Normal Labour

Question 1

What is normal labour?

Answer 1

when the foetus, placenta and membranes are expelled via the birth canal.

• spontaneous
• 37-42 weeks gestation
• foetus presents vertex (head down)
• spontaneous vaginal delivery

Question 2

What must occur for normal labour to occur?

Answer 2

• the cervix has to soften
• myometrial tone changes (to allow contractions)
• progesterone decreases
• oxytocin increases
• prostaglandins increase

Question 3

What are the role of the prostaglandins?

Answer 3

They help trigger labour and prime the cervix

Question 4

What are the 3 main stages of labour?

Answer 4

• first stage
• second stage
• third stage

Question 5

What phases are in the first stage of labour?

Answer 5

• latent phase
• active phase
• transition

Question 6

What phases are in the second stage of labour?

Answer 6

• pushing phase

Question 7

What occurs in the latent phase of labour?

Answer 7

• longest part (up to days)
• irregular contractions
• cervical changes - becomes more anterior, dilates up to 4 cm

Question 8

What occurs in the active phase?

Answer 8

• lasts 8-12 hours (depending whether nulliparous or multiparrous)
• cervix from 4-10cm dilated
• regular painful contractions (up to 3/4 in 10 mins, lasting 1 min)

Question 9

what occurs in the transition phase?

Answer 9

• cervix is 8-10 cm
• women vomits, shakes, empties bowels
• requests more pain medication
• says she can’t cope

^These all mean she is transitioning to the second stage of labour

Question 10

What occurs in the second stage?

Answer 10

• usually 2-3hrs (depending on whether nulliparous or multiparous)

Can be passive or active.

• passive :when fully dilated but no involuntary contractions
• active: expulsive contractions, maternal effort or part of baby can be seen

Question 11

What occurs in the 3rd stage of labour?

Answer 11

From birth of baby –> expulsion of placenta and membranes.

physiological (60 mins)- placenta delivered by maternal effort
active (30 mins) - uterotonic drugs, cord clamping

Question 12

what are the steps of labour?

Answer 12

• engagement, flexion and descent
• internal descent rotation of head (to occipital-anterior position)
• crowning and extension of the head
• restitution (head and shoulders rotate 90 degrees)
• anterior shoulder delivery (below suprapubic arch)
• posterior shoulder delivery (via upwards traction)
• delivery of the baby

Question 13

What is engagement?

Answer 13

When the largest diameter of the foetal head fits into the largest part of the maternal pelvis

Question 14

When is the head crowning?

Answer 14

when its visible at the vulva and no longer retreats

Question 15

How can the foetus be monitored?

Answer 15

• intermittent auscultation (Low risk)

- continuous - high risk

Question 16

how is the cardiotocograph used?

Answer 16

• paddles on the abdomen

- measure BOTH foetal heart and uterine contractions

Question 17

What is the normal foetal heart rate?

Answer 17

• 110-160

- varies by >5 BPM

Question 18

How can the mother be monitored?

Answer 18

Normal observations 
abdominal palpation (to see where the baby is lying)

Question 19

What is the rhomboid of muchaelis?

Answer 19

can be seen at the bottom of the back, shows all the pelvic bones being displaced as the baby is Making way to come through

Question 20

What are the pharmacological supports through labour?

Answer 20

• oral analgesia (paracetamol and dihydrocodine) - low risk units
• entonox
• opioids (morphine)
• remifentanil PCA - should be monitored continuously
• epidural - should be monitored continuously

Question 21

What is a side effect of remifentanil?

Answer 21

It can affect maternal respiratory function - get sleepy and often need oxygen

Question 22

What is a side effect of an epidural?

Answer 22

Often lowers the mothers blood pressure

Question 23

IF the amniotic sac hasn’t already ruptured to cause the beginning of labour, when will it likely rupture?

Answer 23

In the active phase of stage 1

Question 24

What is the desired uterine activity?

Answer 24

3-4 contractions within 10 minutes, with each contraction lasting around 1 minute.

Question 25

Which hormone is the main one responsible for uterine contractions?

Answer 25

Oxytocin

Question 26

What is the 3rd stage of birth?

Answer 26

The time between when the baby is delivered to when the placenta is delivered

Question 27

What is a physiological 3rd stage?

Answer 27

When the placenta is delivered naturally

the cord is left attached to both the baby and the placenta until the colour has drained (and all blood is in baby) before being clamped

Question 28

What is an active 3rd stage?

Answer 28

This is using prophylactic uterotonic drugs (oxytocin), with early clamping of umbilical cord and cord contraction until the placenta is delivered.

Question 29

In an active 3rd stage, how long should the cord be left attached to the baby before being clamped?

Answer 29

At least 1 minute.

Question 30

How long does the placenta take to be delivered?

Answer 30

Usually 5-30 minutes.

Question 31

How is amniotic fluid created?

Answer 31

By the babies kidneys

Question 32

What other word is used to describe the amniotic fluid?

Answer 32

water/liquor

Question 33

What colour is normal for amniotic fluid?

Answer 33

clear
straw
slightly pink

Question 34

What does green/brown/blood in the amniotic fluid suggest?

Answer 34

Baby has opened bowels
foetal distress
baby past due date

Question 35

What is a membrane sweep?

Answer 35

When a gloved hand is inserted into the cervix and a circular motion is performed.
This aims to separate the amniotic sac from the cervix membrane.
1 in 10 chance of waters breaking.
they stimulate the release of prostaglandins.

Question 36

What are two common symptoms of late pregnancy?

Answer 36

• loss of the mucus plug

- bloody show