Objective
The objective of supervising the dilation stage is to determine the start of labour, to observe the progress of dilation and to detect in time any problems with the progress of dilation, to assess the state of the foetus and to determine the end of the dilation stage.
Short history-taking
The following aspects are important:
- when did the contractions start?
- how long do the contractions last?
- has there been a loss of a plug of blood-tinged, cervical mucus (a show)?
- is there loss of amniotic fluid?
Monitoring the foetal condition
In the dilation period it is important to monitor the foetal condition. Initially this is done by regularly listening to the heart sounds. Note, in particular, whether decelerations occur shortly after the contraction has ended. An accelerated foetal heart rate can also be a sign of foetal distress. In general, the foetal heart rate should be between 120 and 160 beats per minute. Attention should be paid to the possible presence of meconium in the amniotic fluid, evidence of a foetal bowel movement. This can be seen if the membranes break during dilation and the ensuing leakage of amniotic fluid is tinged green. Amniotic fluid containing meconium can be a sign of intra-uterine asphyxia.
Physical diagnostic examination
Assess the general condition of the woman: is she tired, anxious or tense? Measure the pulse rate, blood pressure and temperature. Observe the woman and see if there are any signs of cyanosis, anaemia or oedema. Pay particular attention to oedema in the face or ankles.
Inspection of the abdomen
Note the curvature, are the contractions visible?
Measuring contraction activity
Determine by palpation:
- the intensity of the uterine contractions
- the duration of the contraction in seconds
- the time between contractions.