During the supervision of the dilation stage there are a number of key points that determine how to proceed further.
During the dilation stage, it is important to obtain a good impression of how the dilation process is progressing. This is in the first place dependent on the woman’s parity. Generally speaking, the process of dilation in a primigravida with a so-called ‘inexperienced birth canal’ will take longer than in a multigravida who has delivered one or more children vaginally. It is also important to know how the previous dilation stage proceeded. If this proceeded without problems, the chance of problems in the subsequent dilation stage is slightly smaller. The quality of the contractions should also be noted. Slow dilation with moderate contraction activity gives less reason for concern than slow dilation with very powerful contraction activity. The condition of the foetus during the dilation stage is vitally important. This is mainly assessed by noting the frequency of the foetal heart beat, in particular, immediately after a contraction. If clear bradycardia is present, further examination of the foetal condition is necessary.
Finally, the mental condition of the woman is vitally important. The obstetric care provider plays an important role in this respect.
Usually, it is not necessary for the midwife or doctor to be present during the entire dilation stage. However, clear instructions must be left behind as to when the obstetric care provider should be contacted again.
This is necessary in the case of:
- Urge to push.
- Blood loss that is more than spotting.
- Pain between the contractions.
- The membranes rupturing.
In addition, an estimate of the rate of dilation is made and, on the basis of this, the care provider should decide when to return. The pregnant woman should be informed of this.
Tasks to be performed:
- Check the medical records for findings that could be important for the parturition.
- Consult with the woman about which position she wants to give birth in.
- Alert the maternity assistant if the birth is to be expected within about two hours.
- Make sure there is adequate lighting.
- Make sure that the room is warm enough.
- If necessary, cut or shave the hair around the vaginal orifice.
- Give due consideration to the psychological supervision of the woman and her partner.
- Regularly check the contractions for duration and strength.
- Regularly check the foetal heart sounds for frequency and rhythm.
- Regularly check the woman’s blood pressure.
- Regularly check the woman’s pulse rate.
- Regularly perform a digital vaginal examination (see above) and note how far dilation has progressed.
- After each task, note the findings and the time.
- If you leave, give clear instructions about how and when you should be warned again.
- Wait until the moment that the woman spontaneously indicates the urge to bear down.
- Perform a digital vaginal examination.
- If the woman indicates the urge to push during the contraction, there is sufficient dilation and the head is rotated on its axis on the pelvic floor, the dilation stage has been completed, the delivery or pushing stage has started and the woman can actively push.