Normal Labour

Question 1

What constitutes normal labour?

Answer 1

• Spontaneous with no intervention
• Cephalic presentation
• 37-42 weeks

Question 2

What are the three main events for normal labour to start?

Answer 2

1. Cervix softens
2. Myometrial tone changes, allows for coordinated contractions
3. Decreased progesterone and increased oxytocin and prostaglandins to allow for initiation of labour

Question 3

How many stages of labour are there?

Answer 3

3

Question 4

What are the main events of the 1st stage of labour?

Answer 4

Contractions make your cervix gradually open
• Latent phase
• Active stage
• Transition stage

Question 5

What is the latent phase?

Answer 5

• Shortening, thinning and dilatation of cervix up to 4cm
• Irregular and short lasting contractions that are mild in tone
• Can last up to days

Question 6

What is active stage?

Answer 6

• 4-10cm dilation
• 3-4 regular and painful contractions in a 10 minute period each lasting about a minute
• 8-10 hours depending on nulliparous or multiparous

Question 7

What is transition stage?

Answer 7

• 8-10cm dilation more obviously noticed by physical changes
• Shaking vomiting, open bowels
• Need more pain relief
• Feeling she can no longer cope

Question 8

What are the main events of the 2nd stage of labour?

Answer 8

Starts when cervix is 10cm dilated and ends when baby is born.
• Passive phase
• Active phase

Question 9

What is the passive phase?

Answer 9

• Full dilation assessed by vaginal examination

* No presenting parts or involuntary expulsive contractions

Question 10

What is the active phase?

Answer 10

• Presenting parts
• Expulsive contractions
• Encouraged maternal effort
• Birth of baby

Question 11

What is the 3rd stage of labour?

Answer 11

Between birth of baby and when the placenta (or afterbirth) comes out

Question 12

What are the ways of managing 3rd stage of labour?

Answer 12

Active and Passive management.

Question 13

What is active management of 3rd stage of labour?

Answer 13

• Uterotonic drugs - Syntocin, Syntemetrin
• Optimal cord clamping
• Delivered by controlled cord traction - within 30 minutes of birth

Question 14

What is passive management of 3rd stage of labour?

Answer 14

• No uterotonics
• No cord clamping
• Placenta delivered by maternal effort - within 60 minutes of birth

Question 15

What is the acronym for progressive mechanisms of labour?

Answer 15

Deep 
Flood 
In-road 
Expect 
Reopened 
Exit road 
Shoulder

Question 16

What are the progressive mechanisms of labour?

Answer 16

Descent 
Flexion 
Internal rotation 
Extension 
Restitution 
External rotation 
Delivery of shoulder

Question 17

Brief description of each mechanism?

Answer 17

• Descent - before onset of labour, monitor progress
• Flexion - as head meets sloping pelvic floor
• Internal rotation - as head meets pelvic floor
• Extension - head has to push out of birth canal
• Restitution - head rotates to be back in line with rest of body
• External rotation - face looks laterally at the medial thigh
• Delivery of shoulder - should be anterior shoulder so that it’s under pubic arch

Question 18

What is intermittent assessment of labour?

Answer 18

1st stage: every 15 minutes for a full minute

2nd stage: every 5 minutes or after every contraction

Question 19

What is continuous assessment of labour?

Answer 19

CTG or foetal scalp electrode (invasive)

Question 20

Other things to monitor labour ?

Answer 20

• Maternal observation
• Abdo palpitation
• Vaginal examination
• Monitoring of liquor - clear/straw/pink is fine. meconium (baby faeces) is post date/fetal distress
• Monitoring contractions - 10min palp. per 30 min
• External signs - Rhomboid of Michaelis (baby head in pelvis)