General Considerations:
All women with an uncomplicated term pregnancy admitted during active
first or second stage should be evaluated by a skilled birth attendant.
The contribution of a qualified and skilled attendant with midwifery
skills is critical for ensuring good outcome.17-20 All
women should receive emotional support through labour companionship and
continuous support during labour and delivery. They should also be
encouraged to adopt a birth position of their choice (including upright
positions). Women and companions must be informed about the progress of
labour, possible reasons for delays explained and care options
effectively and respectfully communicated. 2 If a
deviation from the adequate progress of any stage of labour occurs, it
is mandatory to call for a second person trained to assist and consider
the transfer to an obstetric-led care unit.17-21
Maternal clinical assessments (maternal pulse, blood pressure,
temperature) as well as the fetal assessments have to be performed
frequently. Health care providers should palpate the woman’s abdomen for
a prompt and thorough clinical assessment to rule out a full bladder and
encourage the woman to empty her bladder regularly. Leopold´s manoeuvres
are the standard method to determine fetal size, fetal presentation,
position, engagement of the presenting part and descent. By digital
vaginal examination, cervical dilatation, fetal presentation, position
and attitude should be evaluated in all women admitted in labour.2-22-23-24
If breech presentation is identified, the health care provider should
offer a caesarean section, where possible and appropriate. If abdominal
delivery is not possible or consented to, breech vaginal birth should be
assisted by a well-trained skilled birth attendant. Women and health
care providers should be aware of its potential
complications.21
Fetal wellbeing should be assessed during the entire process of labour
and birth. In low risk women, the recommended method for fetal heart
auscultation is intermittent fetal heart rate auscultation using Doppler
ultrasound or Pinard fetal stethoscope. Evidence shows that continuous
cardiotocography (CTG) on admission in labour probably increases the
risk of caesarean section without improving birth outcomes as well as
the likelihood of a woman and her baby receiving a cascade of other
interventions.3 Diagnosis and management of fetal
heart rate abnormalities are covered in another manuscript in this
series.25