LABOUR; FIRST STAGE

 

 1ST OF LABOUR

*this is a period from the time the cervix starts to dilate upto the time it dilates to its fulllest 10cms.

       **CAUSES OF LABOUR**

1.HORMONAL CAUSES**

*the uterine contractions help initiate labour and expulsion of the foetus.so,oxytocin is released from the posterior pituitary gland to excite tthe uterine muscles initiating labour.

2.MECHANICAL CAUSES**

*this involves excitement of the uterine muscles by the overstrtching of the uterus due to pressure of the foetus on the uterus causing uterine contractions.

3.CHEMICAL CAUSES***

*this involves the release of oestrogen in pregnacy that allows the electrons or impulses to pass thru the uterine muscles causing contractions.

FACTORS THAT INFLUENCE THE PROGRESS OF LABOUR**

1.PASSAGE**

*in cases where the vagina or birth canal is smaller that the foetal presenting part then labour prolongs.

2.PASSANGER**

*in cases where the foetal presnting part is bigger than the bith canal like cephalopelvic disproportion.this will prolong the onset of labour.

3.POWERS***

*this is when the woman is unable to initiate her abdominal and uterine powers to initiate labour.

4.PERSONALITY**

√Stress causes jncordination of the muscleals,When woman comes to labour,stress will causes uterine muscles to incoordinate causing failure or delay of the foetus to be expelled.

 PHYSIOLOGY OF 1ST STAGE OF LABOUR***

1.FUNDAL DOMINANCE**

*this involves the passage of uterine contractions within the uterus.

*uterine contractions start from either sides of the uterus and spreads downwards pushing the foetus into the lower uterine segment.

2.POLARITY**

*this involves the harmony or cordination that occurs between the two poles of the uterus(upper and lower uterine segment).

*So,as the contraction starts,the upper uterine segment strongly contracts and the lower segment relaxes so that the foetus is pushed into the lower uterine segment.

3.CONTRACTIONS AND RETRACTION**

*during the first stage of labour the uterine contractions start from the upper uterine segmment and spread to the lower uterine segment.this motion helps the foetus to be delivered.

*these contraction last for 50-60 seconds but occur every after 1-2minutes.

 

4.FORMATION OF UPPER AND LOWER UTERINE SEGMENT***

*this is a normal thing and process...

*at the beginning of 16 weeks of gestation,the upper and lower uterine segment starts to form.

*the upper uterine segment is formed by the fundus while the lower is formed by the cervix and the ischmus.

 

5.FORMATION OF THE BAGS OF WATER**

*the bags of water form in the uterine cavity because the maintain the pressure in the uterus.

*they are made up of the fore waters and the hind waters.

*the fore waters come first and the hind waters last.

 

6.FOETAL AXIS PRESSURE***

*during the uterine contractions,the contraction exert pressure on the foetus,the foetus become hypoxic and this initiates more contraction delivering the foetus.

 

7.GENERAL AXIS PRESSURE**

*the contraction start from the upper segment exertimg pressure on the hind waters,the hind water also exert pressure on the foetus and finally the foetus pushes the fore waters and the cervix will dilate delivering the foetus.

 

8.CERVICAL DILATATION**

*the cervix dilates to its fullest of 10 cms.

*during labour it starts to dilate so that it evens way for delivery of the foetus.

*it occurs or takes 1 hour/2cms in multi gravidas and 1.5-2hours/per 2cms in prime gravidas.

9.UTERINE CONTRACTIONS**

*the uterine contractions become more and more stronger and severe so that the foetus is delivered.

10.RUPTURE OF MEMBRANES**

*during labour,contractions become stronger and longer.

*these contraction exert pressure on the membranes of conception causing them to rupture giving access to expulsion or delivery of the foetus.

11.RETRACTION RING**

*this forms as the uterus grows toward accomodating the growing foetus.

*sometimes it can even be mistaken for a full bladder cuz it is seen on the lower abdomen.

NOTE***WHEN YOUR TOLD TO WRITE PHYSIOLOGY,,IT DOESNT MEAN WRITE ALL THESE....LOOK AT THE ATTACHED MARKS AND THEN CHOOSE WHAT U THINK WILL EARN U MARKS....TEFYONSE BANE...!!

 

NURSING CARE**

AIMS

*To monitor the progress of labour.

*To monitor maternal wellbeing.

*to monitor foetal well being.

 

ENVIROMENT**

*the woman is admitted in the delivery room of the labour ward(according to the stem).

*keep room clean to prevent infections.

*good lit for easy observations.

*have a partograph to monitor foetal an maternal wellbeing and to monitior the progress of labour.

*the room to have drips stand for iv fluids and drugs.

*all equipments to be used in the sexond and third stage e.g cord clamps shud be available.

 

      POSITION**

*woman is advised to be in the right or left lateral position to prevent hypotensive syndrome,

*woman is advised to turn for comfort.

*use an airing to relieve pressure b4 labour starts.

*2-4 hrly turnings.

 

OBSERVATION***

I want to start by saying its on the observations that we open up the partograph.

*observe for the severity of pain.

*observe for cervical by doing vaginal exams.

 

PSYCHOLOGICAL CARE**

*explain to the woman what she will pass thru.

*explain the pain.

*explain to say labour is a normall thing and every woman goes thru.

*allow her to ask questions even b4 labour progresses.

*encourage her to say the mother or significant other wud be close during delivery(hospital setting).

* explain that it may take hours to complete the all process of labour especially to prime gravidas.

 *observe for the woman's response to labour.

*observe for the maternal and foetal wellbeing and progressing of labour using the partograph.so,on this 1 u say....The maternal and foetal wellbeing including the progress of llabour will be monitored using the partograph.

 

MATERNAL WELLBEING**

*observe and record the drugs given for continuity of care.

*record any fluids given should be recorded.

*observe for vitals signs.

 

FOETAL WELLBEING**

*observe for the foetal heart reate 4hourly using a pinards foetal scope.

*observe for the state of liquor even for meconium stains.

*observing for moulding.

 

MONITORING PROGRESS OF LABOUR**

*observe for uterine contractions.

*observe for cervical dilatation.

*observe for descent of the foetal head.

NUTRITION**

*woman requires energy during labour.

*give energy giving drinks for energy.

*if unable to swallow,,,IV dex

*give easily digestable foods.

 

INFECTION PREVENTION***

*use sterile equipments.

*use antiseptic solutions on vulva swabbing.

*use sterile gloves on doing a vaginal exam.

*ensure a clean room

: PAIN MGT**

*observe for severity of pain.

*give analgesics

*tel mother to be taking a deep breath during each contraction.

*en continue observing for pain.

REST**

*woman need rest to reverve energy required for pushing.

BLADDER CARE/ELIMINATION***

*advise woman to be emptying bladder regularly to prevent bladder injury.

*if unable then catherize the woman to drain uine as a full bladder may prolong labour.

*clean cather if dirty or change.

EXERCISES**

*Advise woman to be walking round the delivery room provided the cervix hasn't dilated more than 6cms.

*exercises help in the descent of the foetal head.

*this also promotes blood circulation.