When labour is established the uterine contractions will come at intervals (from one hour or more to ten minutes).  The mother should choose a position she prefer and relax completely each time contraction begins.  Breath deeply (the key of relaxation.)  No strain during 1 st stage (will cause prolapse and unnecessary exhausts the mother).  The mother may walk in the intervals between pains if the membranes are intact. Once the membranes rupture:  The mother is asked to lie down to avoid leakage of liquor amnii.  If the mother complains from backache:  Apply firm massage on lumber region to alleviate pain from modified side lying position.  The rectum should be empty by enema and the mother should be asked to empty the bladder at 2 hours interval.

 Vaginal examination is performed when indicated  Pulse, temp, and blood pressure are recorded every 2 hours in normal cases and more frequently if any abnormality.  The foetal heart rate should be listened every 15 minutes in the 1 st stage of labour and every 5 minutes in the 2 nd stage especially towards the end of uterine contraction to detect any abnormality.  The normal variation of foetal heart ratio (F.H.R.) is between beats per minute. If the F.H.R. delayed to return after the end of uterine contraction is an early sign of foetal disress.  Normally there is slowing of F.H.R. during uterine contraction, and may return to normal after contraction.  F.H.R. above 160 or below 100 is more dangerous.

Woman‘s positions during normal labour

When the cervix is fully dilated:  The mother lies lithotomy position and ask her to bear down during uterine contraction (there a reflex desire to bear down during the contractions) and relax in between.  Relaxation between contraction is important in the 2 nd stage of labour to enable the mother to regain her strength and to recover from the effect of the last effort.  Instruct the mother to take deep breath and bear down to increase the power of expulsion of the foetus  The attendant supports the perineum and press on it during uterine contraction to prevent perineal laceration.  At crowning the mother will be asked to stop bearing down and pant in and out softly and easily with mouth open.  If the perineum is much stretched and about to tear episiotomy will be done.

As soon as the signs of separation and descent of the placenta are detected:  Massage the uterus to help it to contract to stop any bleeding.  After delivery of the placenta  Inspect the external genitalia and perineum (any laceration 1cm. Or more should be repaired.  Observe the mother carefully for one hour for fear of postpartum hemorrhage.

Post partum exercises should start with shorter duration which consists of:  Warm up period.  Gentle stretching exercises.  Postural correction exercises.  Specific strengthening exercises.  Relaxation techniques.  Avoid strenuous exercises (cause significant ↑ of lactic acid concentration in breast milk which affect the taste and acceptance of milk by the infant. Exercises program at 60-70% of the maximum heart rate for 45 minutes a day., Five times a week for 12 weeks, will significantly improve the cardiovascular fitness of post natal woman.

Prophylactic: Diminish respiratory complications Diminish vascular complications as thrombosis and embolism. Guard against prolapse and stress incontinence. Curative: Restore the muscle tone (abdominal and pelvic floor. Re-education of posture sense. Help excretion (micturition and defecation). Help involution of uterus. Lactation: To aid lactation by improving the blood supply of the breast and allowing free flow of milk. Pervent sagging of the breast.

 Post partum heamorrhage.  Nephritis.  Puerperal fever.

1 st day oBreathing exercises. oCirculatory exercises. oRelaxation exercises. oStatic abdominal exercises.  2 nd day oRepeat the previous exercises and add the following exercises. oLeg exercises. oPelvic floor exercises. oArm exercises. 3 rd day oRepeat exercises of the second day and add the following: oPelvic rocking exercises.  4 th day oRepeat exercises of the third day and add the following: oHip shrugging. oPelvic rotation. oPosture correction training. 5 th day oRepeat exercises of the fourth day and add the following: o1 st step of trunk flexion.

/ /