1. Dr. Areefa Al Bahri
Assistance professor
Nursing college- midwifery department-Islamic university of Gaza

12. Management of Complications Availability of Doctors
Quality in Labour Room
Privacy
Infection Control
Partograph
Trained Staff
Management of Complications
Referral
Protocols
Drugs Availability
Behavior of Staff
Labor room register
Availability of Doctors
Resource: Dr Sandeep Mahatme

13. Assessment : Labour Room
Labour table with Mcintosh sheet
Suction machine
Oxygen cylinder with face mask
Attached toilet in the labor room
Designated Newborn Corner (Radiant warmer, separate drug tray for the baby, suction canula, Pedal suction machine /mucus extractor, Ambu bag)
Privacy in the labor room
Flooring, Walls, Ceiling and Lighting adequate
Emergency Drug tray with:
Oxytocin injection
Diazepam Injection
Magnesium Sulphate Injection
Lignocaine Hydrochloride Injection
Nifedipine Tablet
Normal Delivery Kits availability
Equipment for assisted vacuum delivery
Equipment for forceps delivery (outlet forceps)
Surgical set for Episiotomy and minor procedures available
Availabilty of Gloves, Sterilized cotton gauze, Sterile syringes and needles, drip sets and IV infusions
Protocols displayed
* Critical component for functionality
Resource: Dr Sandeep Mahatme

14. Labor room Protocol Delivery tray Availabilty of Gloves,
Sterilized cotton
gauze,.
Spot light
Curtain
Oxygen Cylinder
Labour table
Attached toilet
Monitor
Infection control
Drugs
New born corner
Trained staffs
Trained midwives & Dr.
Partographs
Watch
Labor room

15. delivery trolley Speculum Artery Forceps Needle holder Sponge holder
Thumb Forceps
Scissors- Straight & curved
Cord Tie
Gloves size 6, 6.5, 7,8
Xylocaine loaded Syringe
Urinary Catheter
Guaze, Pad
* Retractor

18. Newborn Care Corner Radiant warmer Neonatal Ambu Bag with face mask
Mucous Extractor
Infant tray with clean cloth for draping the baby
Oxygen cylinder with flow meter
Nasal catheter
Laryngoscope and Endotracheal intubation tube
Paediatric Stethoscope
Baby scale

19. Surgical set for Episiotomy and minor procedures available
Description
Quantity 1
Episiotomy Scissor 2
Scissor Straight 3
Sponge Holding Forceps 4
Vaginal Speculum 5
Artery Forceps Straight 6
Artery Forceps Curved 7
Needle Holder 7 Inch 9
Kidney Tray 10
Tissue Forceps Toothed 1x2Teeth 11 12
Instrument Tray
Caesarean Section Set

20. First stage midwifery care
Welcoming the woman & introduce your self
Review the referral note or pregnancy card to review history.
Ask to woman to empty bladder
Explain every procedure before do it
Check and record the vital sign: BP-RR-Temp
Do abdominal examination
Auscultate fetal heart sound.
Assess uterine contraction.
Maternal VS- IV fluid if needed
Oral intake
Assess bladder for fullness
Amniotomy if needed
Subsequent VE

21. Midwifery care in first stage
Nutrition and fluid :
1- encourage intake of oral fluid and come candies.
2- Encourage voiding every 2 hr.
Ambulation and position:
1- encourage ambulation if continues monitoring is not required.
2- encourage woman to avoid lying on her back.
3- if lying back encourage to be on left lateral position.
Hygiene:
1- offer to woman have a shower upon admission if she desire.
2-encourage and assess having warm shower if woman is not active phase.
3- assist woman to keep Perineal clean after vaginal examination.
4-change wet linen whatever possible .

23. When to do artificial rupture of membrane:
1- perform artificial rupture of membrane if woman is more than 4cm.
2- head is well applied.
3- Head is engaged
The AROM is don by physician at MOH hospital and it can be don my midwife under doctor supervision or if the woman is 6 cm or more and its better not to do keep your delivery as much as without intervention.
If you perform AROM Follow-up
1- follow the progress of labour utilizing the partogram.
2- conduct vaginal examination After AROM & Q 2-4 hr
3. cervical examination should be kept to a minimum to avoid promoting intraamniotic infection.
Document all of procedure, assessment finding on partogram.

24. In general, vaginal examinations are performed:
On admission
At one to four hour intervals in the first stage and at one hour intervals in the second stage
At rupture of membranes to evaluate for cord prolapse
Prior to intrapartum administration of analgesia
When the parturient feels the urge to push to determine whether the cervix is fully dilated
If the FHR falls, to evaluate for conditions such as cord prolapse or uterine rupture.

25. Cervical examination steps

27. How to help the mother to relieve her Pain
Changing of body positions: lying down, walking, sitting etc.
Vocalization: reading Quran and chanting.
Breathing exercise
Touch and massage.
Hot/cold packs.
Warm shower: if possible may relieve her pain & increase her labour contraction.
Relaxation techniques.
Document alternative measures & any medication given.

28. Application of partogram
Under supervision of physician:
Undersupervioin of doctor:
Perform Aminotomy if the membrane is intact
Augment uterine contraction by oxytocin in absence of contraction
Perform vaginal examination Q2 hr
If no progress after 6 hr of augmentation , SC is indicated

30. Partogram in first stage of labour
Star partogram for every woman in active phase of labour.
Record fetal condition include:
Assess fetal heart Q 30 mint.
Use the following keys in documentation:
I= intact membrane.
C= clear
B= blood staining
M= meconium
Moulding:
0= bon are normally separated.
+ = bon touching each other.
++ = bone overlapping but easily separated.
+++ = bone overlapping but can not separated.

31. 0= bon are normally separated

33. Use of oxytocin:
The midwife will obtain the physician order before initiating and oxytocin infusion:
1- perform vaginal examination.
2- commence oxytocin via dropper machine
3- follow the following standard of oxytocin initiation.
6- add 5 unit to 500 ml R/l
7- increase the drip rate according to protocol at 30 minutes interval until contraction lasting for sec. and occurring 3-4/10 minute.

34. Use of oxytocin Keep woman under continues fetal monitoring.
Reduce oxytocin if good contractions have been established to prevent hyper stimulation
Reassess progress by vaginal examination q/2 hr
Discontinue oxytocin in case of:
1- hypertonic uterine contraction.
2- Prolong fetal deceleration
3- Persistent fetal bradycardia.
4- Document .