Trial of labour can be determined by some intrinsic factors, these factors determines and identifies the indication for trial of labour. However, these factors may include the following;
- The effectiveness of the uterine contraction; if uterine contraction increases in strength and duration, it positively influences flexion, moulding, descent and internal rotation.
- The give of the pelvis(ligaments and joints); this is due to the effect of relaxin a hormone produced by the placenta.
- The maternal condition; the mother must be medically and mentally fit at the onset of labour and every effort must be made to maintain such fitness throughout the course of labour.
- The fetal condition: the fetus must be healthy at commencement of labour, that is the midwife must rule out any sign of fetal distress or conditions that may predispose to it. Close attention must be paid to the fetus response to the contractions by observing the fetal heart rate every fifteen minutes so that any deterioration in its condition can be detected at once.
The Responsibility of a Medical Practitioner (Midwife) During Trial Of Labour
Hospital Admission;
- Welcome her warmly into a comfortable bed.
- Take history of when the contraction started, any show, rupture of membranes, the presenting part and its application to the cervix.
Position;
- Encourage ambulation and upright position of the woman to promote good uterine contraction and dilatation of the cervix
Psychological Care;
- Explain the situation to the woman and her support person.
- Reassure her to instill hope in her.
- The midwife should be kind in her approach to the woman
- Answer her question tactically and attend to her personal needs.
General Examination;
- Perform head to toe examination to exclude anaemia, infection, oedema and varicose vein.
Investigation;
encourage her to do the following investigation
- Urine testing to exclude presence of glucose, protein and acetone.
- Check her vital signs and record
- Blood test; blood group, PCV, rhesus factor, clotting time if not yet done.
Observation;
- Observe uterine contraction every 2 hours noting its effectiveness on the labour, that is if further descent and flexion have occurred
- Note the condition of the mother by observing the pulse rate and blood pressure every fifteen minutes, temperature and respiration every four hours.
- Note the condition of the fetus by checking the fetal heart rate every fifteen minutes, nothing the rhythm and volume.
Abdominal Examination;
palpate the uterus to determine
- The position of the occiput
- Degree of flexion
- Level of the head in relation to maternal pelvis.
Maintenance of Personal Hygiene;
- Perform proper vulva swabbing before each vaginal examination using aseptic techniques.
- Ensure that she has a warm bath, oral care and she is well groomed. This will make the woman look fine and also boost her morale.
Vaginal Examination;
- Perform vaginal examination to note the degree of cervical dilatation, level of the presenting part and its application to the cervix, state of the membranes, time of rupture and nature of liquor and also exclude cord prolapse.
- Vaginal examination should be performed by one person through the period of trial of labour, but where it is not possible, it should be performed by the most experienced midwife on duty whenever indicated.
- Vaginal examination should be limited for fear of infection, since the woman may go in for surgery.
Care of Bladder and Rectum;
Ensure that the bladder and rectum are emptied before second stage of labour. This will;
- Enable good uterine contraction and promote descent of the fetus.
- Prevent injury to the pelvis organs thus vesico-vaginal fistula(VVF) and recto-vaginal fistula(RVF) are avoided.
- Allow enough space for manipulation of labour.
- Help to maintain sterile or clean delivery.
- Test the urine to exclude any abnormal constituent.
- Encourage her to empty the bladder every two hours, if she cannot, catheterize her to empty bladder.
Nutrition;
The woman may need glucose for energy, hence;
- Place her on intravenous fluid five to ten percent as prescribed.
- Avoid oral intake of food since she may go in for surgery at the long run.
- If she is severely thirsty wet her lips with water or give a little sip of water.
Progress of Labour;
Continue to monitor how the labour is progressing through assessing the uterine contraction, noting the frequency, strength and duration and its influence on descent and flexion of the head which is confirmed by vaginal examination.
Record findings.
Major Observation that Would Compel the Midwife to Seek for Medical Assistance During Trial of Labour
- Abnormal uterine action
- Lack of progress of labour that is the inability of the presenting part to descend.
- Signs of obstructed labour.
- Fetal distress
- Maternal distress.
- Bleeding
- vomiting
- Sudden rise in blood pressure.
- Cervix not dilating.
- Early rupture of membrane.
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