3. 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.

4.  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 120- 140 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.

5. Woman‘s positions during normal labour

6. 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.

7. 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.

8. 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.

9. 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.

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

11. 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.

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