What should a labor care guide prioritize?

Labor Care Guide Priorities

A comprehensive labor care guide should prioritize one-to-one continuous support during labor, appropriate pain management with neuraxial techniques when requested, and evidence-based monitoring that minimizes unnecessary interventions while ensuring maternal and fetal safety. 1

Core Components of Labor Care

Continuous Support During Labor

• Provide one-to-one care throughout labor, which has been shown to:
  • Increase likelihood of spontaneous vaginal birth
  • Shorten labor duration
  • Decrease cesarean birth rates
  • Reduce need for analgesia
  • Improve maternal satisfaction with childbirth experience 2
• Support can be provided by healthcare staff, doulas, or chosen companions, with evidence suggesting doula support may be particularly effective 2

Pain Management

• Offer neuraxial analgesia (epidural/spinal) when requested, regardless of cervical dilation 1
• Reassure patients that neuraxial analgesia does not increase cesarean delivery rates 1
• Use dilute concentrations of local anesthetics with opioids to minimize motor block 1
• Consider patient-controlled epidural analgesia (PCEA) for maintenance of labor analgesia, which provides fewer anesthetic interventions and reduced dosages of local anesthetics 1

Monitoring and Assessment

• Implement appropriate fetal monitoring based on risk assessment
• Monitor maternal vital signs, contractions, and labor progress
• Document cervical dilation and fetal station to create "labor curves" that provide diagnostic and prognostic information 3
• Recognize and respond to labor abnormalities promptly

Nutrition and Hydration

• Allow moderate amounts of clear liquids for uncomplicated laboring patients 1
• Avoid solid foods during labor 1
• For patients at increased risk of aspiration (e.g., morbid obesity, diabetes) or increased risk for operative delivery, consider further restrictions of oral intake 1

Medication Management

• When oxytocin is needed for labor augmentation:
  • Start at no more than 1-2 mU/min
  • Increase gradually in increments of 1-2 mU/min
  • Monitor fetal heart rate, uterine tone, and contraction patterns
  • Discontinue immediately if uterine hyperactivity or fetal distress occurs 4
• Consider prophylactic administration of nonparticulate antacids, H2-receptor antagonists, and/or metoclopramide before surgical procedures 1

Special Considerations

• Early insertion of neuraxial catheter for complicated parturients (e.g., twin gestation, preeclampsia, anticipated difficult airway, obesity) to reduce need for general anesthesia if emergency intervention becomes necessary 1
• Use pencil-point spinal needles instead of cutting-bevel spinal needles to minimize risk of post-dural puncture headache 1
• Ensure proper rest and sleep management during labor with appropriate environmental controls and support 5

Third Stage Management

• Administer effective uterotonic agents for postpartum hemorrhage prevention
• Practice delayed cord clamping
• Implement early skin-to-skin contact
• Use controlled cord traction when feasible 6

Common Pitfalls to Avoid

1. Unnecessary interventions: Avoid routine interventions without clear medical indication
2. Inadequate support: Failing to provide continuous support during labor
3. Poor communication: Not involving the woman in decision-making about her care
4. Rigid protocols: Not adapting care to individual circumstances
5. Delayed recognition of complications: Missing signs of labor abnormalities that require intervention

By prioritizing these evidence-based practices, a labor care guide can help ensure optimal outcomes for both mother and baby while promoting a positive birth experience.