B.1.) On Admission
First impressions are vivid [26]. Parturients and their partners
need to feel welcomed.
· The nurse greets them in a calm and pleasant manner.
· The patient is taken into the labour ward for assessment
and evaluation, together with her belongings (delivery accessories, baby's
wears)
· The nurse helps the patient undress and gets into
hospital gown.
· The patient is made comfortable and may lie in the left
lateral decubital position.
· The labour ward needs to be tidy, well lit and airy
enough to accommodate patient and
her husband. Room kept at comfortable
temperature levels between (37.8 - 40) oC.
· A warm blanket placed over the patient and one wrapped
around her feet are very comforting.
· The nurse then develops a rapport and establishes the
nursing database, comprising of a concise patient obstetrical and medical
history.
· After obtaining essential information from the patient,
the nurse may then begin intrapartal assessment and evaluation [32].
B.2.) Intrapartum Clinical Assessment and
Evaluation
B.2.1. Nursing Management of First Stage of Labour
[33]
· First the vital signs are taken and noted. These
include: temperature, blood pressure, pulse rate, respiratory rate. At this
time, the foetal heart tones are auscultated using a foetoscope (normal foetal
heartbeats of (140-160)/min.)
· Anthropometric measurements are equally taken and
noted. These are: corporal weight, height, abdominal girth, fundal height (FH)
from which the estimated foetal weight (EFW) can be derived using Steven
Johnson's formula [35]:
Figure 2: Estimated Foetal Weight
EFW = I 155 x (FH - n) + 275
]g
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Where :
n = 12 if head is not engaged n = 11 if head is
engaged
FH = Fundal height
EFW = Estimated Foetal Weight (normal) = (2.500 -
3.800)g
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· A clean-voided midstream of urine specimen is collected
and a dipstick test rapidly conducted for proteins, ketones and glucose
[25].
· Number of uterine contractions is noted every after 10
minutes while simultaneously appreciating the intensity and duration of each
contraction. In specialized centres a cardio-tocogram is preferable used to
monitor the effects of such contractions on the
foetal heartbeats. This is an essential element in the
assessment of materno-foetal wellbeing.
· Aseptic vaginal exams are done after every 2 hours using
a pair of sterile gloves and an antiseptic solution to assess the cervix, the
presenting part and the membranes.
· At a cervical dilatation of 4cm, 2-4 regular
contraction in 10 minutes each lasting 40-60 seconds; a partogram should be
opened. This vital tool is of imperative significance as it effectively detects
dystocic labour (obstruction and cephalo-pelvic disproportion) as well as acute
foetal distress. It also sets landmarks (the alert and action lines) where an
intervention must be carried out to guarantee materno-foetal wellbeing. Such
interventions could be induction of labour mechanically or pharmacologically,
augmentation of labour, assisted delivery by forceps or vacuum extractor, an
emergency cesarean section [33].
· Cervical assessment is better evaluated using the Bishop
Scoring system as shown below: [35]
Table 1: The Bishop Scoring System
SCORE
FACTOR
|
0
|
1
|
2
|
3
|
Dilatation (cm)
|
0
|
1 - 2
|
3 - 4
|
> 5
|
Effacement (%)
|
30
|
40 - 50
|
60 - 70
|
> 80
|
Station
|
-3
|
-2, -1
|
0
|
+1, +2
|
Cervical Consistency
|
firm
|
medium
|
soft
|
|
Cervical Position
|
posterior
|
median
|
anterior
|
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· A bishop score <7/13 requires that labour should be
stimulated using mechanical or pharmacological methods.
· If patient has not had child education classes, the
latent phase is time when the nurse can have anticipation guidance, teaching on
breathing techniques to cope with such contractions. Breathing techniques can
promote relaxation of abdominal muscles and
Patient Satisfaction with Intrapartum and Postpartum Nursing
Care: Buea Regional Hospital Annex.
increase size of the abdominal cavity lessening discomfort
during contraction of uterine wall.
· Dietary intake must be limited to sips of clear fluids
and ice chips at frequent intervals. Cleaning of the mouth with toothbrush or
glycerin swabs help to counteract the dry and thirsty sensations of the
mouth.
· IV fluids may be ordered to counteract dehydration and
provide energy. An infusion of 500ml of 5% Dextrose, or 500ml of Hartman's
solution depending on the indication is administered to keep veins open.
· Analgesia may be administered during a
well-established contraction if the patient is not to give birth within the
next 1 to 2 hours. If analgesia is administered the patient must remain in bed
for safety [24].
· The patient is advised to void at least every 2hours.
If patient is not on IV medications, or the presenting foetal part not engaged
or membranes not ruptured, she has bathroom privileges otherwise she uses a
bedpan. A foley's urinary catheter may be used in case of inability to void
[45].
· Showers or bed baths may be taken depending on progress
of labour. Allowing warm water to strike lower part of the back may be very
relaxing
· A cleansing enema may be ordered on admission because
some women experience loose stools prior to active labour.
· If the amniotic membranes have not ruptured
previously, they may be ruptured artificially as a mechanical means of inducing
labour. The time of rupture, colour and odour of the amniotic fluid is taken
and noted. Note that this is accompanied by a continuous monitoring of
predicting parameters of maternal and foetal wellbeing [25].
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