Management of first stage of labor

“First stage of labor starts from the onset of the true labor pain and ends with full dilatation of cervix “

Principles of management of first stage of labor

1. Noninterference  with watchful expectancy so as to prepare the patient for natural birth.
2. To monitor carefully the progress of labor , maternal conditions and fetal behavior so as to detect any intrapartum complication early.

Acute management of first stage of labor :

1. General management
2. Position
3. Bowel
4. Rest and ambulation
5. Diet
6. Bladder care
7. Relief of pain
8. Assessment of labor and partograph recording
9. Abdominal palpation
10. Note the fetal wellbeing
11. Vaginal examination

GENERAL MANAGEMENT :

• Encouragement , emotional support and assurance are given to keep up the morale
• Constant supervision is ensured.
• Antiseptic dressing

Position :

• Generally , a women in early normal labor may not be confined to bed.
• While in bed she may take the position most comfortable to her
• She should avoid dorsal supine position to avoid aortocaval compression.

Bowel :

• An enema with soap and water or glycerin suppository is traditionally given in early stage .
• This may be given if the rectum feels loaded on vaginal examination.
• But enema neither shortens the duration of labor nor reduce the infection rate

Rest and ambulance :

• If the membrane are intact , the patient is allowed to to walk.
• This attitude prevents venacaval compression and encourage decent of head .
• Ambulation can reduce the duration of labor , need of analgesics and improve maternal comfort.
• If labor is monitored electronically or analgesics drug is given ,she should be on bed.

DIET :

• There is delayed emptying of stomach in labor.
• Low pH of the gastric content is a real danger if aspirated following general anesthesia when needed unexpectedly .
• So food is withheld during active labor.
• Fluids in the form of plain water , ice chips or fruit juice may be given in early labor
• Intravenous fluid is started when patient is under regional anesthesia.

Bladder care :

• Patient is encourage to pass urine by herself as full bladder often inhibits uterine contraction and may lead to infection
• Privacy must be maintained and comfort must be ensure
• If the patient fails to pass urine especially in late first stage, catheterization is to be done with strict aseptic precaution.

Assessment of progress of labor and partograph recording :

• Pulse is recorded every 30 min .
• Blood pressure is recorded every 1 hour
• Temperature is recorded at every 2 hour
• Urine output is recorded for volume , protein , acetone
• any drug is given is recorded on partograph

Note the fetal well-being :

• Fetal heart rate along with its rhythm and intensity should be noted every half hour in the first stage and every 15 min second stage or following rupture of membrane
• To avoid confusion of maternal and fetal heart rates ,maternal pulse rate should be counted.
• Normal fetal heart rate ranges from 110- 160 beat per minute.
• Continuous electronic fetal monitoring should be done.

Vaginal examination :

• Dilatation of the cervix in centimeters in relation to hours of labor is a reliable index to note the progress of labor
• To note the position of the head and degree of flection
• To note the station of the head in relation to ischial spine
• Color of liquor ( clear or meconium stained ) if the membrane are rupture
• Degree of molding of the head

Evidence of maternal distress are :

• Anxious look with sunken eyes
• Rising pulse rate of 100 per min or more
• Dehydration, dry tongue
• Hot , dry vagina often with offensive discharge
• Acetone smell in breath
• Scanty high colored urine with presence of acetone