SHREE SARSWATI KANYA KELAVANI MANDAL SANCHALIT

SHREE R.G.PATEL COLLEGE OF NURSING, KADI

SUBJECT:- Obstetric & Gynecological Nursing

TOPIC:- Visit Report ( Labour Room )

SUBMITTED TO:-

SUBMITTED BY:-

Ms. Bhavika G. Sonagara

Roll No.-12
F.Y. M.Sc. Nursing
Shree R.G. Patel College of Nursing
Nanikadi, Kadi.

Date of Submission:-
 LABOUR ROOM
SOLA CIVIL HOSPITAL, AHMEDABAD
Introduction:

 I am F.Y. M.Sc Nursing with Obstetrics and Gynaecology Nursing speciality, R.G. Patel
College of Nursing were posted in sola 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 fulfill 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 tundle 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.
Staffing Pattern:

Head of Labour Room

T Matron (1)

Sister

In Charge (1)

JR. Staff Nurses (8)

Class 4 employee (6)

Doctors unit in Labour room

 EQUIPMENT AND ARTICLES NEEDED IN LABOUR ROOM:

ARTICLES:

 Delivery table
 Head light
 Warmer/ Table with 200 watt bulb
 Kally's pad
 Linen
 White sheet
 Green sheet
 Mackintosh
 Gloves
 Cotton pad
 Gauze pieces
 Perineal pads
 Big bucket
 Plastic Apron

 Labour tray containing:

 Artery forceps
 Needle Holder
 Scissors (Episiotomy)
 Swab Holding Forceps
 Tooth Forceps dissecting
 Curved Cutting needle
 Scissor Plain
 Sim's Speculum
 Sterilized Gloves
 Sterilized Pad
 Umbilical cord clamp
 Syringes and Needle (Sterile)
 Sterilized Gauze
 Sterilized Cotton
  Draping towel(Sterile)
 Miscellaneous (Instruments)
 Cervical Dilator
 Uterine Curette
 Forceps
 Sterile Drum
 Boiler
 Weight Machine
 BP Instrument
 Liquid soap
 Sterilizer
 Uterine Sound
 Allis Forceps
 Ventose cup Syringe
 Oxygen cylinder
 Suction machine
 Infantmeter
 Almirah
 Hand Towel

EQUIPMENT REQUIRED FOR BABY CARE:

 Mucus extractor
 Cord clamp
 Feeding tube
 Fetoscope
 Stethoscope
1. Non-stress test (NST)

 Non-stress test is a simple, painless procudure in which a baby's heartbeat is

continuously monitored for 20 minutes or more along with recording foctal 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 condition 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 or 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 women 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 le 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 sig. tow electronic devices will be strapped to mother abdominal.
 The transducer ultrasound will monitor baby's heartbeat.
 The other device will record any uterine contraction fet 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 non-invasive test
- The test is simple, inexpensive and takes less time.
- There are no contradictions or complications.
- No special expertise require.
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
beating is provided by a heating mechanism mounted overhead. The beating 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 mamally 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.

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 suctioning

• Course breath sounds.

• Noisy breathing

• Visible secretions in the airway values.

• Decreased SpO2 in the pulse oximeter & Deterioration of arterial blood gas
Clinically increased work of breathing/

• Suspected aspiration of gastric or upper airway secretions. Patient's rubility 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

• Tracheal and/or bronchial mucosal trauma

• 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 circut or ambu bag for pre oxygenate 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. (Sp02)

• 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 offen 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 noninvasive 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, pikts 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 themetabolism

of oxygen, or the amount of oxygen being used by a patient. For thispurpose, it is necessary to
abo 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.

Limitations and advancements Oximetry is not a complete measure of respiratory sufficiency. A

patient suffering from hypoventilation (poor gas exchange in the hrs) 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 blood flow 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 methe moglobin 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, eg, from a fire in an apartment. A
pube CO-oximeter measures absorption at additional wavelengths to distinguish CO from O;
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.

• To use as blunt curette.

b. Sim's speculum:

Uses:

• To impect cervix and vagina

• To clean vagina and cervic

• To inspect the cervix and vagina to any local cause for bleeding. During Dilatation and
curettage, ete.
e. 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.

• 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.

• Also about which are the instruments and drugs used in labour room I also 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 intrautal
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 unt 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.
Recovery room:

A separate recovery room may be omitted in facilities with less than 1500 births per year
Requirement:

A recovery room should contain not less than 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..

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 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 lund washing charting and storage
for supplies and equipment.

Labour room norm (In respect of Equipment, Medicine and others).

CIVIL INFRASTRUCTURE:

Labour room with attached bath

1. Floor and walks 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) Slipper

c) Patient carrying trolley

Nursing station
3. One room for sterilization which should have Autoclave machine Preferably electrically
operated) Instrument Sterilizer (Preferably electrically operated)

1. Dressing drums -15

2. Instrument cabirate

3. Sterilized caps, masks, gowns

4. Liquid soap

5. Wall cabinate

6. Formal Sterilizer

7. Litter

8. Lysol solution
4. Labour room should have
• Labour Table Tables with foam mattress & legging

• Step per table

• Bucket per table v) Other accessories

• Stool per table

• Oxygen Cylinder with fittings

(Mask/Hood /catheter-per table)

• Shadow less lump per table

• Instrument trays

• Instrument Trolley

• Baby weighing machine

• B.P Instrument (Stand)

• Saline set/B.T set

• Saline stand per table

• Baby holding Tray

• Towel for wrapping baby

• Foetal Doppler

• Outlet forceps

• Voleilum

• Labour tray containing:

• Artery forceps

• Needle holder e) Scissors

(Episiotomy)

• Tooth dissecting forceps

• Curve cutting needle

• Scissors (plain)

• Swab holding forceps

• Sam's Speculum

• Catgut

• Sterilized gue

• Sterilized gloves

• Sterilized pad

• Umbilical cord clamp

• Syringe and needle (sterilized)

• Sterized Cotton Swab

• Draping towel (sterilized)

MEDICINE
• Inj. Magnesium sulphate

• Inj. Ampicilin/Gentamycin f)

• Inj. Va-K

• Mesoprostol

• Inj. Oxytocin,

• Inj. Nifedepine

• Plasma expander

• 25% Dextrose solution (amp)

• Inj. Lignocaine ) 5% Dextrose solution

Record in Labour room
• Birth record
• Death record
• Admission record
• Abnormal birth record
• IUD insertion record
• Partograph

Others
• Emergency Medicine Tray containing:
• Screen for door and windows
• Curtain in between the tables
• Wall clock
• Un Interrupted power supply/Generator support
• Waste disposal bin with colour coded bag
• Hub cutter
• Sodium hypochlorite solution
• Providon lodine
• Rectified spirit
• Rack/Table

Conclusion:-

Labour room is an important department which provides care and conduct delivery mothers
who are in intranatal period. The placement in Labour room for 1 month helped me to gain
knowledge and skill for conduction of delivery and immediate newborn care. I came to know
how to handle mother with intranatal period and the know the conceptual importançe of
interpersonal relations and neonate. 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 BT: "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 : 6TH Edition. 2004; New central book agency
publication, Calcutta. Page no: 179-190.

3. Jacob Anamma: "A COMPREHENSIVE TEXT BOOK OF MIDWIFEREEY"" edition 2005; Jaypee
brother medical publication; New Delhi, page no: 164-172.

4. Kumari Nechun (2010): 1 edition; "MIDWIFERY AND 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
 SHREE R.G.PATEL COLLEGE OF NURSING, KADI
EVALUATION TOOL FOR ORIENTATIN VIST REPORT

Name of the Student: Roll No.:

Year of Study: Date of Submission:

Topic:

Total Marks: Marks obtained:

Sr. Evaluation Criteria 5 4 3 2 1

No.
1 Introduction and overview

2 Objective defined

3 Organizational chart drawn

4 Physical set up drawn

5 Policy described

6 Staffing patterns described

7 Role and responsibilities described

8 Resources and References used

9 Overall appearance and cleanliness

10 Punctuality in Submission

[*Scoring: 5= Very good, 4= Good, 3= Below Average, 1= Poor]

Signature of Student: ___________________ Signature of Evaluator:________________

Remarks:______________________________________________________________________