Observation report of labour room made By Sonal Patel

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Observation report of labour room
Introduction:
 I am F.Y.M.Sc Nursing with Obstetrics and Gynaecology Nursing speciality, JG
College of nursing were posted in civil hospital, Ahmedabad with other speciality
students.
 We are posted individually in different area of obstetrics and gynaecology department
of civil hospital, Ahmedabad.
 I was posted in Labour room for 1 weeks from to fulfil some procedure, assignments,
learn about delivery, immediate new born care, instruments used in Labour room,
drugs used in Labour room, etc.
Objectives:
Objectives of Labour room are as follows:
 To orient with physical setup of Labour room.
 To introduce with staff.
 To conduct delivery.
 To do per vaginal examination of pregnant women.
 To do per abdominal examination of pregnant women.
 To learn about instruments used in labour room.
 To take history of pregnant women.
 To assist in episiotomy suturing.
 To find out abnormalities in pregnant women.
 To give treatment/care to pregnant women.
 To educate mother about family planning, breast feeding, perineal care, etc.
 To learn about drugs used in labour room.
 To handle newborn and give immediate newborn care.
 To prepare mother for caesarean section.
 To find out abnormalities in newborn.
 To learn about equipments used in labour room.

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Physical set up of Labour Room

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Staffing pattern:
Head of labour room
Matron (1)
Sister in charge (1)
Staff nurses (8)
Class 4 employee (6)
Doctors unit in labour room
In labour room there are six units, they are as follows:
 Monday: AUM
 Tuesday: LDK
 Wednesday: TLP
 Thursday: MJ
 Friday: HVO
 Saturday: TMS

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EQUIPMENT AND ARTICLES NEEDED IN LABOUR ROOM :
ARTICLES:
Delivery table Head light
Warmer /Table with 200 watt bulb Kally’s pad
Linen White sheets
Green sheet Mackintosh
Gloves Cotton pad
Gauze pieces Perineal pads
Big bucket Plastic apron
Labour tray containing:
a) Artery forceps b) Tooth dissecting forceps
c) Needle holder d) Curve cutting needle
e) Scissors (Episiotomy) f) Scissors (plain)
g) Swab holding forceps h) Sim's Speculum
i) Catgut j) Sterilized gloves
k) Sterilized gauze I) Sterilized pad
m) Sterilized Cotton Swab n) Umbilical cord clamp
o) Draping towel (sterilized) p) Syringe and needle (sterilized)
Miscellaneous (instruments)
Cervical dilator Uterine sound
Uterine curettage Allis forceps
Multiple tooth vulsellum Ventose cup
Forceps Syringe
Sterile drums Oxygen cylinder
Boiler Suction machine
Weighting machine Infantomer
BP instrument Almirah
Liquid soap Hand towel
Sterilizer
EQUIPMENT REQUIRED FOR BABY CARE:
 Mucus extracter
 Cord clamp
 Feeding tube
 Fetoscope
 Stethoscope

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Equipments of labour room:
1. Non-stress Test ( NST)
 Non-stress test is a simple, painless procedure in which a baby's heartbeat is
continuously monitored for 20 minutes or more along with recording foetal
movement.
 Performing time:-
- The Non-stress test can be done whenever the need arises so there is no specific time
for it. around 30 weeks
 Who needs the Non-stress test or Indications:-
- Women with pre existing medical conditions such as diabetes.
- Women with pregnancy-induced medical conditions such as hypertension
- Baby is less active than normal
- Baby is small for its age
- Amniotic fluid is either too much or too little
- Women who have previously lost their babies in the second half of their pregnancies
- Women with pregnancies continuing after week 40 to basically check on the well-
being of baby.
 Nursing responsibility :-
- Explain procedure before performing test.
- Informed consent should be given prior to testing, and a woman has the right to
refuse this test if she chooses
 Position and Procedure:-
- Explain the testing procedure to the patient.
- Empty the patient bladder provide lateral position or semi fowler or sitting position
to the women.
- The recording is obtained with the patient lie down on left side, or lateral recumbent
position. ( to avoid supine hypotension)
- Place USG.
- Document the date and time the test is started and write patient name, the reason for
test.
- Record maternal vital sign
- Two electronic devices will be strapped to mother abdominal.
- The transducer ultrasound will monitor baby's heartbeat.
- The other device will record any uterine contractions felt by the mother.
- Women are advised to press the button whenever she feels the fetal movement.
- If there are no movements, the technician may wake baby up with a buzzer
- The test takes about 20 minutes to an hour.
 Advantages: -
- It is a non-invasive test.
- The test is simple, inexpensive and takes less time.
- There are no contradictions or complications
- No special expertise required

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- Provide immediate answer.
2. Radiant warmer:
 Radiant Warmer, is a body-warming device to provide heat to the body. This device
helps to maintain the body temperature of the baby and limit the metabolism rate.
Heat has a tendency to flow in the heat gradient direction that is from high
temperature to low temperature. The heat loss in some newborn babies is rapid;
hence, body warmers provide an artificial support to keep the body temperature
constant. In certain areas with very cold climate, babies are kept on Radiant Warmer
for couple of hours immediately after birth to ensure the baby is stabilized after birth.
 Radiant Warmers consists of an open tray (where the baby is kept) and the artificial
heating is provided by a heating mechanism mounted overhead. The heating
mechanism consists of quartz which produces the desired heat and a reflecting
mechanism to divert the heat at the baby tray. The skin temperature of the baby can be
monitored by a temperature measuring knob that is kept continuously attached to the
body. The variation in the skin temperature can be seen on a small LCD panel which
continuously shows the body temperature. Radiant warmers are equipped with alarm
to indicate the change in temperature and hence attract attention of medical
professional attending the baby. The heat generated can be controlled manually by a
knob as well as automatically depending on the Radiant Heat Warmer.
 Radiant Warmers can be manual or automatic (servo system – heater output is
determined automatically based on skin temperature. The skin temperature is set at
36.5 degree Celsius) depending on the mechanism that the manufacturer employs for
temperature control. The heat generated and the temperature of the skin can be
individually seen but the basic difference between these two models will be the
regulation of temperature. The automatic model increases the heat output in small
predetermined steps to reach at the desired temperature of the body. The device may
seem simple to handle, but it is always recommended to have a proper training and
read the manufacturers guidelines for person handling this equipments. It is necessary
to regularly clean and disinfect the instrument.

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3. Suction apparatus:
 The patient with an artificial airway is not capable of effectively coughing, the
mobilization of secretions from the trachea must be facilitated by aspiration. This
is called as suctioning.
 Indication
- Therapeutic
- Coarse breath sounds.
- Noisy breathing.
- Visible secretions in the airway.
- Decreased SpO2 in the pulse oximeter & Deterioration of arterial blood gas values.
- Clinically increased work of breathing.
- Suspected aspiration of gastric or upper airway secretions.
- Patient’s inability to generate an effective spontaneous cough.
- Changes in monitored flow/pressure graphics.
- X-ray changes consistent with retained secretions.
- The need to maintain the patency and integrity of the artificial airway.
- The need to stimulate a cough in patient’s unable to cough effectively secondary to
changes in mental status or the influence of medication.
- Presence of pulmonary atelectasis or consolidation, presumed to be associated with
secretion retention.
- During special procedures like Bronchoscopy & Endoscopy.
 Diagnostic
- The need to obtain a sputum specimen / ETA (Endo Tracheal Aspiration) for
Bacteriological or microbiological or cytological investigations.
- This is the picture which shows us about the ETA sampling.
 Hazards and complication
- Hypoxia / hypoxemia

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- Tracheal and / or bronchial mucosal trauma
- Cardiac or respiratory arrest
- Pulmonary hemorrage / bleeding
- Cardiac dysrhythmias
- Pulmonary atelectasis
- Bronchoconstriction / bronchospasm
- Hypotension / hypertension
- Elevated ICP
- Interruption of mechanical ventilation
 Necessary equipment
- Vacuum source with adjustable regulator suction jar
- Stethoscope
- Sterile gloves for open suctioning method
- Clean gloves for closed suctioning method
- Sterile catheter
- Clear protective goggles, apron & mask
- Sterile normal saline
- Bain’s circuit or ambu bag for preoxygenate the patient
- Suction tray with hot water for flushing
 Monitoring
- Breath sounds
- Oxygen saturation
- RR & pattern
- Haemodynamic parameters (pulse rate, Blood pressure)
- Cough effort
- ICP (If indicated and available)
- Sputum characteristics (colour, volume, consistency & odor)
- Ventilator parameters (PIP, Vt & FiO2)
 Assessment of outcome
- Improvement in breath sounds.
- Decreased peak inspiratory pressure; Increased tidal volume delivery during
ventilation.
- Improvement in arterial blood gas values or saturation as reflected by pulse
oximetry. (SpO2)

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- Removal of pulmonary secretions.
4. Pulse oximeter:
 A pulse oximeter (saturometer) is a medical device that indirectly monitors the
oxygen saturation of a patient's blood and changes in blood volume in the skin,
producing a photoplethysmograph. It is often attached to a medical monitor so staff
can see a patient's oxygenation at all times. Most monitors also display the heart rate.
Portable, battery-operated pulse oximeters are also available for home blood-oxygen
monitoring.
 Function
- A blood-oxygen monitor displays the percentage of arterial hemoglobin in the
oxyhemoglobin configuration.
- A pulse oximeter is a particularly convenient non-invasive measurement
instrument.
- The monitored signal bounces in time with the heart beat because the arterial
blood vessels expand and contract with each heartbeat.
- Advantages
- A pulse oximeter is useful in any setting where a patient's oxygenation is unstable,
including intensive care, operating, recovery, emergency and hospital ward
settings, pilots in unpressurized aircraft, for assessment of any patient's
oxygenation, and determining the effectiveness of or need for supplemental
oxygen.
- Assessing a patient's need for oxygen is the most essential element to life; no
human life thrives in the absence of oxygen (cellular or gross).
- Although a pulse oximeter is used to monitor oxygenation, it cannot determine the
metabolism of oxygen, or the amount of oxygen being used by a patient. For this
purpose, it is necessary to also measure carbon dioxide (CO2) levels.
- It is possible that it can also be used to detect abnormalities in ventilation.
- However, the use of a pulse oximeter to detect hypoventilation is impaired with
the use of supplemental oxygen, as it is only when patients breathe room air that
abnormalities in respiratory function can be detected reliably with its use.
Therefore, the routine administration of supplemental oxygen may be unwarranted
if the patient is able to maintain adequate oxygenation in room air, since it can
result in hypoventilation going undetected.
- Because of their simplicity and speed, pulse oximeters are of critical importance
in emergency medicine and are also very useful for patients with respiratory or
cardiac problems, especially COPD, or for diagnosis of some sleep disorders such
as apnea and hypopnea.

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- Limitations and advancements
- Oximetry is not a complete measure of respiratory sufficiency. A patient suffering
from hypoventilation (poor gas exchange in the lungs) given 100% oxygen can
have excellent blood oxygen levels while still suffering from respiratory acidosis
due to excessive carbon dioxide.
- It is also not a complete measure of circulatory sufficiency. If there is insufficient
bloodflow or insufficient hemoglobin in the blood (anemia), tissues can suffer
hypoxia despite high oxygen saturation in the blood that does arrive.
- A higher level of methemoglobin will tend to cause a pulse oximeter to read closer
to 85% regardless of the true level of oxygen saturation. It also should be noted
that the inability of two-wavelength saturation level measurement devices to
distinguish carboxyhemoglobin due to carbon monoxide poisoning from
oxyhemoglobin must be taken into account when diagnosing a patient in
emergency rescue, e.g., from a fire in an apartment. A pulse CO-oximeter
measures absorption at additional wavelengths to distinguish CO from O2 and
determines the blood oxygen saturation more reliably.
Instruments used in Labour room:
a. Anterior posterior wall retractor:
Uses:
- To retract anterior posterior vaginal wall.
- To visualize the cervix.

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- To use as blunt curette.
b. Sim’s speculum:
Uses:
- To inspect cervix and vagina.
- To clean vagina and cervix.
- To inspect the cervix and vagina to any local cause for bleeding.
- During Dilatation and curettage, etc.
c. Low Forceps( Wrigley’s forceps):
Uses:
- To give traction to head of baby.
- To rotate head of baby.
- To compress the head of baby.
- To stimulate uterine action.
d. Vulsellum( Teal’s):
Uses:
- To catch cervix in pregnant patient.

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- To use in MTP, D and E.
- To test the degree of descent of uterus.
- To grasp or twisting off fibroids during myomectomy.
e. Uterine sound:
Uses:
- To know the direction and length of uterocervical canal.
- To check for displaced IUCD.
- To differentiate between inversion of uterus and myomatous polyp.
- To manoeuvre the uterus from below in laparoscopy or minilaprotomy.
- To feel any intrauterine foreign body, polyp or septum.
- To know relation of the pelvic mass with the uterus.
- To diagnose suspected perforation.
f. Ovum Forceps:
Uses:
- To use in D and E procedure.
- To used for retained placenta.
g. Episiotomy scissor

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Uses:
- To give episiotomy in labour.
h. Umbilical cord scissor:
Uses:
- To cut umbilical cord of baby after delivery of baby.
Routine of Labour room:
In Labour room recording, medication, delivery, charting, rounds continue round the clock.
 In the morning, student sister along with one staff nurse done bedding and arrange
trolley, instruments, dressing materials, etc needed in labour room used for delivery
and immediate newborn care.
 Over is taken from night duty staff by the incharge sister and morning duty staff
nurses.
 Inventory of the ward articles is done by morning and evening sstaff.
 The rounds of doctors are routinely done in the morning according to unit of obstetric
gynaecology department.
 All the new orders as well as old orders are being carried and charted in the paper.
 Collection of blood sample, urine, and other investigation are being carried out in the
morning and at admission of antenatal mother.
 Medication and enema administered to antenatal mother as prescribed by doctors.
 Assist in conduction of delivery to doctors.
 Immediate newborn care is given to newborn baby.
 Prepare dressing materials and instruments for sterilization for next delivery.

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 Receive baby from operation theatre and give newborn care and send it to specific
ward.
 Handel obstetric emergency as it came.
 Non stress test also been done in Labour room.
Student activity
 It was my first experience in Labour room of V.S. hospital, I realized the how difficult
and tried to work in Labour room.
 I learned about which are the instruments and drugs used in labour room.
 I also learned and observed how non stress test is to be done.
 I learned about radiant warmer and mechanical ventilator which are used in labour
room for baby and mother.
 I had given enema and all care which are needed in pre intranatal period.
 I had assisted doctors in conduction of delivery.
 I had done per abdomen and per vaginal examination.
 I had taken history and maintain partograph to fill up our assignment for related to
intranatal period.
 I had assisted doctor in episiotomy suturing.
 I had given immediate new born care to new born babies.
SETTING OF LABOUR ROOM
Introduction:
 The obstetric unit should be located so as to prevent unrelated traffic through the unit
and to provide for reasonable protection of mothers from infection and from cross
infection.
 An emergency communication system connected to the operations and control station
shall be provided by the facility.
Requirement :
A labour room should have meet the following requirement:
1. Minimum of 80 sq.ft. of area should be provided per labour bed.
2. The labour room should be located so as to permit visual observation of each room
from the nurse work station.
3. Labour room should afford privacy.
4. A labour room should contain facilities for medication, hand washing, charting, and
storage for supplies and equipment.
5. At least two labour beds with adjacent toilet should be provided for each delivery
room.
6. No more than two labour bed may be located in one labour room.

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Recovery room:
A separate recovery room may be omitted in facilities with less then 1500 births per year
Requirement:
 A recovery room should contain not less then two beds and should have charting facilities
located so as to permit visual observation of all beds.
 Provision for medicine dispensing ,hand washing, clinical sink with bedpan washer,and
storage for supplies and equipment should be provided .
 A toilet with hand washing facilities should be provided for staff.
Labour ,delivery,recovery room:
 Each LDR room should have a minimum have a minimum of 250 square feet of
floor space exclusive of toilet or vestibule.
 Each LDR room should be provided with directly accessible shower for use by that
room only.
 Each LDR room should be equipped with oxygen ,suction,medical air,and electrical
outlets.
 Each LDR room should contain facilities for medication storage,hands-free hand
washing ,charting and storage for supplies and equipment.
Labour room norm (In respect of Equipment, Medicine and
others)
CIVIL INFRASTRUCTURE:
1. Labour room with attached bath.
Floor and walls to be finished by pasting with non slippery tiles and there should be space for
setting up of New Born Care Enclosure with.
a) Radient warmer
b) Foot sucker with sterilized catheter / mucous sucker
c) Ambu bag
2. One buffer room in front of labour room having provision for:
a) Wash basin b) Instrument cabinate
c) Slipper d) Sterilized caps, masks, gowns
e) Patient carrying trolley f) Liquid soap
g) Nursing station h) Wall cabinate
3. One room for sterilization which should have
i) Autoclave machine (Preferably electrically operated)
ii) Instrument Sterilizer (Preferably electrically operated)
iii) Dressing drums iv) Formal sterilizer

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v) Lifter vi) Lysol solution
4. Labour room should have
i) Labour Table /Tables with foam mattress & legging ii) Step per table
iii) Bucket per table iv) Stool per table
v) Other accessories
a) Oxygen Cylinder with fittings (Mask/Hood /catheter-per table )
b) Shadow less lamp per table c) Instrument trays.
d) Instrument Trolley e) Baby weighing machine
t) B.P Instrument (Stand) g) Saline set / B. T set
h) Saline stand per table i) Baby holding Tray
j) Towel for wrapping baby k) Foetal Doppler
I) Stethoscope m) Outlet forceps
n) Volsellum
vi) Labour tray containing:
a) Artery forceps b) Tooth dissecting forceps
c) Needle holder d) Curve cutting needle
e) Scissors (Episiotomy) f) Scissors (plain)
g) Swab holding forceps h) Sim's Speculum
i) Catgut j) Sterilized gloves
k) Sterilized gauze I) Sterilized pad
m) Sterilized Cotton Swab n) Umbilical cord clamp
o) Draping towel (sterilized) p) Syringe and needle (sterilized)
MEDICINE
a) Mesoprostol b) Ing. Magnesium sulphate
c) Inj. Oxytocin. d) Inj. Ampicilin / Gentamycin
e) Inj. Nifedepine f) Inj. Vit-K
g) Plasma expander h) Inj. Lignocaine
i) 25% Dextrose solution (amp) j) 5% Dextrose solution
Record in labour room:
1. Birth record 2. Death record
3. Admission record 4. Abnormal birth record
5. IUD insertion record.
vii) Emergency Medicine Tray containing:
viii) Screen for door and windows

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ix) Curtain in between the tables
x) Wall clock
xi) Un Interrupted power supply / Generator support
xii) Waste disposal bin with colour coded bag
xiii) Hub cutter
xiv) Sodium hypochlorite solution
xv) Partograph
xvi) Log Book
xvii) Providon Iodine
xviii) Rectified spirit
xix) Rack / Table
Conclusion
 Labour room is an important department which provides care and
conductdelivery mothers who are in intranatal period.
 The placement in Labour room for 1 month helped me to gain
knowledge and skill for conductionof delivery and immediate newborn
care.
 I came to know how to handle mother with intranatal period and the
neonate.
 I know the conceptualimportance of interpersonal relations and
importance of teamwork.
 It was enriching experience where I got opportunity to update my
knowledge on labour room, management of intranatal period.
BIBLIOGRAPHY:-
1. Basvanthappa B.T : “TEXT BOOK OF MIDWIFERY AND
REPRODUCTIVE HEALTH NURSING”; first edition 2006, Jaypee
brother publication, New Delhi. Page no; 210-218.
2. Dutta D.C : “TEXT BOOK OF OBTETRICS” ; 6 TH Edition , 2004;
New central book agency publication, Calcutta. Page no: 179-190.
3. Jacob Anamma : “A COMPREHENSIVE TEXT BOOK OF
MIDWIFEREEY”;1stedition 2005; Jaypee brother medical publication; New
Delhi, page no:164-172.
4. Kumari Neelam; (2010); 1st edition; “MIDWIFERY AND

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GYNAECOLOGICAL NURSING”; S.vikas and company; Jalandhar city;
Page no :156-164.
5. Myles : “ TEXT BOOK OF MIDWIVES” ; Fourteenth edition,2003 ;
Elsevier publisher, Philadelphia. Page no; 285-287.
6. Rao Kamini “TEXT BOOK OF MIDWIFERY AND OBSTETRICS
FOR NURSES”; First edition, 2011, Elsevier publisher, Philadelphia. Page
no: 277-281.
REFERENCES
1. http://www.en.wikipedia.org/wiki/
2. http://www.medscape.com/viewarticle/551032_4
3. http://www.healthline.com /evaluation-and-management
4. http://www.uptodate.com/contents
5. http://www.ncbi.nlm.nih.gov/pubmed/19089770
6. http://www.empowher.com/media/reference
7. http://www.pregmed.org/.htm
8. http://www.stanfordchildrens.org/ens-90-P02430