DETAILED ASSESSMENT DURING THE FIRST STAGE OF LABOR

If the woman is in active labor, the history taken on arrival may be the only history obtained
until after baby is born. If birth is not imminent, obtain a more extensive history and physical
examination.

History taking

-full history of woman’s pregnancy

-both physical and psychological events
-past pregnancies
-general health and family medication information

Performing a detailed interview of a woman in labor can be difficult because of the constant
interruptions caused by labor contractions be patient. Remember that the longest contraction is rarely
more than 60 seconds. if a woman concentrates so intently on breathing exercise she completely forgets
a question asked just before a contraction, repeat the question as the contraction subsides, as if it had
not been asked before,or as if is no trouble to ask it again.

CURRENT PREGNANCY HISTORY

Important information needed for a complete history includes documentation of gravid and
para status; a description of this pregnancy (planned or not, pattern and place of prenatal care,
adequacy of nutrition, whether any complication such as spotting, falls, hypertension of pregnancy,
infection, or alcohol or drug ingestion has occurred);plans for labor ( does she want medication for pain,
will she use breathing exercise, will she have a support person with her);and future child care (will she
breastfeed nor formula feed, has she chosen a paediatrician)

PAST PREGNACY HISTORY

Document prior pregnancies, including number, dates, types of birth, any complications, and
outcomes including sex and birth weights of children .What is the current health status of children/

PAST HEALTH HISTORY

Document any previous surgeries (surgical adhesions might interfere with free fetal passage);
heart disease or diabetes (special precaution are required during labor and birth; anemia( blood loss at
birth may be more important than it is usual); tuberculosis (lung lesions may be reactivated at birth by
changes in lung contour)); kidney disease or hypertension (blood pressure must be monitored even
more carefully than usual); or if she has even had sexually transmitted infection such as herpes (the
infant may be exposed to the disease by vaginal contract if the disease is still active) determine also
whether a woman’s lifestyle places her at high risk for prescription or non-prescription drug use or
human immunodeficiency virus(HIV) infection.
FAMILY MEDICAL HISTORY
Ask if any family member is cognitively challenged or has a condition such as heart disease, a
blood dyserasia, allergies, seizure, diabetes, kidney disease, cancer or a congenital disorder. Adequate
preparation can then be muscle for a child who might have special needs.

PHYSICAL EXAMINATION

After history taking a woman receives a thorough physical examination including a pelvic
examination, to confirm the presentation and position of the fetus and the stage of cervical dilatation.
Physical examination during labor begins, as does all physical assessment, with a woman’s
overall appearance, does she appear tired? Pale? Ill? Frightened? Is there obvious edema or
dehydration? Does she have open lesions any where? Be prepared to adapt further examination
techniques to a woman’s stage of labor, frequency of contraction and labor progression.
Palpate for enlargement of lymh nodes to detect the possibility of infection. Inspect the mucous
membrane the mouth and the conjunctiva of the eyes for color. Does the color (paleness) suggest
anemia? What is the condition of the woman’s teeth? Are there any teeth appear abscessed (such a
condition need to be documented because it might account for a poatpartal fever)? Examine the outer
and inner surface of her lips carefully. Does she have herpes lesions (pinpoint vesicles on an
erythematous base)? Mothers with active lesions, regardless of the lesion site, should use care when
handling their infants such as ensuring that they wash their hands before touching the infant. Either the
woman or family members with oral herpetic lesion should be avoid kissing the newborn. Breastfeeding
is encouraged even if the woman is taking antiviral drug as long as there are no lesions on the breast.
Assess lungs to be certain they are clear to auscultation. Listen for normal heart sounds and
rhythms. Many pregnant women at term have a grade II to III systolic ejection murmur because of extra
volume of blood that must cross the heart valves. Inspect and palpate her breasts. Are they free of cysts
and lumps? Mark the chart of a woman who has a palpable mass in her breast for re examination after
labor and birth. This is probably an enlargement milk gland but need further evaluation.

FETAL ASSESSMENT

Initial fetal assessment

Although passive is labor, a fetus is subjected to extreme pressure by uterine contraction and pass age
through the birth canal, so it is important to ascertain that the FHR remains within normal limits despite
these pressure.
AUSCULTATION AND FETALHEART SOUND
Fetal heart sounds are transmitted best through the covers portions of the fetus, because that is
the part in closest contact with the uterine wall. This means that in a vertex or breech presentation, fetal
heart sound are usually best heard through the fetal back in a face presentation, the back become
concave so that sounds are best heard through the more convex thorax. In breech presentation,
fetalnheart