SBA - Presentation 3 (d)

Care during labor: Assessment, supportive care and vaginal examination

Maternal Health Division Ministry of Health & Family Welfare Government of India

Session Objectives
To learn about Assessment of woman in labor Supportive care during labour

Vaginal examination during labour

Care during labor: Assessment, supportive care and vaginal examination

What is the importance of Intrapartum care?

Ensuring a safe delivery resulting in a healthy mother and child Early detection and management of complications and timely referral, if required

Care during labor: Assessment, supportive care and vaginal examination

Assessment of a pregnant woman in labour

Take history Check records Carry out general physical examination Do abdominal examination Fetal lie Fetal presentation FHR Frequency and duration of contractions Conduct a P/V examination to decide the stage of labour

Care during labor: Assessment, supportive care and vaginal examination

Supportive care during labour

Ensure privacy and respect dignity of the women Ensure a draught free room for delivery (25C - 28C) Explain all examinations and procedures Discuss the findings with her Take consent for all procedures Reassure that all is well Allow a birth companion to Massage the mothers back Hold the her hand Sponge her face between contractions
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Supportive care during labour

Allow a comfortable position for labour and delivery

Encourage frequent change in position and mobility in first stage

Encourage frequent emptying of bladder (2 hourly)

Allow light low-fat food

Encourage her to have plenty of fluids Enema should not be given routinely

Care during labor: Assessment, supportive care and vaginal examination

Supportive care during labour

The non - pharmacological methods of pain relief

Speaking in calm and gentle voice

Offering encouragement and reassurance to the woman

Relaxation techniques
Placing a cool cloth on womans forehead.

Care during labor: Assessment, supportive care and vaginal examination

Vaginal examination during labour

Vaginal examination: Take consent Do not shave perineal area Ask woman to pass urine Wash hands with soap and water Be gentle Carry out the vaginal examination under strict aseptic conditions Do not do vaginal examination if woman has bleeding Vaginal examination should be done only at defined interval, too frequent P/V may cause infection

Care during labor: Assessment, supportive care and vaginal examination

Vaginal examination
Done for:
Pelvic adequacy Stage of labor Progress of labor Assess cervical dilatation and effacement Determine membrane status - absent or present Station of the presenting part Assess pelvis
Document all findings of vaginal examination

Care during labor: Assessment, supportive care and vaginal examination

Pelvic assessment
In a normal pelvis
Sacral promontory is not reached.
Sacrum is well curved. Sidewalls are nearly parallel.

Ischial spines are not prominent and both cannot be felt at the same time.
Posterior surface of the symphysis pubis is smooth, and rounded curve Sub pubic angle accommodates two fingers Transverse diameter of the outlet admits 4 knuckles.
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Cervical effacement

Cervical effacement: progressive shortening and thinning of the cervix during labour. Cervical dilatation: increase in the diameter of the cervical opening measured in centimeters A fully dilated cervix has an opening of 10 cm at this stage, the cervix is no longer felt on vaginal examination.

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Thank you

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