
    • During a contraction, suggest to the mother doing some deep breathing exercises.
    • Maintain secrecy and privacy.
  • Prevention of Infection
    • During childbirth, the mother and fetus are porn to infection.
    • Take extra care while handling people who have hepatitis B, HIV, or AIDS.
    • Therefore, throughout the prenatal time, physically educate the ladies on diet, personal cleanliness, and the treatment of anemia.
    • Cleaning your hands both before and after the mother's checkup.
    • Always utilize sterilized tools and adopt an aspectic method while using gloves.
  • Diet
    • Patient require adequate nutrition and hydration during labour.
    • Tea, biscuit, soup and fruit can be given in early stage.
    • A liquid diet is given in last stage.
    • Solid food should be avoided.
    • I/O charting should be done.
  • Position and Posture
    • Can sit in comfortable position.
    • Relax in between contractions.
    • Lateral position is better to avoid venacaval compression.
  • Monitor Vital Signs
    • Monitor vital signs 2 hourly or as per needed.
    • Pulse rate more than 100/b/min indicates infection or hemorrhage.
    • Blood pressure 140/90mm of hg indicates hypertension.
  • Assess Uterine Contraction
    • Nature of uterine contraction as regard to its strength, duration and frequency should be recorded hourly during latent phase and half an hourly during active and transitional phase.
    • Always record by placing a hand on the patient uterine fundus.
    • Cannot be judged by the reaction of women.
    • Nature of contraction are mild,moderate and severe.
  • Observe the Fetal Heart Rate
    • Assess the fetal heart rate half an hourly in 1st stage of labor and in every 15 mins in the 2nd stage of labor following rupture of membrane.
    • Should count for full 1min to identify variation.
    • Normal range 120-160b/min.
    • Assess by auscultation with Doppler or fetoscope.
  • Intravenous Fluid
    • I/V fluid is given when prolonged or if there are sign of dehydration.
    • Maintain a fluid balance.
  • Care of bowel and bladder
    • Encourage the patient to pass urine 1-2 hourly.
    • Catheterization should be done if necessary.
    • Empty bladder helps to allow then presenting part to descend and to prevent delay in labour.
    • Bowel movement during labor is reduced due to increased intestinal mobility.
  • -Vaginal Examination
    • It is done frequently if necessary otherwise, it is done every 4 hourly or if at risk done 2 hourly or more.
      • Dilation of the cervix ; the progress of labor is usually passed by a degree of dilation of the cervix in cm in relation to hours of labor is reliable index.
    • To know the position of head and degree of flexion.
  • Observe the Membrane Rupture
    • Observe membrane rupture or not.
    • If ruptured , observe the color of liquor amnio.
  • Preparation for Childbirth
    • The 1st stage of labor ends with the complete dilation of the cervix.
    • Teaching about beating down or pushing effort.
    • For a multiparous woman, birth usually occurs within minutes of complete dilation, perhaps only one push later.
    • But the nulliparous woman usually pushes for 1-2 hours before delivery. The nurse will begin preparation for delivery when a multiparous woman is 6-7 cm dilated because progression through the last few cm of dilation can occur from few minutes to hours.
    • Transfer of nulliparous woman should take place when the presenting part begins to descend the perineum between contraction during the 2nd stage of labor.
  • Preparation for Delivery
    • Scrubbing facilities, cleaning agent, mask and protective glasses should be available.
    • Facilities for handwashing during the delivery process should be there.
    • Gown and gloves for a doctor/nurse/midwife.
    • Sterile drape and towel for drapping the women and sterile instrument are arranged of convenience in use on a sterile table.
    • Supplies for clean vulva are available [ anti-sceptic solution,sterile water ].
    • A delivery area should be warm and free from dust.
    • Infant identification or tag material and infant blankets should be pre-arranged.
    • Material for a care of infant's eyes.
    • Check if the equipment are in working conditions or not.
    • Emergency equipment , anesthesia, laryngoscope are supplies are available and in good working condition.
    • Women record is up to date and ready for used in delivery.

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