Download - Labor Watch
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LABOR WATCHOBJECTIVES:At the end of the lecture the students will:
Know the routines and SOPs of the different affiliatedhospitals and birthing centers.
Know their responsibilities during labour.
Assess patients needs during each phase of the firststage.
Recognize any abnormal manifestations and refer. Able to give proper health teaching to patients and
folks.
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LABOUR is described as the process by which thefetus, placenta and membranes are expelled throughthe birth canal.
NORMAL LABOUR occurs at term and is spontaneousin onset with the fetus presenting by the vertex. Theprocess is completed within 18 hours and no
complications arise.
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THREE STAGES OF LABOUR
FIRST STAGE: (Cervical Stage) The period from the
onset of true labour contractions until full cervicaldilatation and effacement is achieved. Two importantevents take place during the first stage : cervicaldilatation and effacement.
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Cervical effacement/Obliteration/Taking up. It refers to theshortening of the cervical canal from a length of about 1 to2 cm until it is paper thin. In primis, dilatation begins
when the cervix is completely effaced. In multis, dilatationand effacement takes place at the same time. Effacement isexpressed in percentage.
Cervical dilatation refers to the enlargement or wideningthe cervical canal. Uterine contraction causes dilatation bypulling the cervix over the presenting part, called the
Ferguson Reflex. The BOW and the fetal head also act as awedge in dilating the cervix. It will be noted that there isincreased amount of show as dilatation is completed sincethe last of blood tinged operculum is dislodged. Dilatationis expressed in centimeters.
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SECOND STAGE: (Expulsive Stage)This occursfrom full cervical dilatation until the birth ofthe baby. The main event of thisperiod is the birth of the baby.
THIRD STAGE: (Placental Stage). This is the periodfrom delivery of the baby to the expulsion of theplacenta.
FOURTH STAGE: (Immediate Postpartum Period).
The period from delivery of placenta until thecondition of the woman has stabilized.
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THREE PHASES OF FIRST STAGE OF LABOUR
Early
Active
Transition
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PHASES OF
FIRST STAGE
OF LABOUR
CERVICAL
DILATATION
INTERVAL DURATION TIME FRAME
Early 0-3 cm 5-30 Mins. 30-50 Seconds 12-24 Hours
Active 4-7 cm 3-5 Mins. 60 Seconds 4 12 Hours
Transition 8-10 cm 2-5 Mins. 60 - 90Seconds
10mins. -1 Hr.
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I. EARLY FIRST STAGE LABOUR
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PHYSICAL SIGNS (Early First Stage Labour)
Bloody show
Cramping
Pressure tightening
Loose stools
Backache
Flu
Resting
Contractions
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EMOTIONAL SIGNS (Early First Stage Labour)
Restless In control
Confident
Fear
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MANAGEMENT (What to do?)
Distracting
Sleep
Eat/Drink
Rest
Walk
Watch T.V./Read
Shop/Run Errands
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II. ACTIVE FIRST STAGE LABOR
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Physical Signs (Active First Stage Labour) Contractions demand full attention Retreat in wards Irritable Walk become slow Leg pains Water might break Less aware of surroundings Bleed more Nauseated Backache
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Emotional Signs (Active First Stage Labour)
Serious
Full Attention
Tired
Discouraged
Losing confidence
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MANAGEMENT (What to do?)Manage Pain:
Relax
Breath Rock
Visualization
Music Massage
Groan
Dim lights
Shower Freedom of movement
Hot/cold packs
Conserve Energy Let Labour Take over
Change positions
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Positions for Labour
Upright Position: gravity can help encourage the baby
to move down into mothers pelvis and to keep her asactive as possible.
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Squatting encourages baby to descend quickly andmakes pushing easier.
Kneeling(on something soft supported by birthpartner) and;
Leaning/Resting your hand (on birthing ball or bed)can help stretch your pelvic ligament or the slight
rocking movement back and forward may help to easepain.
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Standing and standing with bended knees, gravity willhelp baby move downward
Sitting Upright is the best position if youve beenstanding for long time and feel tired or if you had anepidural and want to remain upright and have limitedmovement.
Lying on the side if you had an epidural or if the babyis coming too quickly, this position can slow things
down.
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III. TRANSITION PHASE OF EARLY STAGE OFLABOUR
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PHYSICAL SIGNS :(Transition Phase of First Stage Labour)
Shaking
Sweating Nausea
Vomiting
Groaning Backache
Rectal pressure/urge to push
Tremble Loss of modesty
Unpleasable
Hot/cold
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EMOTIONAL SIGNS :
(Transition Phase of Stage Labour)
Cant take it anymore
Cant go on
Overwhelmed
Confused
Out of control
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MANAGEMENT (What to do?)
Support
Squat/Kneel/Lean Comfort Measures
Open up/ Release
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Students Responsibilities
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Students ResponsibilitiesHandle:
Prepare the instruments needed or open pack
Primi Set G1-G2 -2 forceps1 bandage scissors
1 needle holder
1 suture scissors
Multi Set G3 and above - 2 forceps1 bandage scissors
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Don gloves
Drape the patient after perineal prep has been done
Arrange the instruments Fill the syringe with anesthesia
Open the suture and cut 1/3 by 2/3 or per doctorspreference
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Assist: Position patient at D.R. table.
Adjust light
Provide O.S., syringe, xylocaine 2%, rubber ear syringe
and suture to the sterile pack. Provide D.R. chair to the doctor if needed.
Check and regulate IVF.
Check FHB and BP
Provide the needs of Handle
Record the time of birth and the delivery of placenta.
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Circulating:Adjust Kelly pad when needed.
Remove O.B. Pad/ Adult Diaper
Do perineal preparation aseptically
Gather relevant information from the patient. Prepare I.D. band for the baby.
Work and provide the needs of baby care
Record the time of baby out together with the assistingnurse.
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Baby Care: Prepare the crib or Basinet
Open light/ Heat lamp
Check suction machine and attached suction tip (NGT
F8) Gather needed materials from folks e.g. baby dress,
wrap, diaper and adult diaper for the mother.
Don gloves
Stand at the side of the patient while holding 1 sterileO.S.
Observe the time of baby out.
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Students responsibilities
as soon as the baby is out:Baby Care:
While holding one of the babys legs, wipe the noseand mouth. Wipe also the body with the sterile towelprovided. Suction with rubber syringe when needed.
Once pulsation stops, clamp the umbilical cord 2cmfrom the base. Cut.
Remove the first towel and initiate Skin to Skin contactof the baby with the mother.
Cover the babys head (bonnet) and body with a cleanbaby wrap.
Place I.D. band; 1 at the left leg and 1 at the right wrist.
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Observe until the baby is able to hold and suckcorrectly at the mothers breasts.
Inject Vitamin K at the left vastus lateralis and Hepa B
vaccine at the right vastus lateralis. Measure head, chest, abdominal circumference and
length of the baby.
Check weight and temperature by anal route.
Apply ophthalmic ointment from inner to outercanthus.
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Handle:
Offer 2 forceps to the doctor one at a time, thenbandage scissors.
Wait until the placenta is delivered.
In delivering the placenta:
*Wait for the signs of placental separation, beforepulling the cord.
Assist the doctor while doing episiorrhaphy.
Do final perineal cleaning and flushing. Transfer the patient out of D.R. via stretcher after adult
diaper has been fixed.
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Assist:
Inject Oxytocin 10 units I.M. to the mother.
Check BP after the placenta is out. Check for uterine contraction
Apply ice pack per doctors order.
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Circulating:
Help in the cleaning and transferring out of patient.
Maintain the tidiness and cleanliness of the unit.
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Thank you!!!