Intrapartum Management
An Interactive Guide to the Management of Labour
Explore the key clinical practices for each stage of childbirth.
Stage 1: Cervical Effacement & Dilation
This is the longest stage, beginning with the onset of regular contractions and ending when the cervix is fully dilated to 10 cm. It's a journey of preparation and progress, divided into two distinct phases.
📈 Monitoring
- Maternal: Vitals every 4 hrs. Contractions every 30-60 mins.
- Fetal: Intermittent FHR auscultation every 30-60 mins (low-risk).
- VE: Performed sparingly to confirm labour and assess progress.
🧘♀️ Support & Comfort
Provide education and reassurance. Encourage mobility (walking, birthing ball). Offer fluids and light snacks. Non-pharmacological pain relief: massage, breathing exercises.
📈 Monitoring
- Maternal: Vitals every 1-2 hrs. Contractions every 15-30 mins.
- Fetal: Intermittent FHR auscultation every 15-30 mins (low-risk).
- Partogram: Initiated to graphically track labour progress.
🛠️ Interventions (if needed)
- Amniotomy (ARM): May be used to accelerate labour.
- Oxytocin Augmentation: For inadequate contractions.
- Pain Relief: Epidural analgesia is a common option.
Stage 2: Pushing & Birth of the Baby
This stage begins with full cervical dilation (10 cm) and ends with the birth of the baby. It's the active, "pushing" phase where active management and close monitoring are crucial.
❤️ Monitoring
Close monitoring of both mother and baby is critical. Fetal heart rate is checked every 5-15 minutes. Maternal vitals and pushing effectiveness are continuously assessed. Document findings on the partogram.
📝 Patient Preparation
- Consent: Ensure informed consent for procedures (e.g., episiotomy, instrumental delivery if anticipated).
- Environment: Optimize lighting, warmth, and privacy.
- Bladder: Encourage voiding or consider catheterization if bladder is distended.
- Analgesia: Assess and manage pain effectively; top-up epidural if required.
🤸♀️ Patient Positioning
- Upright Positions: Encourage squatting, sitting, kneeling, or standing to utilize gravity and open the pelvis.
- Lateral Positions: Left lateral position can improve uterine blood flow and fetal oxygenation.
- Semi-recumbent: Common in hospital settings, but ensure hips are flexed and legs supported.
- Avoid Supine: Minimize supine (lying flat on back) position due to risk of aortocaval compression.
🗣️ Explaining to the Patient
- What to Expect: Explain that the cervix is fully dilated and it's time to push.
- Pushing Guidance: Instruct on effective pushing techniques (e.g., pushing with contractions, bearing down, listening to natural urges).
- Breathing: Guide on breathing patterns during and between contractions.
- Reassurance: Provide continuous encouragement and positive reinforcement. Explain any interventions clearly before performing them.
🛡️ Perineal Management
Implement perineal support or warm compresses as the baby's head crowns to prevent tearing. Perform episiotomy only for specific medical indications (e.g., fetal distress, instrumental delivery, impending severe tear).
Stage 3: Delivery of the Placenta
The final stage of labour, from the birth of the baby until the placenta is delivered. The primary goal is to prevent postpartum haemorrhage (PPH) through a set of recommended procedures.
Active Management of Third Stage of Labour (AMTSL)
This is recommended for all women to significantly reduce the risk of postpartum haemorrhage (PPH).
Uterotonic Drug Administration
Administer Oxytocin (10 IU IM) immediately after birth of the anterior shoulder or birth of the baby, to promote uterine contraction and placental separation.
Controlled Cord Traction (CCT)
Apply gentle, sustained traction to the umbilical cord while counter-pressure is applied to the fundus (Brandt-Andrews maneuver) once signs of placental separation appear.
Uterine Massage
After placental expulsion, perform continuous uterine fundal massage to ensure the uterus remains firm and contracted, reducing the risk of atony and PPH.
