Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
Figure 5.1. Positions that a woman may adopt during labor. (WHO, 2003)
Monitor progress of the first stage of labor using the partograph
Findings which suggest satisfactory progress in the first stage of labor are:
• regular contractions of progressively increasing frequency and duration.
• rate of cervical dilatation at least 1 cm per hour during the active phase of labor (cervical
dilatation on or to the left of alert line).
• cervix well applied to the presenting part.
Findings which suggest unsatisfactory progress in first stage of labor are:
• irregular and infrequent contractions after the latent phase, or
• rate of cervical dilatation slower than 1 cm per hour during the active phase of labor
(cervical dilatation to the right of alert line), or
• cervix poorly applied to the presenting part.
Use the partograph card (see Figure 5.2 below) to monitor progress of the first stage of labor.
Unsatisfactory progress in labor can lead to prolonged labor (the woman has been
experiencing labor pains for 12 hours or more without delivery). Be sure to transfer women
immediately to a facility with operative facilities as soon as unsatisfactory progress has been
identified.
Other signs that indicate the woman is experiencing a complication include:
• There is vaginal bleeding in labor and delivery.
• The diastolic blood pressure is 90 mm Hg or more.
• The woman complains of severe headache or blurred vision.
• The woman is found unconscious or having convulsions.
• The fetal heart rate is less than 100 or more than 180 beats per
minute after a contraction.
• Membranes have been ruptured for more than 12 hours before
childbirth.
• The woman has a fever.
Follow national
protocols for
management
and referral of
complications.
Integrated maternal and newborn care
Basic skills course
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