LABOUR ROOM SET-UP & LABOUR ROOM PROTOCOL ACCORDING TO NATIONAL HEALTH GUIDELINES

LABOUR ROOM SET-UP & LABOUR ROOM PROTOCOL ACCORDING TO NATIONAL HEALTH GUIDELINES

• A well-equipped and systematically organized labour room is crucial for ensuring safe childbirth and reduction in maternal and neonatal mortality and morbidity.

• According to National Health Mission (NHM) guidelines, every delivery point must follow standardized labour room protocols to maintain hygiene, preparedness, and emergency responsiveness.

CLASSICAL AYURVEDA PERSPECTIVE ON SUTIKA GRIHA (LABOUR ROOM)

• Ancient texts describe the Sutika Griha as a special room for postpartum care of the mother, designed to ensure physical, mental, and spiritual well-being.

Sanskrit Reference (Aṣṭāṅga Hṛdaya, Uttarasthāna 2/1–2):
"प्रसूतां यत्नतः काले सूतिकागृहसंस्थिताम्।
दद्यादन्नं यथोद्दिष्टं स्नानपानादिकं तथा॥"
Meaning: The woman who has delivered should be carefully managed in a separate room, and appropriate food, bath, and drinks should be provided.

MODERN CONCEPT OF LABOUR ROOM

• Labour room refers to a designated area in a hospital or maternity centre where childbirth is conducted in a clean and safe environment.

• It is equipped with necessary instruments, sterile environment, trained personnel, and emergency management facilities.

COMPONENTS OF A STANDARD LABOUR ROOM SET-UP
(As per NHM and LaQshya Guidelines)

PHYSICAL INFRASTRUCTURE

• Location: Near emergency services like OT and blood bank for quick referral.

• Space: At least 100–120 sq. ft. per delivery table, well-ventilated and air-conditioned.

• Zoning: Divided into clean and septic zones; restricted entry to maintain asepsis.

EQUIPMENT AND SUPPLIES

• Delivery Table with Lithotomy Position

• Sterile Delivery Kits

• Newborn Resuscitation Table with Radiant Warmer

• Oxygen Supply and Suction Apparatus

• Partograph Charts and Monitoring Equipment

• Emergency Drugs and Intravenous Fluids

• Sterile Linen and Towels

• BP Apparatus, Fetal Doppler, Pulse Oximeter

• Baby weighing scale, baby ID bands

WASTE DISPOSAL AND INFECTION CONTROL

• Color-coded bins for Biomedical Waste

• Handwashing facilities with elbow taps

• Availability of gloves, masks, PPE

• Use of 0.5% chlorine solution for disinfection

LABOUR ROOM PROTOCOL (MODERN GUIDELINES)
(As per WHO, GoI and FOGSI Guidelines)

TRIAGE AND ADMISSION

• Triage the pregnant woman into emergency/non-emergency.

• Immediate assessment of vitals, fetal condition, and labour stage.

USE OF PARTOGRAPH

• Graphical representation of labour progress (dilation, descent, contractions).

• Helps identify prolonged or obstructed labour.

LABOUR STAGE-WISE MANAGEMENT

• First Stage:

  • Monitor contractions every 30 mins.

  • Vaginal examination every 4 hours.

  • Encourage ambulation, oral fluids.

• Second Stage:

  • Prepare sterile field, episiotomy if indicated.

  • Ensure presence of trained birth attendant.

  • Immediate neonatal assessment post-delivery (APGAR score).

• Third Stage:

  • Active Management of Third Stage of Labour (AMTSL):

    • Injection Oxytocin 10 IU IM within 1 minute of delivery.

    • Controlled cord traction.

    • Uterine massage.

• Fourth Stage:

  • Observe mother for 2 hours for PPH, vitals every 15–30 minutes.

ESSENTIAL DRUGS TO BE AVAILABLE

• Oxytocin, Misoprostol, Magnesium Sulfate, Injection Vitamin K

• IV Fluids (RL, DNS), Antibiotics

• Anti-hypertensives, Anticonvulsants

DOCUMENTATION AND COMMUNICATION

• Maintain Delivery Register, Partograph, Mother and Child Protection Card.

• Use Safe Birth Checklist (WHO) for standard procedures.

• Inform family about newborn status and postpartum care instructions.

INFECTION PREVENTION AND CONTROL (IPC)

• Hand hygiene before and after patient contact.

• Autoclaved instruments, proper linen sterilization.

• Avoid unnecessary per-vaginal examinations.

NEONATAL CARE PROTOCOL

• Immediate drying and warmth to prevent hypothermia.

• Delayed cord clamping (1–3 mins).

• Initiate breastfeeding within the first hour.

• Vitamin K injection and Eye prophylaxis.

REFERRAL SYSTEM AND EMERGENCY RESPONSE

• Availability of Emergency Transport Services (Ambulance with life support)

• Rapid referral in cases of:

  • Eclampsia

  • PPH

  • Fetal distress

  • Obstructed labour

QUALITY INITIATIVES AND AUDITS (LaQshya & RMNCH+A)

• Labour rooms to be certified under LaQshya – Labour Room Quality Improvement Initiative.

• Conduct Maternal Death Surveillance and Response (MDSR)

• Periodic Skills Training for Staff Nurses and Midwives.

SANSKRIT QUOTES FROM CLASSICS ON SAFE DELIVERY

Suśruta Saṃhitā, Śārīrasthāna 10/15
"गर्भिण्याः प्रजननं यथा स्यात्
सुखं प्रसवकाल उपेक्षितव्यः॥"
Meaning: The process of delivery in a pregnant woman should be carried out carefully and safely.

Charaka Saṃhitā, Śārīrasthāna 8/38
"प्रसवकाले युक्तं स्नेहस्वेदनवमनं हितम्।
सङ्कोचमुत्सर्गश्च यथास्वं प्रवर्तते॥"
Meaning: During the time of labour, the use of sneha and swedana helps facilitate the process.

AYURVEDA RECOMMENDATIONS FOR SUTIKA PARICHARYA (POST-DELIVERY CARE)

• Use of herbal decoctions and medicated ghṛita.

• Massage (abhyanga) with tailas like Balātaila.

• Diet rich in strength-giving (br̥ṃhaṇa) and easily digestible food.

• Prevention of infections through dhoopana (fumigation).