Step to follow INTRAPARTAL CARE I. II.

When the patient comes in the birthing center, the Midwife should greet the woman and make her comfortable. Should Examine the woman for EMERGENCY Signs as FF: 1. Loss of Consciousness, convulsion 2. Vomiting, severe headache with blurring of vision. 3. Vaginal Bleeding 4. Looks very Ill 5. Fever 6. Severe Breathing difficulty. The midwife should assess the womans and Fetal Status 1. Ask about Labors History a. When did the contraction started b. Have the water broken (Bag of Water) c. Is the baby moving 2. Check the record (HBMR and Child record) a. EDD b. Prior Pregnancy (GTPAL) c. Any Cesarean Section 3. Assess uterine Contraction: Intensity, Duration and Interval 4. Observe the woman response to Contraction. 5. Perform Abdominal Exam (Leofolds Manuever, FHT) between contractions.

III.

The midwife should determine the stages of Labor. 1. Explain to woman that you will perform Vaginal Examination (Internal Pelvic Exam) 2. Inspect the vulva for the following: a. Bulging of perineum b. Visible fetal Parts c. Vaginal Bleeding d. Leaking Amniotic Fluid (Clear, Meconium, Foul smelling) e. Warts, Keloid tissue, Scars that may interfere delivery 3. Perform Gentle Vaginal Examination (do not start During Contraction) a. Do not shave perineal area b. Wash hands with soap before and after each examination c. Put on gloves d. Position the woman legs flexed and apart (lithotomy) e. Determine the cervical dilatation in centimeters f. Feel for the presenting part. g. Feel for the Membrane are they intact. h. Feel for cord (pulsating or not) ***Note (DO NOT perform Vaginal Examination if there is any abnormal bleeding 4. Explain findings to the woman and reassure her. 5. Record findings in labor record or partograph. SIGNS BULGING THIN PERINEUM Vagina gaping ad head visible Full cervical dilation Cervical Dilatation Multigravida > 5 cm Primigravida > 6 cm Cervical dilation > 4cm CLASSIFY Imminent Delivery MANAGE Manage 2nd stage of labor Record in Partograph

IV.

Late Active

Early Active Labor

Cervical Dilatation at 0-3 cm Contractions weak and <2 in 10 minutes

Not in Labor

Manage 1st stage of Labor Record in partograph Record in Labor record Manage 1st stage of Labor Record in partograph Record in Labor record Record in Labor record

1. FIRST STAGE OF LABOR (LATENT or PRODROMAL PHASE) Cervix is dilated 0-3 cm.

Contraction are weak (< 2 in 10 minutes)

Assessment: Dilatations 0-3 cm Frequency 5-10 mins Duration 20-40 mins Intensity mild Mother is excited, apprehensive but can communicate Nursing Care: Encourage walking : shortens 1st stage of labor Encourage to void q 2-3 hrs : full bladder inhibits uterine contraction breathing (chest breathing technique)

What to do: Every hour: check for emergency signs, frequency, intensity and duration of each contraction, FHR and mood and behavior of the woman. Every 4 hours: Check vital signs and cervical dilatation Record findings in partograph and labor record. NOTE: after 8 hours, if contraction is strong and more frequent but no progress in cervical dilatation: *REFER*

Active or Accelerated Phase:

Cervix is dilated 4 cm or more (Active labor)

Assessment: o Dilatations 4-8 cm o Frequency q 3-5 mins lasting for 30-60 secs o Duration 30-60 secs o Intensity moderate Nursing Care: o M edications have meds ready o A ssessment include: v/s, cervical dilatation & effacement, fetal monitor, etc o D ry lips oral care (ointment), dry linens o Breathing abdominal breathing (teach or coach proper breathing technique)

Transitional or Transient Phase Assessment: o Dilatations 8-10cm o Frequency q 2-3 mins contractions o Duration 45-90 sec o Intensity strong o Mood of mother suddenly change accompanied by hyperesthesia (hypersensitivity of mother to touch) of the skin Management o sacral pressure, cold compress Nursing care: o T tires o I inform of progress (to relieve emotional support) o R restless support her breathing technique o E encourage & praise o D discomfort

What to do: Check every 30 minutes for emergency signs, frequency and duration of contraction, mood and behavior. Check every 4 hours: fever, PR, BP, Cervical Dilation. Record Time of Rupture of membranes and color of the amniotic fluid. Record findings in partograph. CAUTION 1. DO NOT do IE more frequently than every 4 hours. 2. DO NOT allow the woman to push unless delivery is imminent 3. DO NOT give medications to speed up labor (DANGEROUS) may cause trauma to mother and baby. 4. DO NOT give fundal Pressure may cause uterine rupture and fetal death.

SECOND STAGE OF LABOR: this is from full dilatation (10CM) of the cervix until birth of the baby. How to tell if woman is in 2nd stage of labor On IE, cervix is fully dilated Woman wants to bear down Strong uterine contraction 2-3 minutes Bulging of the perineum, fetal head visible during contraction BOW will rupture. What to do during the second stage of labor? Check frequency, Intensity and duration of the uterine contraction