1st Stage of Labour

Question 1

What are the stages and phases of labour?

Answer 1

Latent phase
Active 1st stage
Rest and thankful phase
Active 2nd stage
3rd stage
4th stage

Question 2

When does oxytocin flow best according to Nolan 2020?

Answer 2

When women feel safe, when privacy is guranteed and when they are unobserved

Question 3

When and where is oxytocin released from in labour?

Answer 3

Released from the posterior pituitary lobe into the circulation
Released in pulses with increasing frequency and amplitude in the first and second stages of labour
A few pulses released in the third stage of labour
During labour, the fetus exerts pressure on the cervix of the uterus, which activates a feedforward reflex, which releases oxytocin.

Question 4

What is the problem with Friedman’s work (Friedman’s trajectory)

Answer 4

Friedman was an American obstetrician in the 1950s. His research all took place on white women (middle class, similar ages, supine position), where he tried to find out the labour trajectory. He plotted it on a graph (Friedman’s curve) which estimated the length of each stage of labour.

Question 5

What do the NICE guidelines describe can be descriptions of the 1st stage of labour

Answer 5

there are contractions and
there is some cervical change, includin cervical position, consistency, effacement and dilation up to 4cm.

Question 6

What happens to the endocrine in the onset of labour?

Answer 6

Progesterone withdrawal

Question 7

What happens to the immune in the onset of labour?

Answer 7

Leukocyte and leukotriene activation

Question 8

What happens in terms of mechanical factors in the onset of labour?

Answer 8

Enhanced uterine stretching and amnio-chorionic membrane disruption.

Question 9

What do the endocrine, immune and mechanical factors cause in the onset of labour?

Answer 9

An inflammatory activation and protaglandin production to transform the myometrium to an active contractile state at term.

Question 10

What does progesterone activate?

Answer 10

Prostaglandins which aids the mechanical process

Question 11

What does activated leukocytes cause?

Answer 11

Inflammatory response aiding the mechanical process.

Question 12

How does labour start in terms of progesterone withdrawal?

Answer 12

The mechanisms that supress progesterone’s function near term to allow labour an delivery are still shrouded in uncertainty.
A hypothetic scheme of the mechanisms that control progesterone reposnsiveness in teh pregnant human myometrium

Question 13

What do the placental oestrogens, relaxin and prostogalndins do? (Fuchs et al 1991)

Answer 13

Soften the collagen fibres in the cervix and make it more distensible

Question 14

How is uterine tissue prepared for labour?

Answer 14

Under the influence of oestrogen, prostoglandins and distension of uterine tissue, uterine tissue is prepared for labour through cell multiplication and hypertropjy (increase in size of cells)

Question 15

What helps stimulate contractions?

Answer 15

Uterotrophins, including oxytocin, raise levels of intracellular calcium

Question 16

What else is oxytocin secreted by that is a major contributor to inc oxytocin levels in uterine tissue

Answer 16

fetus

Question 17

Due to the influence of oestrogens, what does the number of gap junctions in the muscles increasing cause?

Answer 17

Allows inccreased coordination of myometrial contractility

Question 18

What are gap junctions?

Answer 18

Transcellular membrane channels which allow ion exchange between cells to propagate an electrical signal and subsequent muscle contractions.

Question 19

what do the NICE guildines say about assessment of women in 1st stage of labour?

Answer 19

-When performing an initial assessment of a women in labour, listen to her story and take into account her preferences and emotional and psychological needs.
-Carry out initial assessment to determine if midwifery-led care in any setting is suitable for the woman, irrespective of any previous plan including consultant led care

Question 20

what are maternal factors to consider?

Answer 20

Review and discuss the antenatal notes (including all antenatal screeningresults).
* Review the personalised care plan.
* Review if there are any antenatal or intrapartum risk factors for fetal hypoxia
* Ask about the length, strength and frequency of contractions.
* Ask about any pain they are experiencing and discuss options for pain relief.
* Record pulse, blood pressure, temperature and respiratory rate, and carry outurinalysis.
* Record if any vaginal loss.
* Check if needs intrapartum antibiotics for group B streptococcus prophylaxisand, if so, that these are available in chosen place of birth if needed

Question 21

What do the NICE 2023 guidlines say about transfer to obsetetric based care in regards to bp

Answer 21

A single reading of either raised diastolic blood pressure of 110 mmHgor more, or raised systolic blood pressure of 160 mmHg or more －either raised diastolic blood pressure of 90 mmHg or more or raisedsystolic blood pressure of 140 mmHg or more on 2 consecutivereadings taken 15 to 30 minutes apart

Question 22

What do Marshall and Raynor say about low and high blood pressure

Answer 22

Hypotension may be caused by being in a supine position, by shock or as a result of vasodilation associated with epidural
Hypertension is an indicator of pre-eclampsia
Labour may further elevate bp

Question 23

What are the observations of the unborn baby upon arrival

Answer 23

Ask about the baby’s movements in the last 24 hours.
* Palpate the woman’s abdomen to determine the fundal height, the baby’s lie, presentation,position, engagement of the presenting part, and frequency and duration of contractions.
* Auscultate the fetal heart rate for a minimum of 1 minute immediately after a contraction;palpate the woman’s pulse to differentiate between the heartbeats of the woman and thebaby.
* Carry out intermittent auscultation immediately after a palpated contraction for at least1 minute, repeated at least once every 15 minutes, and record it as a single rate on aportogram and in the woman’s notes (NICE 2022: Fetal monitoring in labour)
* If there is uncertainty about whether the woman is in established labour, a vaginal examinationmay be helpful after a period of assessment, but is not always necessar

Question 24

What to consider when conducting a VE

Answer 24

Be sure that the examination is necessary and will add important information to the decision-making process.
* Recognise that a vaginal examination can be very distressing for a woman,especially if she is already in pain, highly anxious and in an unfamiliarenvironment.
* Explain the reason for the examination and what will be involved.
* Ensure the woman’s informed consent, privacy, dignity and comfort.
* Explain sensitively the findings of the examination and any impact on the birthplan to the woman and her birth companion(s).* Advise the woman that she can decline the examination before it starts, or askto stop at any stage during the examination.

Question 25

What does Lewin et al (2005) find about women’s experiences of VE in labour?

Answer 25

Women undergoing albour dislike VE
VE’s seem to be the pivotol assessment tool used in labour. Students have reported e.gs in which midwives undertook routine 3-4 hourly VE’s, based on guidlines rather than individual needs.
These are often said to be painful and performed with littl accompanying info in a sometimes ritualistic and intimidating manner.

Question 26

What are the methods of induction of labour that we should inform women that the available evidence DOES NOT support

Answer 26

Herbal supplements
Acupuncture
Homeopathy
Castor oil
Hot baths
Enemas
Sexual inetrcourse

Question 27

What is the definition of the latent phase (WHO 2018)

Answer 27

Is a period of time characterized by painful uterine contractions and variable changes of the cervix, including soe degree of effacement and slower progression of dilation up to 5cm for first and subsequent labours.

Question 28

What are some points to know about the latent phases from Marshall and Raynor

Answer 28

Also known as early labour
May last 6-8 hours in primips where cervix dilates from 0-4cm
Very subjective
Poorly understood
Difficult to measure.

Question 29

What is the intrapartum guideline about the latent first stage of labour in the NICE guidlines.

Answer 29

A period of time, not necessarily continuous, when:
There are painful contractions and
There is some cervical chnage, inclduing cervical effacement and dilation up to 4cm.

Question 30

What does the colour of amniotic fluid mean:
green

Answer 30

meconium stained

Question 31

What does the colour of amniotic fluid mean:
Golden

Answer 31

Rh incompactability

Question 32

What does the colour of amniotic fluid mean:
Greenish yellow

Answer 32

Post maturity

Question 33

What does the colour of amniotic fluid mean:
Dark couloured

Answer 33

concealed accidental haemorrhage

Question 34

What does the colour of amniotic fluid mean:
Dark Brown

Answer 34

IUD

Question 35

What does the colour of amniotic fluid mean:
Clear or colourless

Answer 35

Normal

Question 36

What are the benefits of amniotic fluid?

Answer 36

Protecting the fetus: The fluid cushions the baby from outside pressures, acting as a shock absorber.* Temperature control: The fluid insulates the baby, keeping it warm and maintaining a regular temperature.* Infection control: The amniotic fluid contains antibodies

Question 37

What is meant by POWER

Answer 37

Uterine action contracts and retracts causing descent
Maternal effort as the secondary power

Question 38

How can we as midwives increase: oxytocin

Answer 38

Staying calm and confident
Avoid disturbances

Question 39

How can we as midwives increase: Endorphins

Answer 39

Staying calm and confident
Avoid disturbances
Delay use of opiods/epidural

Question 40

How can we as midwives increase: Adrenalin

Answer 40

Being infromed and prepared
Trust and confidence in caregivers
Environmental effects

Question 41

What did Hollins-Martins (2014) find about music therapy in labour

Answer 41

The results of this narrative review have provided promising results about the effectiveness of music interventions at reducing stress, anxiety, labour pain and depression in childbearing women

Question 42

What does the evidence show about walking and upright positions in the first stage of labour

Answer 42

Can reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers’ and babies wellbeing

Question 43

What is the care in the 1st stage of labour according to NICE 2023

Answer 43

Record the following observations during the first stage of labour:* half-hourly documentation of frequency of contractions (usually 3-4every 10 minutes)* hourly pulse* 4-hourly temperature and blood pressure* frequency of passing urine* if the woman appears to be in established labour, offer a vaginal examination (after abdominal palpation and assessment of vaginal loss)