Assessment
Health care providers should assess maternal general conditions (pulse, blood pressure, temperature, urine output). They should also evaluate frequency, intensity and duration of contractions in 10 minutes, cervical dilatation, fetal presentation, position and attitude by digital vaginal examination and Leopold´s manoeuvres, in all women admitted in labour. These would help to determine the possibility of giving birth vaginally because abnormal fetal presentations and attitude are causes of labour dystocia.2-22-23-24 By offering vaginal examination, health providers will also be able to assess asses state of membranes, liquour characteristics, presence of bleeding or discharge and cervical effacement. If the following signs are present: presenting part outside the pelvis, ballooning of lower uterine segment, formation of retraction band or maternal and fetal distress, suspect obstructed labour or cephalopelvic disproportion.4
There are interventions that have been proved to prevent delay in progress of active phase of first stage: the continuous support during labour, labour companionship, the use of comfortable position of woman’s choice, and free mobility.2 To provide adequate pain relief, available options must be discussed with the woman prior to the onset of labour and offered according to her wishes and using health facility protocols and norms. For women at low risk, oral fluid and food intake during labour is recommended.2