Care during labor: Assessment, supportive care and vaginal examination

1. SBA - Presentation 3 (d) Care during labor: Assessment, supportive care and vaginal examination Maternal Health Division Ministry of Health & Family Welfare Government of India

2. 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

3. 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

4. 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

5. Supportive care during labour • Ensure privacy and respect dignity of the women • Ensure a draught free room for delivery (25°C - 28°C) • 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 patient’s back • Hold the woman’s hand • Sponge the woman’s face between contractions Care during labor: Assessment, supportive care and vaginal examination

6. 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

7. 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 woman’s forehead. Care during labor: Assessment, supportive care and vaginal examination

8. 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 patient 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

9. 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

10. 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. Care during labor: Assessment, supportive care and vaginal examination

11. 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. Care during labor: Assessment, supportive care and vaginal examination

12. Thank you Care during labor: Assessment, supportive care and vaginal examination