UNIT4.0

TOPIC: LABOUR AND DELIVERY

Instructional Materials: 

• White board & Marker

• Videos

• Pictures 

• Partograph

• Mama and Neonatalie model

• Pelvic bone

Teaching Method:

• Lecture

• Discussion

• Brainstorming

• Demonstration

Types of Assessment: 

• Q&A, 

• Assignment

• MCQ

Learning Objectives: At the end of the lesson the students will be able to;

• Define Labour

• Identify False and True labour

• Describe the Stages of labour

• Describe Good practices and supportive care during labour

• Describe the management of labour

• Identify the danger signs during labour

4.0 INTRODUCTION 

Intra-partum care is the care provided during labour, between the onset of regular uterine contractions to the delivery of fetus, the placenta and its membranes. The period could be normal or complicated.

4.1 DEFINITION OF LABOUR

It is described as the process by which the fetus, the placenta and membranes are expelled through the birth canal. The term labour is only used when the pregnancy has exceeded 28 weeks otherwise it is called abortion.

4.2 NORMAL LABOUR

It is described as the spontaneous and progressive contraction of the uterus at term with the fetus presenting by the vertex. The process ends naturally with the sole effort of the mother and no complications to the mother or child. A normal labour is said to occur when the mother by her own efforts delivers a live healthy baby as a vertex presentation within 24hrs. The active phase should not exceed 12 hours.

4.2.1 Signs of True Labour

1. Regular and Progressively (Intermittent) Strong uterine contractions after 28 weeks of gestation.

2. Blood stained mucus discharge (show)

3. Sudden gush of water (Breaking of membranes)

4. Progressive thinning and opening of the cervix (cervical effacement and dilatation).

4.2.2 Signs of False Labour 

              1. No cervical dilatation and effacement.

              2. No show.

              3. No accompanying backache after contractions.

              4. Contractions are erratic and no muscle (uterine) retraction.

4.3 STAGES OF LABOUR

First stage: It begins with the regular uterine contractions until the full dilation of the cervix.

• The latent phase: Is the period of cervical effacement which begins with the onset of labor and ends when the cervix is 4cm dilated. In a primigravida this phase lasts for about 6-8hrs.

• The Active phase: It started when the cervix reaches 5cm. Progress is more rapid with the cervix dilation at a rate of 1cm per hour

Second stage: It starts from the full dilation of the cervix to the complete expulsion of the baby.

Third stage: It starts from the birth of the baby to the complete expulsion of the placenta and membranes; it also involves the control of bleeding.

Fourth stage: It is the few hours after delivery, in which both mother and child are allowed to rest and be observe closely.

4.4 GOOD PRACTICES AND SUPPORTIVE CARE DURING LABOUR

1. Explain all procedures, seek permission for examination and carry out procedures e.g. abdominal examination.

2. Keep the woman informed about the progress of labour by discussing the findings with her.

3. Praise the woman, encourage and reassure her that things are going well.

4. Ensure and respect the privacy of the woman during examinations and discussions.

5. Encourage the woman to bathe or wash herself and her genitals at the onset of labour

6. Always wash your hands with soap and water before examining the woman.

7. Ensure cleanliness of the delivery suite or area.

8. ENEMA should NOT be routinely given during labour. It should only be given if there is an indication e.g. when there is complain of constipation on admission or at the onset of labour or if the woman wishes to have it.

Therefore encourage the woman to eat and drink as she wishes throughout labour.

9. Allow the woman to be mobile during first stage of labour

10. Changing position can also help in relieving pain and discomfort. 

11. Other methods of relieving pain includes:-

1. Calm and gentle voice of the birth attendant

2. Giving encouragement, reassurance and praises

3. Relaxing techniques like deep breathing exercise, 

4. Massages, placing a cool cloth on the forehead.

12. Encourage and assist the woman to pass urine