This assessment is based on a scenario of Linda and Rob.
Linda is in the active phase of labour and in this stage the cervix will open up to near complete dilation. Contractions will lengthen, lasting from 45 to 60 seconds and should come at two- to three-minute intervals. Linda’s contractions are becoming more intense. In active phase, Linda won't be able to hide her contractions from those around her—Linda may need to change her breathing or activity, Linda’s facial expression will change as she manages the increasingly intense sensations (Fraser & Cooper, 2009). During active phase the cervix usually dilates about a centimeter an hour, sometimes faster, sometimes slower. (Stables & Rankin, 2010).
Linda and Rob have a birth plan; Linda wants it to be all-natural birth with medication as required. A birth plan is a way of communicating with the midwives and doctors who care for you in labour (Stables & Rankin, 2010). All natural birth is a philosophy of childbirth that is based on the belief that a women who are adequately prepared are innately able to give birth without routine medical interventions but as Linda has stated ‘medication as required’. Techniques for Rob (husband) to relieve the anxiousness and still be supportive, labor support is crucial for Linda’s physical and emotional well-being. Rob should remain with Linda; give firm, clear, positive, and simple directions; remind her to change her positions; assist with breathing patterns; offer a cool washcloth for her brow and lip balm; and keep her hydrated with water and/or ice chip ( Mercer, Hackley, & Bostrom, 1984). Remind her to take one contraction at a time and not to give in to the panicky feelings. If Linda panics: call her by name, take her face in your hands, develop and maintain eye contact, breathe with Linda or talk her through the contraction, try variations in breathing patterns, and give lots of reassurance that she is near the end! (Stein-Parbury, 2009).
Maternal heart rate and BP and fetal heart rate should be checked continuously by electronic monitoring or intermittently by auscultation during the 1st stage of labour (Stein-Parbury, 2009).
Linda has made it known that she is physically exhausted. Linda is in the passive second stage of labour, according to Johnson & Taylor (2010) Transition is the most difficult phase of labour for most women; however, it is also the shortest phase generally lasting ½ hour to 1½ hours in length. Physically, Linda is experiencing contractions 2-3 minute’s part, lasting 60-90 seconds, and is very strong in intensity. Contractions may even "piggy-back" which means one contraction may start to fade away and another one comes along immediately (Spiby, Henderson, Slade, Escott, & Fraser, 1999). During this phase she may notice increased bloody show; nausea, vomiting, burping, or hiccups; shaking; hot/cold feelings; fatigue; and sensitivity to touch. Additionally, she may indicate increased pressure on the perineum and/or rectum.
Rob is still feeling a little anxious, as a midwife it is your role to make the room more relaxing for the entire family, so suggest breathing slowly and explain what Linda is going through at this stage of the labor, turn lights down and music on if it will help the mother and father (Stables & Rankin, 2010).
Linda has asked for pharmacological pain relief, there are a number of pain relief medications out there this day and age, to name a few that are the more common ones;
Breathing nitrous oxide and oxygen ('gas') can provide some pain relief. You can control how much gas you breathe in, and many women find it provides good pain relief during their labour. This has been used for many decades and it is safe for babies and for their mothers (Page & McCandlish, 2006).
Another pain relieving method is an injection of a narcotic, such as pethidine. These narcotics are strong painkillers but they may cause drowsiness and nausea. Sometimes an anti-nausea