Role of Midwives in Managing Labour: Communication, Support, and Pain Relief

Learn about the important role of midwives in managing labour, including communication, support, and pain relief methods. Discover how midwives provide physical and emotional support to pregnant women, and how they can help manage labour pains through non-pharmacological methods. Understand the significance of managing labour progress and the importance of monitoring the mother and baby during labour. Explore the role of midwives in promoting hygiene and preventing complications during labour. Gain insights into the assessment techniques used by midwives, such as abdominal and vaginal examinations, to monitor labour progress and ensure a safe delivery.

Midwifery
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Midwives play a vital role in taking care of women in labour. According to Whitburn, Jones, and
Davey (2017), labour pain is a very excruciating experience. Therefore, pregnant women need
more attention and care. The painful physiological phenomenon of labour has been associated
with the reduced blood supply to the uterine muscles during contractions (Levett, Smith,
Bensoussan and Dahlen 2016). During this process, pregnant women need close attention from
their spouse or a midwife. Midwives can offer both physical and emotional support to women in
labor. They can achieve these through communication between midwives and the woman,
information support, emotional support activities, interpretation of the experienced labour pains
and finally support care during labour activities (Sydsjo et. al 2015). Effective communication
between a midwife and woman in labour can be achieved through empowering the woman,
advocacy skills and also by enabling the woman to feel special and relaxed. This can be achieved
by explaining the physiological changes and encouraging relaxation exercises such as shallow
and fast breaths during a contraction and deep breaths during a relaxation. This promotes
increased oxygen supply to the uterine muscles and will help the patient bear labour pains more
easily (Yuksel, et.al, 2017). Providing information on what is to be expected will help them bear
it more easily. For example, informing her that the intensity of pain and duration is going to
increase as labour progress will help her become psychologically prepared (Sitras, Benth and
Eberhard-Gran, 2017). The midwife also can determine the cultural preferences and provide for
them if possible and continuously updating the mother on the fetus and her progress. With a
better understanding of the labour process especially for primigravida, the patient will be able to
relax and the process will take place smoothly. The chances of good labour outcomes are also
increased and complications are minimized. Moreover, a midwife can encourage the woman to
ask questions whenever they don’t understand anything and also extending advice and

encouragement. They should also praise her whenever she does a good job. They can also
encourage companion to be present during labour. This will make the woman feel loved and
important. Midwives can also play an important role in managing labour pains. Since labour pain
is due to physiological prices, the best way to manage is through non-pharmacological methods.
According to Emelenyo et. al (2017), labour pains can be alleviated through massage especially
in the flank region. This helps to get distracted from the pain. Heat packs can also be used as
they encourage the release of endorphins which helps the mother bear labour pains more easily.
Water immersion or taking a shower especially with warm water can be helpful to ease the pain.
Many women find it relaxing being in a warm water bath or a warm shower and this helps them
cope with contractions (Koyyalamudi et.al 2016). Relaxation is also another point to deal with
labour pains. This will depend on the mother’s preference. Some mothers may like music,
incense, and others. Breathing exercises help ease labour pains and also leads to relaxation. Deep
breathing helps to increase blood oxygenation, therefore, triggering the release of endorphins and
decrease the release of stress hormones. Aromatherapy which is the use of some essential oils
together with a massage has been found to be helpful to some mothers. Even though there is no
evidence of use, some women have proven it to be helpful. Furthermore, acupuncture has been
found to relieve labour pains. Even though the exact mode of action is not understood, some
women have found it helpful. Lastly, some hospitals use the TENS machine to relieve pain. The
machine sends a small electric current through the body to counteract the pain caused by uterine
contractions. Many women have found it helpful and progressed well in labour as it is safe for
both the mother and the baby except for mothers with a pacemaker (Samadzadeh et. al, 2017).
According to Ozkan, Kadioglu, and Rathfisch (2017), energy is very important during the
process of labour especially the second stage and for a pregnant mother to have enough energy

during the second stage of labor; the mother should have taken enough before or during the first
stage of labour. According to World Health Organization recommendations, all women at low
risk are encouraged to take oral fluids and food during labour. Oral food is restricted in mothers
who are at risk of aspiration as it may lead to complications during labour. Midwives should
encourage pregnant mothers to take light drinks such as milk and porridge especially when there
are no contractions. Use of glucose is also helpful and plenty of water to prevent dehydration.
Midwives should explain to the mother on the importance of taking food or fluids during the
active phase of labour so that the woman can corporate. Oral fluids also improve uterine
contractions hence labour progresses faster. The midwife can also help the mother by holding the
cup or plate and encouraging the mother to take sips. Enough fluids are also important in
preventing fetal distress especially in meconium stained grades 1 and 2. Puerperal sepsis is the
leading cause of maternal deaths after delivery. This is mainly caused by unhygienic or septic
procedures during delivery. To prevent the occurrence of sepsis, the midwife should encourage
the mother to at least take a shower before reaching the second stage of labour. This will ensure
that the perineal area is clean and free of as many microorganisms as possible. Midwives should
also ensure that all procedures done are aseptic in nature. For example, hand washing before and
after every procedure and after handling one patient to another. They should also wear sterile
gloves when performing procedures such as vaginal examination, delivery of the baby,
performing an episiotomy, catheter insertion and inspection of the perineum after birth. Sticking
to the aseptic techniques prevents the transfer of microorganisms to the body causing infections
(Dombroski, 2016).
Bladder in women is in close proximity with the uterus, therefore, a lot of consideration should
be looked into. A full bladder during labour can lead to complications. Full bladders decrease

uterine contractions and also descend of the fetus. Due to this, it can lead to prolonged labour
and even fetal distress. In extreme cases, a vesicovaginal fistula can result due to the head of the
fetus pressing on the bladder wall resulting in ischemia and finally necrosis. Midwives should
encourage women in labour to empty their bladder every two hours. If they are unable then a
catheter should be inserted to drain urine. A full bladder can also lead to post-partum hemorrhage
as the uterus cannot contract effectively. It is therefore important to ensure that the bladder is
empty at every stage of labour (Roth, et.al 2019).
Managing labour progress is very important. Observing the mother from time to time helps to
point out any changes and any complications that may arise and therefore act accordingly. It can
also help in predicting the outcomes of labour and this will enable the midwife to decide in the
best way to save both the mother and the baby. According to Shaw and Kean (2016), abdominal
palpation is one of the important techniques used to manage labour. Fundal palpation is used to
assess if the fetus gestation is consistent with the gestation period. The normal gestation period is
between 38 and 42 weeks. The fundal height should correspond to the weeks but at term when
engagement has occurred the fundal height will be lower than the gestation weeks but not by
much. Mostly the range is between 36 and 38. If the fundal height is far much below and the
baby is a term then it may indicate a small baby. If it is higher than the gestation weeks then it
may be an indication of a big baby, multiple pregnancy or conditions such as polyhydramnios.
Fundal palpation can also help to monitor uterine contractions and when to employ pain relief
methods. Lateral palpation of the abdomen is important to determine fetal lie and position. These
factors are important as they determine the mode of delivery and the length of labour during
labour. The lie can be longitudinal, oblique or transverse. Only the longitudinal lie is normal
during labour and can allow vaginal delivery, oblique and transverse lie require caesarian section

mode as the fetus cannot maneuver through the non-cylindrical birth canal. The fetal position
also affects the mode of delivery and length of labour. The normal position that allows for
vaginal delivery easily is the right or left occipito-anterior positions. This is easy as the occiput
has to rotate only an eighth of the pelvic brim to be just below the pubis symphysis. The other
position that can be possible is the direct occipito-posterior but labour will be prolonged and
back pains are more intense. Another abdominal palpation is the pelvic palpation (Lee and
Azzam, 2016). Pelvic palpation determines the fetal presentation, if engagement has occurred or
not, fetal descend and the degree of flexion. The normal presentations that can allow for vaginal
delivery are cephalic and breech although sometimes breech may be difficult. Other
presentations such as a compound, hand, and others will need a caesarian mode of delivery.
Fetal engagement is when the widest diameter that is the biparietal diameter of the fetal head has
entered the pelvic brim. This usually occurs two weeks before birth but it may delay until labour
starts. Fetal descend is measured in fifths by using finger grip on the pelvic region. Five-fifths
means there in no descend and the fifths should be decreasing (5/5, 4/5, 3/5, 2/5, 1/5) as labour
progress and should be consistent with cervical dilatation. Flexion of the fetal head can be
determined by pelvic palpation. The normal is that of complete flexion as it allows the shortest
diameter of the head to pass through the pelvic brim hence vaginal delivery is possible. The
strength of contractions can also be assessed in abdominal palpation.
Moreover, the vaginal examination is important in monitoring labour progress (Oguodjobi, et.al
2017). Assessment of the external genitalia is important to depict any unusual changes. The
pubic hair should be clean and mostly black in color. There should be no discharge before
rupture of membranes and if membranes have raptured then the liquor and should be clear and
odorless. Any strange odor or color may be an indication of a problem. Strange color such as

green or yellow-green indicates meconium stained liquor and is a sign of fetal distress and
appropriate action should be taken to save the baby. The foul smell of amniotic fluid can indicate
that there is an infection such as chorioamnionitis and appropriate action should be taken.
Inspection for any signs of female genital mutilation is important as it affects the normal
dilatation and it may lead to extensive tears due to lack of elasticity. The vulva and vagina should
be warm and moist in normal labour progress. In situations when the vulva and vagina are hot
and dry, it is an indication of obstructed labour and therefore a caesarian section is needed. The
cervix position and characteristic should also change as labour progresses. During the onset of
labour, the cervix is posterior and it should move to the center as labour progresses. The cervix is
also thick and long at the start and progresses to be thin and short as cervical dilatation and
effacement occur. The cervix should also dilate from 1 cm to full dilatation of 10 cm at a rate of
1cm per hour. Any changes in this progress indicate an abnormality. For example, slow cervical
dilatation may indicate prolonged labour which can be fatal to the fetus. Fetal station can also be
determined through vaginal examination. This is how far the fetal head has descended in relation
to the pelvis. The station is assigned numbers from -5 to +5. The number -5 shows that the fetal
head has not engaged and it is still above the pelvic brim. When the station is zero, it shows that
the fetal head is in the level of ischial spines. The station of +5 shows that the fetal head is at the
vaginal opening and the baby will be born shortly. This stationing should be gradual in normal
labour.
According to Pinas and Chandraharan (2016), uterine contractions help the baby to descend
towards the birth canal. During labour, the uterus usually divides into two segments; the upper
uterine segment and the lower uterine segment. The upper uterine segment is mainly composed
of longitudinal muscles which contract and retract. The lower uterine segment with oblique

muscles contract slightly and relax to allow room for the fetus which is being expelled from the
upper uterine segment. The contractions are usually strong at the fundus and reduce in intensity
downwards a phenomenon known as fundal dominance. As labour progresses the contractions
change in intensity, duration, and interval. During the early stage of labour, contractions are mild
and far apart though they occur in regular intervals. They may take an interval of up to ten
minutes to occur. They also don't last long a period between thirty to ninety seconds. As one
progresses the intervals between two contractions become closer. During the active phase of
labour, the contractions become more intense or become moderate in intensity. They generally
last for about 45 to 60 minutes and occur at a closer interval of about three to six minutes. At this
phase cervical dilatation is between 4 to7cm. In transition phase, the contractions become even
stronger and last longer. They last for about 60 to 90 seconds and the interval reduces greatly to
one to two minutes between two contractions. They can even come as close as after every thirty
minutes as the mother inters second stage of labour. During the transition phase, cervical
dilatation is between 7 and 10 cm. First stage of labour usually lasts for between eight and
thirteen hours. It lasts longer than this then it is an indication of prolonged labour. The cause
might be due to poor uterine contractions which are contributed by many factors such as
maternal energy and fatigue. Sometimes, labour may be augmented if contractions are very poor
by use of oxytocin. When augmented the midwife should be careful in monitoring labour as
oxytocin may cause uterine hyperstimulation which can cause uterine rupture. The midwife
should be keen on noticing that uterine contractions are increasing gradually and consistently to
rule out any complications.
Partogram is a single sheet of paper used to record key data of the mother and the fetus in a
graphical form (Jain, Parikh and Kanabar 2017). It is used to monitor both fetal and maternal

wellbeing during the progress of labour from the active phase of labour when cervical dilatation
if 4 cm. It is intended to provide an accurate record of the progress in labour so that any delay or
deviation from normal may be detected quickly and intervened accordingly. The partogram has
both the fetal part and the maternal part. The patient's information, date of admission and time of
ruptured membranes are important. Ruptured membranes are important to determine premature
rupture of membranes and any risk of infection so that it can be prevented or treated accordingly
and save the fetus from getting infected. The normal fetal heart rate is between 110 and 170 beats
per minute. Fetal heart rate should be recorded every 30 minutes. Any deviation from the normal
range shows that the fetus is in distress and appropriate action should be taken to determine the
cause and act appropriately. Activities such as turning to the left lateral position, oxygen
administration and giving intravenous fluids to the mother may be of great help. State of liquor
and membrane rupture is also important in the partogram. The color should be clear and odorless
and this should be recorded every four hours. Green color indicates meconium stain liquor and
shows that the fetus is in distress.
Cervical dilatation is done and recorded every four hours. There should be a gradual increase of
1 cm per hour and a straight line plotted to join the dilatations marked with an x should fall
between the action line and the alert line. If it falls below the action line, then it indicates
prolonged labor. If there is no progress in cervical dilatation, then it may indicate obstructed
labour due to ill-fitting presenting part. The fetal descend (plotted by a circle) should be
consistent with cervical dilatation such that it should be at zero when cervical dilatation is at 10
cm, this shows normal progress. Cervical contractions should be assessed and recorded after
every 30 minutes noting the intensity, duration, and interval. The duration should be increasing,
intensity should also be increasing and the interval should be decreasing. Deviation from this

may indicate signs of prolonged labour. It also shows the type and amount of drugs and fluids
given to the mother which makes it easy to intervene in case of an emergency. Blood pressure is
recorded every two hours and should be within the normal range of 100/60 and 120/100 mmHg.
This helps to monitor blood pressure especially in mothers with pre-eclampsia and eclampsia.
Pulse rate is recorded after every 30 minutes and also temperature. Oxytocin concentrations are
also noted and urine analysis results are on the same sheet of paper. This helps to give the fetus
immediate treatment especially when the mother had an infection for example syphilis. The
summary of the birth outcomes is also on the same paper and helps to manage the patient after
delivery for example blood loss and blood pressure after delivery. For the baby, APGAR scores
and birth weight are important on what should be done after delivery. If the midwives follow all
these steps, then management of labour will be successful (Bedwell, Levin, Pett, & Lavender,
2017).

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