This is the continuous assessment by the midwife on the pregnant woman in labour in order to ascertain the progress of mother and foetus as well as identify any abnormalities. This is the period of time characterized by regular rhythmic painful uterine contractions and dilatation of cervix.
Aims
· Determine duration, frequency and intensity of uterine contractions
· Detect changes in the normal foetal heart rate pattern during labour
· Evaluate the descent of the presenting part
· Detect maternal abnormalities and take prompt action
· Know the importance of the alert and action lines on the labour care guide
Types
· Manual and electronic maternal monitoring
· Manual and electronic Foetal monitoring
Requirements
A tray containing:
· Watch with a second hand
· Ball pen
· Observation chart/ partograph/WHO Labour chart (manual/ electronic)
· Chair
· Foetal stethoscope(pinnard)/ Electronic foetal monitor
· Ultrasound gel
· Tissue paper
· Linen (for draping)
· Kidney dish
Steps
1. Timing Contractions
a. Explain procedures to client (refer steps)
b. Ask client to empty bladder and provide privacy
c. Perform hand hygiene and warm palms
d. Assist client to adopt a dorsal/left lateral position in bed
e. Sit on a chair by client and expose client’s abdomen only and place palm over fundus
f. Note time-of onset of each contraction and when each contraction wears off (duration and strength)
g. Note the frequency of contraction in 10minutes
h. Express appreciation to client for her cooperation
i. Report and record, the number and length of each contraction in 10 minutes, starting from the beginning of the 1st contraction
2. Counting Foetal Heart Rate
a. Explain procedure (refer step)
b. Put client in dorsal position
c. Stand by the right side of client and palpate the abdomen to locate the foetal back
d. Locate the position of the anterior shoulder
e. Warm the foetal stethoscope, place it at the located area and listen to foetal heart sound
f. Compare identified sound with maternal radial pulse
g. Count the beats for one full minute noting the volume and rhythm
h. If using electronic monitor, apply gel on located area
i. Place probe on located area and record accurate foetal heart beat
3. Assessing Descent of Foetal Head
a. Explain procedure (refer step)
b. Ensure client remains in the dorsal position
c. Locate the anterior shoulder and keep two fingers over it
d. Locate symphysis pubis and place the ulna border of the right hand just above the symphysis pubis
e. Drop and note the number of finger breadths that can occupy the space between the symphysis pubis and the anterior shoulder
f. Cover client’s abdomen and allow her to assumed her preferred position
g. Communicate findings to her and show appreciation for her cooperation
h. Perform hand hygiene
i. Record findings on partograph/Labour Care Guide
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