9.4 Management of obstructed labour
There are several things that you can do to try to relieve the obstruction if the record of cervical dilatation reaches the Alert line on the partograph, and before it approaches the Action line. The details of these procedures were taught in the Antenatal Care Module (Study Session 22) and your practical skills training, so we will only refer briefly to them here.
- If the woman has signs of shock (fast pulse and low blood pressure), prepare to give her an intravenous infusion of Normal Saline or Ringer’s Lactate to rehydrate her. Use a large (No. 18 or 20) cannula. Infuse her with 1 litre of fluids, with the flow rate running as quickly as possible, then repeat 1 litre every 20 minutes until her pulse slows to less than 90 beats per minute, and her diastolic blood pressure (when the heart relaxes after a beat) is 90 mmHg or higher.
- If you think the obstruction may be due to a very full bladder, prepare to drain it by inserting a catheter. Clean the perineal area and catheterise the mother’s bladder to drain the urine into a closed container. Relieving this obstruction may be enough to allow the baby to be born. Note that catheterisation of the bladder in a woman with obstructed labour is usually very difficult, because the urethra is also obstructed by the deeply engaged baby’s head.
Refer the mother urgently to a health facility where a surgical service is available (Figure 9.4). She may need emergency delivery by caesarean section (cutting open her abdomen and uterus) to get the baby out alive and also to save her life.