Labour and Delivery Care Module: 4. Using the Partograph Study Session 4 Using the Partograph Introduction Among the five major causes of maternal mortality in developing countries like Ethiopia hypertension, haemorrhage, infection, obstructed labour and unsafe abortion , the middle three haemorrhage, infection, obstructed labour are highly correlated with prolonged labour. Learning Outcomes for Study Session 4 When you have studied this session, you should be able to: 4.
What is the difference between a woman who is a multigravida and one who is a multipara? The scale for fetal heart rate covers the range from 80 to beats per minute. Below the fetal heart rate, there are two rows close together.
The first of these is labelled Liquor — which is the medical term for the amniotic fluid ; if the fetal membranes have ruptured, you should record the colour of the fluid initially and every 4 hours. Figure 4. What can you tell from the colour of the amniotic fluid? You should do a digital vaginal examination initially to assess: The extent of cervical effacement look back at Figure 1. Thereafter, in every 4 hours you should check the change in: Cervical dilatation Development of cervical oedema an initially thin cervix may become thicker if the woman starts to push too early, or if the labour is too prolonged with minimal change in cervical dilatation Position of the fetus, if you are able to identify it Fetal head descent Development of moulding and caput Study Session 2 in this Module Amniotic fluid colour if the fetal membranes have already ruptured.
When you record the findings on the partograph, make sure that: You use one partograph form per each labouring mother. Occasionally, you may make a diagnosis of true labour and start recording on the partograph, but then you realise later that it was actually a false labour. You may decide to send the woman home or advise her to continue her normal daily activities. When true labour is finally established, use a new partograph and not the previously started one.
You start recording on the partograph when the labour is in active first stage cervical dilation of 4 cm and above. Your recordings should be clearly visible so that anybody who knows about the partograph can understand and interpret the marks you have made. View larger image. Station of fetal head Figure 4. What does crowning mean and what does it tell you? The methods open to you are limited, but you can assess fetal condition: By counting the fetal heart beat every 30 minutes; If the fetal membranes have ruptured, by checking the colour of the amniotic fluid.
Box 4. Count the fetal heart rate: As frequently as possible for about 10 minutes and decide what to do thereafter. Count every five minutes if the amniotic fluid called liquor on the partograph contains thick green or black meconium.
Whenever the fetal membranes rupture, because occasionally there may be cord prolapse and compression, or placental abruption as the amniotic fluid gushes out.
Summary of Study Session 4 In Study Session 4, you have learned that: The partograph is a valuable tool to help you detect abnormal progress of labour, fetal distress and signs that the mother is in difficulty. The partograph is designed for recording maternal identification, fetal heart rate, colour of the amniotic fluid, moulding of the fetal skull, cervical dilatation, fetal descent, uterine contractions, whether oxytocin was administered or intravenous fluids were given, maternal vital signs and urine output.
Start recording on the partograph when the labour is in active first stage 4 cm or above. Cervical dilatation, descent of the fetal head and uterine contractions are used in assessing the progress of labour. Fetal heart rate and uterine contractions are recorded every 30 minutes if they are in the normal range. Assess cervical dilatation, fetal descent, the colour of amniotic fluid if fetal membranes have ruptured , and the degree of moulding or caput every four hours. Do a digital vaginal examination immediately if the membranes rupture and a gush of amniotic fluid comes out while the woman is in any stage of labour.
Refer the woman to health centre or hospital if the cervical dilatation mark crosses the Alert line on the partograph. Even with a normal fetal heart rate, refer if you see amniotic fluid liquor lightly stained with meconium in latent first stage of labour, or moderately stained in early active first stage of labour, or thick amniotic fluid in all stages of labour, unless the labour is progressing too fast.
Self-Assessment Questions SAQs for Study Session 4 Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Read Case Study 4. Case Study 4. Is the fetal heart rate normal or abnormal? Answer a. As a gravida 5, para 4 mother you know that Bekelech has had 5 pregnancies of which 1 has not resulted in a live birth. At 40 weeks and 4 days the gestation is term or full term.
At -3 station, the fetal head is not yet engaged. You record of all these key measurements on the partograph refer again to Figure 4. Once the placenta has come away from your womb, your midwife pulls the cord — which is attached to the placenta — and pulls the placenta out through your vagina.
This usually happens within 30 minutes of your baby being born. Active management speeds up the delivery of the placenta and lowers your risk of having heavy bleeding after the birth postpartum haemorrhage , but it increases the chance of you feeling and being sick. It can also make afterpains contraction-like pains after birth worse. Read about preventing heavy bleeding on our page What happens straight after the birth.
The cord is not cut until it has stopped pulsing. This means blood is still passing from the placenta to your baby. This usually takes around 2 to 4 minutes. Once the placenta has come away from your womb, you should feel some pressure in your bottom and you'll need to push the placenta out.
It can take up to an hour for the placenta to come away, but it usually only takes a few minutes to push it out. If the placenta does not come away naturally or you begin to bleed heavily, you'll be advised by your midwife or doctor to switch to active management.
You can do this at any time during the 3rd stage of labour. Read more about what happens straight after you give birth. Page last reviewed: 20 March Next review due: 20 March Home Pregnancy Labour and birth What happens in labour and birth Back to What happens in labour and birth. The stages of labour and birth. If your labour starts at night, try to stay comfortable and relaxed. Sleep if you can. When to contact a midwife Contact your midwifery team if: your contractions are regular and you're having about 3 in every minute period your waters break your contractions are very strong and you feel you need pain relief you're worried about anything If you go into hospital or your midwifery unit before your labour has become established, they may suggest you go home again for a while.
You can either walk around or get into a position that feels comfortable to labour in. When you reach the end of the 1st stage of labour, you may feel an urge to push. Monitoring your baby in labour Your midwife will monitor you and your baby during labour to make sure you're both coping well. These pads are attached to a monitor that shows your baby's heartbeat and your contractions Sometimes a clip called a foetal heart monitor can be attached to the baby's head instead.
A foetal scalp monitor will usually only be removed just as your baby is born, not before. Speeding up labour Labour can sometimes be slower than expected. Breaking your waters Breaking the membrane that contains the fluid around your baby your waters is often enough to make contractions stronger and more regular. Oxytocin drip If breaking your waters does not work, your doctor or midwife may suggest using a drug called oxytocin also known as syntocinon to make your contractions stronger.
Finding a position to give birth in Your midwife will help you find a comfortable position to give birth in. Pushing your baby out When your cervix is fully dilated, your baby will move further down the birth canal towards the entrance to your vagina. He or she will wear sterile gloves to do this. During labor, contractions in your uterus open dilate your cervix. They also help move the baby into position to be born. As the baby's head drops down into the pelvis, it pushes against the cervix.
This causes the cervix to relax and thin out , or efface. During pregnancy, your cervix has been closed and protected by a plug of mucus. When the cervix effaces, the mucus plug comes loose and passes out of the vagina.
The mucus may be tinged with blood. Passing the mucus plug is called "show" or " bloody show. But you might not. Effacement is described as a percentage. And if you're checking your own cervix in preparation of a home birth , you should also be working with a certified professional midwife who's trained in handling emergencies. Greenfield, stressing the importance of relying on a trained doctor or midwife to support you during your pregnancy.
It's probably best to leave cervical exams to the professionals, but you might still be curious to see if your body is gearing up for labor. Here's how to do a self-check if your doctor or midwife give you the green light:. There are safer, more noninvasive ways to check your own cervix dilation. And since dilation doesn't really act as the crystal ball that you're looking for anyway, going another route might not be so bad. As weird as it sounds, a red or purplish line can appear in the natal cleft—aka butt crack—of some pregnant people as they dilate and come closer to delivering.
Some doulas prefer this method to help track progression and avoid internal exams. Not a surefire way to determine how close baby is, but it certainly won't hurt to check. Simply have a partner or support person take a picture—yes, of your butt crack. The farther away from your anus and closer to your lower back the line appears, the closer to labor you might be.
The best indicator that your baby is coming soon? Watching for signs that labor is near , like an increase in vaginal discharge, " bloody show ," your water breaking, or intensifying contractions.
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