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Management of Early Labor |
If the patient is in early labor, with a normal pregnancy, and intact membranes, she
may feel like ambulating and this is very acceptable.
Not all women in early labor feel like walking and she need not be forced out of bed. Some patients, particularly those with ruptured membranes and those with certain risk factors are probably better off staying in bed, even during early labor.
While in bed, it is preferable, in women without continuous electronic fetal
monitoring, to have them lie on one side or the other, but to avoid being on their back.
Such lateral positioning maximizes uterine blood flow and provides a greater margin of
safety for the baby.
Women with continuous electronic fetal monitoring may choose whatever position is most comfortable. If there is a problem with uterine blood flow, it will be demonstrated on the fetal monitoring strip and appropriate position changes can be undertaken.
Recheck the maternal vital signs every 4 hours. Elevation of blood pressure may indicate the onset of pre-eclampsia. Elevation of temperature >100.4 may indicate the development of infection.
Because of the risk of vomiting and aspirating later in labor, it is best to avoid oral intake other than small sips of clear liquids or ice chips. If labor is lengthy or dehydration becomes an issue, IV fluids are administered. Lactated Ringer's or Lactated Ringer's with 5% Dextrose at 125 cc/hour (6-hours for 1 L) are good choices.
Periodic pelvic exams are performed using sterile gloves and a water-soluble lubricant. The frequency of such exams is determined by individual circumstances, but for a normal patient in active labor, an exam every 2-4 hours is common. In active labor, progress of at least 1 cm per hour is the expected pattern. If the patient feels rectal pressure, an exam is appropriate to see if she is completely dilated.
Some women experience difficulty emptying their bladder during labor. Avoiding overdistension of the bladder during labor will help prevent postpartum urinary retention. If the patient is uncomfortable with bladder pressure and unable to void spontaneously, catheterization will be welcomed.
Prior to active labor, the fetal heart rate for low risk patients is usually evaluated every hour or two.
Once active labor begins for these women (4 cm dilated, with regular, frequent contractions), the fetal heart rate is evaluated every 30 minutes. This can be done by looking at the electronic fetal monitor (if used), or by measuring the fetal heart rate following a contraction. Fetal jeopardy is likely if the auscultated fetal heart rate is less than 100 BPM, even if it later rises back to the normal range of 120-160. Persistent fetal tachycardia (greater than 160 BPM) is also of concern.
For women with significantly increased risks, it is better to evaluate the fetal heart rate every 15 minutes during the active phase of labor.
Women in the second stage of labor (completely dilated but not yet delivered) usually have their fetal heart rate evaluated every 5 minutes until delivery.