Labour room is a happening place in the hospital. It is expected to be in full readiness for providing intra-partum facilities,that are needed for safe delivery of both low risk and high risk pregnant women. These services comprise of adequate human and material resources. There is absolutely no scope for compromise and complacency, if we want to avoid any mishap during delivery or in the immediate postpartum period, which are considered to be the most crucial periods. Government of India under Laqshya programme has recommended “Safe birthing checklists” and “Surgical safety checklists” for the same reason
Labour room readiness can be ensured by use of additional simple checklist that comprise of list of items which are most crucial for delivery of services. The doctors, nurses, support staff form the human component of the facility readiness. Instruments, equipments, medicines, disposables form the material component of the readiness for smooth and un-interrupted delivery of services. Nurse or doctor in charge of the labour room has very important responsibility of ensuring the availability of both the components for 24 hours a day, in the labour room complex.
Immediate postpartum period, especially first 2-4 hours are most crucial. It is observed that majority of complications either occur in third stage of labour or immediate postpartum. The common being postpartum haemorrhage, retained placenta, inversion of uterus, amniotic fluid embolism, peri-partum cardio-myopathy or sudden post partum collapse.
With the background experience of some avoidable and unfortunate incidences in our set up, we have developed two separate check lists for low risk and high risk cases for monitoring during immediate postpartum period or post operative period, with great success. It has helped in improving the vigilance and averting the mishaps.
In addition, we are using checklist on day to day basis, for ensuring availability and functional status of essential instruments, equipments(multi-para monitors, ventilator ,infusion pumps),medicines. The oxygen, suction apparatus, oxytocics, IV fluids, other emergency drugs, uterine balloon tamponade like Bakri balloon and ESM-UBT, Non pneumatic anti shock garment, good light source, list of essential emergency phone numbers ,doctors duty list with their contact numbers form mainstay of labour room readiness. There must be designated staff,who will ensure labour room readiness using the check lists on daily basis. There should be a buzzer (and not the bell) in the labour room, which will be helpful for getting additional help in an emergency situation where in, the additional staff rush to labour room for help. Doctors on emergency duty of tertiary care hospital must have up to date information about the availability of blood and blood components in the blood bank of the hospital. Networking of blood banks is helpful in times of crisis, so that the important time is not wasted in searching for the availability of blood of the specific blood group.
Check list is a simple tool that ensures labour room readiness. Clinical checklist also ensures that we are not missing out on any vital parameter during clinical examination of high risk cases.Check lists for post partum monitoring help us in early detection of the complications and averting maternal deaths.