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