Labor – First Stage

Management
Dr. S. Kalavathi
Professor
RMCON, AU.
Introduction

 Labor is a unique experience in women’s life

 Labor events have got great psychological, emotional

and social impact to the woman and her family

 By utilizing the knowledge of physiological changes

during pregnancy, we can give appropriate care to the
mothers in labor

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General Considerations

 Labor pain is real . Mother experiences pain, stress

and fear of unknown/danger

 Mother is sensitive. Caregivers need to be tactful,

sensitive and respect her

 Mother can choose her birth companion

 Continuous emotional support can reduce the need

for analgesia & operative delivery
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General Considerations [Cont..]

 Privacy must be maintained

 Keep her informed and explain her

 Provide environment to her so that she can give birth

with dignity

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Aims of management of Normal Labor

 Maximal observation with minimal active intervention

 To maintain normalcy and to detect any deviation

from normal at the earliest possible moment

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Admission of the Mother

 Quick assessment

 Care according to the stage of labour

 Make her feel comfortable by reassurance and

welcome attitude

 Admission bath

 Dress, Jewels, nailpolish, artificial dentures, lenses

etc
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Antisepsis & Asepsis

 Strict asepsis and antisepsis should be maintained

 Shaving or hair clipping of the vulva

 Shower or bath & wear laundered gown

 Perineal care

 Strict aseptic technique precautions to be taken

during vaginal examinations and during conduction of
delivery
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Vaginal examinations in labor

 Vaginal examination is done on admission by a senior

doctor -to confirm the onset of labor, to confirm the
presenting part & its position & Pelvic adequacy
(Primi)

 This findings serve as a baseline data

 Frequent PV should be avoided

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Vaginal examinations in labor [Cont..]

 Even if the proper aseptic techniques are followed

there is chance of introducing the infection, specially
after the rupture of membranes

 It can be done every 4 hourly in normal labor to

assess the progress of labor

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Vaginal examinations in labor [Cont..]

Indications

 At the onset of labor

 Repeated at 3 to 4 hourly

 Following rupture of membranes to exclude cord

prolapse

 To confirm the onset of second stage of labor

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Management of First Stage

Principles

 Noninterference with watchful expectancy so as to

prepare the patient for natural birth.

 To monitor carefully the progress of labor, maternal

conditions and fetal behavior so as to detect any
intrapartum complication early

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Management of First Stage

General Care

 Admission of the mother

 Confirm the stage in which she is – care accordingly

 Reassure & welcome her

 Constant supervision

 Avoid supine position in bed to avoid vena caval

congestion
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Management of First Stage

Bowel Care

 Traditionally an enema with soap and water or glycerine

suppository is given early in labor

 Enema reduce the load in the rectum & contamination in

second stage

 Studies have proved that enema does not shortens the 2 nd

stage or the rate of infection

Giving enema – Follow the Institution Policy

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Management of First Stage [Cont..]

Rest and Ambulation

 Mother can be ambulated in first stage if

 The membranes are intact

 Not given any analgesia

Ambulation can reduce the duration of labor and

the need of analgesis & improve the maternal
comfort
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Management of First Stage [Cont..]

Diet

 Emptying of the stomach is delayed in labor

 Gastric content pH is low

 Fluids (Juices, water) may be given in early labor

 Intravenous infusion may be started where any intervention

is anticipated or patient is under regional anesthesia

 Food is withheld in active labor

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Management of First Stage [Cont..]

Bladder Care

 Encourage her to empty the bladder by herself frequently

[Full bladder inhibits uterine contractions and may lead to
infection]

 If women can not go to the toilet, bedpan to be provided

 Maintain privacy

 If fails to urinate on her own, catheterize following aseptic

precautions
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Management of First Stage [Cont..]

Relief of Pain

 Pain relief is an important aspect in care of mother in

labour

 Pain relief can be achieved by either Pharmacological or

Non Pharmacological methods (Will be taken as a separate
topic)

 Proper explanation, reassurance, relaxation, back massage

etc. are useful in relief of pain
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Management of First Stage [Cont..]

Relief of Pain (Cont..)

 Common analgesic drug used is Pethidine 50 to 100mg IM –

in well established labour

 Can be repeated after 4 hours

 Pethidine crosses the placenta, causes respiratory depression

to the neonates

Pethidine should not be given if delivery is anticipated

within 2 hours .
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Management of First Stage [Cont..]
Observation
 Maintain partograph

 Maternal Vitals – Pulse, Respiration, BP, Temperature

 Observe the tongue periodically for hydration

 Foetal wellbeing – FHR

 Uterine contractions – duration & interval

 Urine output

 Descend of presenting part – by abdominal palpation, pelvic grip, PV

examination & shifting of maximal intensity of FHS
Management of First Stage [Cont..]
Assessment of Fetal Wellbeing

 Check the FHR – Rate, rhythm, and intensity

 Counted every half an hour in early labour ; Every 15 minutes in late

labour; and every 5 minutes in second stage of labour

 Count FHR for full 1 minute; The observation immediately following

uterine contractions is valuable

 Normal FRH – 110 to 160 beats per minute

 Continuous Electronic Fetal Monitoring –

is done in high risk pregnancies

Clinical Fetal Monitoring

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Clinical Fetal Monitoring

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Management of First Stage [Cont..]

Assessment of Progress of Labor

 Pain – duration and interval. As the labour advances, the

duration increases and the interval decreases

 Station of the head – can be assessed by abdominal

palpation & PV examination

 Cervical dilatation & effacement. After latent phase, in

Primi – 1 cm/hour & in Multi – 1.5 cm/hour is the rate of
dilatation.
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Management of First Stage [Cont..]

Preperation for Second Stage of Labor

 The mother may be anxious of labour, because of pain

and fear of unknown, Fear of outcome of labour etc.

 Physical Preperation of the mother

 Psychological preparation of the mother

 Preperation of delivery tray, resuscitation tray etc.

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Evidence of Maternal Distress

 Anxious look with sunken eyes

 Rising pulse rate of 100 per minute or more

 Dehydration, dry tongue

 Hot, dry vagina often with offensive discharge

 Acetone smell in breath

 Scanty high colored urine with presence of acetone

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Summary & Conclusion

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Thank You…

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