Ensuring safety during Labour and Delivery

To begin, let’s understand what Intrapartum surveillance refers to. It is, simply put, the continuous monitoring of the mother and foetus during labour and childbirth. The primary goal is to ensure the well-being of both, detect complications early and enable timely medical intervention when necessary.

Labour is a dynamic and sometimes unpredictable process, and careful observation during this period plays a critical role in reducing maternal and neonatal morbidity and mortality.

Components of Intrapartum Surveillance

The primary component of intrapartum surveillance is foetal monitoring. It has to be kept in mind that the foetus can experience stress during labour due to reduced oxygen supply, cord compression or prolonged contractions. This is where monitoring the foetal heart rate (FHR) provides invaluable in helping understand how well the baby is tolerating labour. This can be done through intermittent auscultation using a fetoscope or Doppler device, or through continuous electronic foetal monitoring (EFM) using cardiotocography (CTG). Intermittent monitoring is often suitable for low-risk pregnancies, while continuous monitoring is recommended in high-risk situations such as preeclampsia, gestational diabetes, meconium-stained liquor or multiple pregnancies.

Maternal surveillance is another key area. The mother’s vital signs, which include blood pressure, pulse, temperature and respiratory rate are checked at regular intervals. Monitoring uterine contractions, pain levels, hydration status and emotional well-being are vital components of comprehensive care. Abnormal maternal signs such as fever, hypertension or excessive bleeding can indicate complications like infection, preeclampsia or placental abruption, requiring immediate attention.

Care also needs to be taken that labour progress is assessed. Healthcare providers track cervical dilation, effacement, foetal descent and contraction patterns. The use of a partograph which is a graphical chart that records labour parameters over time, helps clinicians identify prolonged or obstructed labour early. Monitoring labour progress helps do away with unnecessary risks and aids decisions regarding augmentation, instrumental delivery or caesarean section.

Amniotic fluid observation is another key component of intrapartum surveillance. The colour, quantity and odour of the liquor provide clues about foetal well-being. Clear fluid generally indicates normal conditions, while green or brown fluid may point to meconium passage and potential foetal distress. Foul-smelling fluid denotes infection and necessitates urgent evaluation.

The human aspect

Nurses and midwives are critical in intrapartum surveillance. Their responsibilities include frequent monitoring, accurate documentation, providing emotional support and communicating changes promptly to the obstetric team. Effective communication and teamwork are essential, as labour can shift rapidly from normal to emergency situations.

The technological assist

Technology-assisted surveillance plays an important role in modern obstetrics. This includes foetal scalp blood sampling, pulse oximetry and advanced ultrasound techniques in selected cases. But it is imperative to understand that technology complements clinical judgement and hands-on assessment but does not and cannot replace it. Over-reliance on machines without proper interpretation can lead to unnecessary interventions.

Smoothening labour

The ultimate aim of intrapartum surveillance is to balance safety with the natural process of childbirth. When performed systematically, it enhances outcomes for both mother and baby. By combining clinical expertise, vigilant observation and supportive care, healthcare professionals can ensure that labour is a positive experience.