General Care of Women in Labour
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Low risk women who present to hospitals in labour
Many women present in labour at hospitals even though they have no risk factors to qualify for hospital delivery. Such women, if not in advanced labour (cervix ≤6 cm dilated) may be transferred to a local midwife obstetric unit if a ‘triage’ system exists, with ambulance or planned patient transport available.
Respect, privacy & companionship
Treat all women in labour with respect & courtesy. Ensure privacy & always perform intimate examinations behind screens or curtains. Each woman should be allowed one visitor to provide companionship during labour, subject to the discretion of the midwife in charge of the labour ward.
Diet & fluids
Low risk women can be allowed to eat & drink during labour. An intravenous infusion is not needed. In general, high risk women should not eat in the active phase of labour, but may drink clear fluids. High risk women usually require an intravenous infusion of Ringer-Lactate solution to run at 120 mL/hour, or 70 mL/hour with cardiac disease or hypertension.
Keeping the bladder empty
A full bladder interferes with the efficiency of uterine contractions. Be ready to assist women to go to the toilet or use a bedpan. If necessary, pass a urinary catheter to empty the bladder.
Posture
Encourage women to walk around in the latent phase of labour, & in the early stages of the active phase of labour if possible. Any posture (sitting, standing, kneeling, lying) is acceptable in both phases of the first stage of labour except the flat supine position which causes aortocaval compression by the pregnant uterus.
Artificial rupture of the membranes (amniotomy)
This procedure is not necessary in the routine management of normal labour, & is contraindicated in HIV-infected women with elevated plasma viral load (VL), unless the expected clinical benefit (better labour progress) is greater than the perceived increased risk of mother-to-child transmission of HIV.
Partogram
In the active phase of labour, all clinical observations must be entered on the partogram. If an adequate entry has been made on the partogram, there is no need to make duplicate written notes. Examples are shown in Fetal Monitoring & Abnormalities of the First Stage of Labour. A clinical assessment & plan should however be written separately in the notes after each labour progress examination.