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1. Care during labor
and delivery
SBA - Presentation 4
Maternal Health Division
Ministry of Health & Family Welfare
Government of India

2. Care during labor and delivery 2
Session Objectives
To learn about:
• Difference between true and false labour
• Stages of labour
• Supplies required for normal delivery
• Monitoring the first stage of labour using partograph
• How to conduct and manage the second stage of labour

3. Care during labor and delivery 3
True labour pains False labour pains
Regular and predictable Irregular
Felt first in lower back & sweeps
towards lower abdomen
Remains confined to lower
abdomen
Not relieved by rest Often relieved by rest
Increase in duration,intensity and
frequency with time
Does not increase in duration,
intensity or frequency
“Show”blood stained mucus
discharge present
“Show”absent
Accompanied by cervical changes Not accompanied by cervical
changes

4. Care during labor and delivery 4
Stages of labour
First stage: From onset of labor till full dilatation of cervix
• Latent Phase
– Cervix < 4 cms
– Contractions are weak
– Less than 2 contractions per ten minutes
• Active phase
– Cervix > or = 4 cms
– Contractions >3 per 10 min lasting 45 - 50 sec
– Rate of dilatation 1cm / hour or more
– Descent present

5. Care during labor and delivery 5
Stages of labour
Second stage: From full dilatation of cervix
till delivery of baby
• Full cervical dilatation
• Bulging thinned out perineum
• Gaping anus and vagina
• Head visible at the perineum

6. Care during labor and delivery 6
Stages of labour
Third stage:
From delivery of baby to delivery of placenta
Fourth stage:
For 2 hrs after delivery of the baby

7. Care during labor and delivery 7
Monitoring of first stage of labour:
Latent phase
• Monitor every 1 hour
– Contractions:
– Frequency: How many contractions in 10 min
– Duration: Each lasting for how many seconds
– Fetal Heart Rate (FHR):
• Monitor the following every 4 hours:
– Temperature, pulse, blood pressure
• Record time of rupture of membranes and color of
amniotic fluid.
• Look for presence of any emergency signs
Difficulty in breathing,shock, vaginal bleeding,convulsions
or unconsciousness

8. Care during labor and delivery 8
In Latent Phase
After 8 hours
Contractions stronger,
more frequent, no change
in dilatation or effacement
ROM +/-
REFER to FRU
Prolonged latent phase
No increase in intensity / frequency /
duration of contractions, membranes
not ruptured and no progress in
cervical dilatation
Ask woman to relax
Monitoring of first stage of labour:
Latent phase

9. Care during labor and delivery 9
Monitoring of first stage of labour:
Active phase
• Monitor the following every 30 minutes:
– Maternal pulse, uterine contractions,FHR
– Look for presence of -
– Meconium or blood stained liquor or cord prolapse
• Monitor the following every 4 hours:
– Cervical dilatation (in cm) by P/V
– Temperature
– Blood pressure

10. Care during labor and delivery 10
In Active Phase
• Never leave the woman alone
• Start maintaining a partograph when the women reaches
active labour
• Ensure adequate hydration,avoid solid foods
• Encourage upright position and walking
• Monitor intensively using Partograph
• Refer immediately if no progress
Monitoring of first stage of labour:
Active phase

11. Care during labor and delivery 11
Partograph
What is a partograph?
• Graphic recording of the progress of labor & condition
of mother and fetus
• Labor record ,thus reduces paper work
• Tool to identify complications of labor and make
timely referrals

12. Care during labor and delivery 12

13. Care during labor and delivery 13
Filling a Partograph
Identification data
• Name
• Age,
• Parity,
• Date and time of admission
• Registration number;
• Time of rupture of membranes.

14. Care during labor and delivery 14
Filling a Partograph
Fetal Condition
• Count fetal heart rate every half hour
• Count for one full minute,immediately following a uterine
contraction
• Fetal distress:
FHR <120 beats/minute or >160 beats/minute; Arrange for referral
• Each of small boxes in the vertical column of partograph represents
a half hour interval

15. Care during labor and delivery 15
Filling a Partograph
Record status of membranes and amniotic fluid
in Partograph as follows:
• Membranes intact (mark‘I’)
• Membranes ruptured (mark‘R’)
– Clear liquor (mark‘C’)
– Meconium stained liquor (mark‘M’)

16. Care during labor and delivery 16
Plotting a Partograph
Labor
• Begin plotting in active labor
• Cervical dilatation > 4 cms and > 2 contractions / 10 minutes
• Plot the initial finding on alert line.Note the time.
• Repeat P/V after 4 hours and plot the cervical dilatation

17. Care during labor and delivery 17
Plotting a Partograph
Chart the contractions every half an hour
• Number of contractions in 10 mins
• Duration in seconds.
– Less than 20 seconds
– Between 20 and 40 seconds
– More than 40 seconds

18. Care during labor and delivery 18
Plotting a Partograph
Interventions
• Mention dose,route and time of administration of any drug
• Mention the food items and liquids consumed

19. Care during labor and delivery 19
Plotting a Partograph
Maternal Condition
• Record maternal pulse every half hour and mark with a dot ( .)
• Record maternal BP every 4 hours using a vertical arrow,
with upper end signifying systolic BP and lower end diastolic BP
• Record the temperature every 4 hours and note on
temperature graph

20. Care during labor and delivery 20
Plotting a Partograph
• If Alert line is crossed (the plotting moves to the right of the alert
line) it indicates abnormal labour : prolonged/ obstructed labour
• Note the time
• Refer to FRU
• Ensure Provision of transport
• Send partograph with patient

21. Care during labor and delivery 21
Plotting a Partograph
• Crossing of the Action line (the plotting moves to the
right of the Action line) : indicates the need for
intervention
• By the time the action line is crossed the woman
should ideally have reached the FRU for the
appropriate intervention to take place

22. Care during labor and delivery 22
What are the indications for referral to FRU –
on the basis of partograph ?
• FHR is <120 beats / min or > 160 beats / min
• Meconium and /or blood stained amniotic fluid
• When cervical dilatation plotting crosses the alert line
(moves towards the right side of the alert line)
• Contractions not increasing in duration,intensity and
frequency (e.g.< 2 contractions lasting for < 20 sec in
10 min)

23. Care during labor and delivery 23
Case studies

24. Care during labor and delivery 24
Monitoring of second stage of labour
• Monitor frequency and duration of contractions
half hourly
• Monitor fetal heart every 15 minutes
• Watch for any emergency signs :excessive
bleeding,convulsions

25. Care during labor and delivery 25
Monitoring of second stage of labour
• Watch for signs of imminent delivery
– Gaping of vulva
– Thinning and bulging of perineum
– Pouting of anus
– Head of the baby seen at vulva
• Encourage the woman to push during contractions
when she has an urge to do so while taking deep
breaths

26. Care during labor and delivery 26
Delivery of Head
• Ensure a controlled delivery of the head by keeping
one hand gently on the head and other supporting
the perineum
• Feel gently around the baby’s neck for presence of
umbilical cord
– If it is loose around the neck, deliver the baby
through the loop of the cord,or slip the cord over
the baby’s head
– If it is tight around the neck,doubly clamp and cut
in between

27. Care during labor and delivery 27
Delivery of shoulders and rest of the body
• Wait for the spontaneous rotation and delivery of the
shoulders.This usually happens within 1-2 minutes
• Apply gentle pressure downwards to deliver the top
(anterior) shoulder
• Then lift the baby up,towards the mother’s abdomen,
to deliver the lower (posterior) shoulder
• Rest of the baby’s body follows smoothly
• Note the time of birth

28. Care during labor and delivery 28
Key messages
• Let the woman choose a comfortable position
during labour and delivery
• Maintain a partograph
• Ensure timely referral

29. Care during labor and delivery 29
Thank you