From the Guidelines
The first stage of labor intrapartum care algorithm should focus on monitoring and supporting the mother during the latent and active phases until complete cervical dilation, with a strong emphasis on identifying the onset of the active phase to diagnose and manage potential labor abnormalities, as highlighted in the most recent study 1. To implement this algorithm, begin by assessing maternal vital signs, fetal heart rate, and contraction patterns upon admission. Perform a vaginal examination to determine cervical dilation, effacement, and fetal position.
Key Components of the Algorithm
- During the latent phase (0-6 cm dilation), encourage ambulation, provide hydration, and offer non-pharmacological pain management techniques like breathing exercises, massage, and hydrotherapy.
- As labor progresses to the active phase (6-10 cm), increase monitoring frequency to every 30 minutes for fetal heart rate and every 1-2 hours for cervical examinations.
- Document progress on a partogram to identify any labor abnormalities, using the normal rate of dilatation as a guide, with a lower limit of 1.2 cm/h for nulliparas and 1.5 cm/h for multiparas, as confirmed by diverse clinical investigators 1.
- For pain management, offer epidural analgesia when requested, typically administered as a continuous infusion of local anesthetic with opioid (such as bupivacaine 0.0625-0.125% with fentanyl 2 mcg/mL at 8-15 mL/hour).
- If labor progress slows, consider amniotomy or oxytocin augmentation (starting at 1-2 mU/min, increasing by 1-2 mU/min every 30 minutes until adequate contractions occur, maximum 20-40 mU/min), while being mindful of the potential for labor disorders such as protracted active phase, arrest of dilatation, and prolonged deceleration phase, as discussed in 1. Throughout this stage, maintain maternal hydration, allow clear liquid intake, provide emotional support, and respect the mother's birth plan while ensuring maternal and fetal wellbeing through continuous assessment and documentation, as emphasized in the recent study 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Dosage of oxytocin is determined by uterine response. The following dosage information is based upon the various regimens and indications in general use. Induction or Stimulation of Labor Intravenous infusion (drip method) is the only acceptable method of administration for the induction or stimulation of labor.
- The initial dose should be no more than 1 to 2 mU/min
- The dose may be gradually increased in increments of no more than 1 to 2 mU/min, until a contraction pattern has been established which is similar to normal labor.
The first stage of labor intrapartum care algorithm involves induction or stimulation of labor using oxytocin through intravenous infusion, with an initial dose of 1 to 2 mU/min and gradual increases until a normal labor contraction pattern is established 2.