Learning guide 1: augmentation of labor to be completed by Learners

1. 
   Prepare the necessary equipment.
   

2. 
   Tell the woman (and her support person) what is going to be done, listen to her and respond attentively to her questions and concerns.
   

3. 
   Provide continual emotional support and reassurance, as feasible.
   

4. 
   Review to ensure that there is a need to correct slow progress of labor.
   

5. 
   Put on personal protective barriers.
   

1. 
   Listen to the fetal heart.
   

2. 
   Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.
   

3. 
   Put high-level disinfected or sterile surgical gloves on both hands.
   

4. 
   Clean the vulva with antiseptic solution.
   

5. 
   Use one hand to examine the cervix and note consistency, position, effacement and dilation.
   

6. 
   Use the other hand to insert an amniotic hook or a Kocher clamp into the vagina.
   

7. 
   Guide the hook or clamp along the fingers of the examining hand in the vagina toward the membranes.
   

8. 
   Place two fingers of the examining hand against the membranes and gently rupture the membranes, between rather than during a contraction, with the hook or clamp in the other hand.
   

9. 
   Remove the hook or clamp from the vagina.
   

10. 
    Allow the amniotic fluid to drain away slowly around the fingers of the examining hand.
    

11. 
    Note the color of the fluid (e.g., clear, greenish, bloody).
    

12. 
    Remove the examining hand from the vagina.
    

1. 
   Before removing gloves, dispose of waste materials in a leakproof container or plastic bag.
   

2. 
   Place all instruments in 0.5% chlorine solution for 10 minutes for decontamination.
   

3. 
   Immerse both gloved hands in 0.5% chlorine solution. Remove gloves by turning them inside out.
   

• 
  If disposing of gloves, place them in a leakproof container or plastic bag.
  
• 
  If reusing surgical gloves, submerge them in 0.5% chlorine solution for 10 minutes for decontamination.
  

4. 
   Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.
   

4. 
   Listen to the fetal heart.
   

1. 
   Continue to monitor progress of labor using the partograph.
   

2. 
   Start an IV infusion of dextrose or normal saline.
   

3. 
   Infuse oxytocin 2.5 units in 500 mL of dextrose or normal saline at 10 drops/ minute:
   

• 
  Increase the infusion rate by 10 drops/minute every 30 minutes until there are three contractions in 10 minutes, each lasting more than 40 seconds.
  
• 
  Maintain the rate until the birth is completed.
  

4. 
   If any contraction lasts longer than 60 seconds or if there are more than four contractions in 10 minutes:
   

• 
  Stop the infusion.
  
• 
  Relax the uterus by giving terbutaline 250 μg IV slowly over 5 minutes, OR
  
• 
  Give salbutimol 10 mg in 1 L IV fluid (normal saline or Ringer’s lactate) at 10 drops/minute.
  

5. 
   If there are not three contractions in 10 minutes, each lasting more than 40 seconds with the infusion at 60 drops/minute:
   

• 
  Increase the oxytocin concentration to 5 units in 500 mL of dextrose or normal saline and adjust the infusion rate to 30 drops/minute.
  
• 
  Increase the infusion rate by 10 drops/minute every 30 minutes until a satisfactory contraction pattern or the maximum rate of 60 drops/minute is reached.
  

6. 
   Consider induction to have failed if labor is still not well established, using the higher concentration of oxytocin, in multigravida and in the woman who has had a previous cesarean section, and arrange for delivery by cesarean section.
   

7. 
   In primigravida, if labor is still not well established using the higher concentration of oxytocin:
   

• 
  Infuse oxytocin 10 units in 500 mL of dextrose or normal saline at 30 drops/minute.
  
• 
  Increase the infusion rate by 10 drops/minute every 30 minutes until good contractions are established.
  
• 
  If good contractions are not established at 60 drops/minute, arrange for delivery by cesarean section.
  

GETTING READY

1. 
   Prepare the necessary equipment.
   

2. 
   Tell the woman (and her support person) what is going to be done, listen to her and respond attentively to her questions and concerns.
   

3. 
   Provide continual emotional support and reassurance, as feasible.
   

4. 
   Ensure there is a need to correct slow progress of labor.
   

5. 
   Put on personal protective barriers.
   

1. 
   Listen to the fetal heart.
   

2. 
   Wash hands thoroughly and put on high-level disinfected or sterile surgical gloves.
   

3. 
   Clean the vulva with antiseptic solution.
   

4. 
   Examine the cervix and note consistency, position, effacement and dilation.
   

5. 
   Insert an amniotic hook or a Kocher clamp into the vagina.
   

6. 
   Gently rupture the membranes. Remove the hook or clamp from the vagina.
   

7. 
   Allow the amniotic fluid to drain slowly around the fingers and note the color of the fluid.
   

1. 
   Before removing gloves, dispose of waste materials in a leakproof container or plastic bag.
   

2. 
   Place all instruments in 0.5% chlorine solution for decontamination.
   

3. 
   Remove gloves and discard them in a leakproof container or plastic bag if disposing of or decontaminate them in 0.5% chlorine solution if reusing.
   

4. 
   Wash hands thoroughly.
   

5. 
   Listen to the fetal heart.
   

1. 
   Use a partograph to monitor labor progress.
   

2. 
   Start an IV infusion of dextrose or normal saline. Infuse oxytocin, increasing the rate until a good contraction pattern is established.
   

3. 
   Stop the infusion if any contraction lasts longer than 60 seconds or if there are more than four contractions in 10 minutes. Administer a tocolytic agent to relax the uterus.
   

4. 
   If a good contraction pattern is not established, increase concentration and rate of oxytocin infusion until a good contraction pattern is established or the maximum rate of 60 drops/minute is reached.
   

5. 
   Recognize the induction to have failed if, using the higher concentration of oxytocin, labor is still not well established in multigravida and in the woman who has had a previous cesarean section.
   

6. 
   If labor is still not well established in primigravida, increase concentration and rate of oxytocin infusion until a good contraction pattern is established. Arrange for delivery by cesarean section if a good contraction pattern is not established at 60 drops/minute.