1.1 Introduction

Reducing maternal and infant mortality is an integral part of national development. Globally, 830 women die every day in childbirth [1], most being from poor and rural backgrounds in developing countries. A woman’s lifetime risk of maternal death is 1 in 4900 in developed countries and 1 in 180 in developing countries, and this difference is mainly due to inequities in access to health facilities. The global maternal mortality rate is 212/100,000 and in India the rate is 174/100,000 [1]. The infant mortality rate is 32/1000 live births globally and in India the rate is 40.5/1000 live births [2]. With the global implementation of the World Health Organization millennium development goals, and with the implementation of various programs by the Indian National Government, the emphasis in childbirth is on institutional deliveries. In India, in rural areas and even in a few urban areas, traditional birth attendants still conduct deliveries at home, and the lack of sterile instruments and clean surroundings, as well as improper handling techniques, leads to sepsis, jeopardizing the health of both the mother and the baby. As health schemes have been emphasizing the need for 100% institutional deliveries, it is important to know about the place where all these deliveries occur, i.e., the labor room. Not all rooms can be considered as labor rooms, as certain guidelines need to be followed for a labor room, e.g., for its layout, sterilization techniques, necessary equipment and drugs, and waste management. These guidelines are discussed in this chapter.

1.1.1 The Labor Room

The labor room is a place equipped for conducting deliveries. It should be spacious, with cross ventilation. There are two concepts of a labor room, the preferable choice being a labor delivery recovery room, allowing the patient to stay from the beginning of labor to delivery and for 4 h postdelivery for maternal recovery. But in developing countries, where there are large numbers of patients and few beds available for total admission, a conventional labor room concept is adopted, where the patient is placed on a delivery table on full dilatation of the cervix and moved back to the ward after delivery. Adequate lighting, a continuous power supply, a hand-washing station, an examination table, and a baby resuscitation area are essential requirements for such a labor room (Fig. 1.1).

Facility of neonatal intensive care unit with pediatrician availability is ideal for labor room.

The essential set of labor room (Fig. 1.1a, b) equipment for initial examination includes a stethoscope (Fig. 1.2), a sphygmomanometer (Fig. 1.3), a wall clock, a thermometer, and a measuring tape. For examining the fetal heart, a fetoscope or handheld Doppler device can be used. For high-risk patients in labor, a cardiotocography machine (Fig. 1.4) is used for initial or continuous fetal heart rate monitoring. A partogram should be maintained. Urine dipsticks (Fig. 1.5) are used for initial diagnosis in preeclamptic and eclamptic patients. A glucometer (Fig. 1.6) is required for testing maternal glucose levels (Figs. 1.7 and 1.8).

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