Normal Labour

Question 1

What is labour?

Answer 1

Labour is the process in which the foetus, placenta and membranes are expelled via the birth canal

Question 2

What are the physiological changes involved in labour?

Answer 2

Cervix softens
Myometrial tone changes to allow for coordinated contractions
Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate

Question 3

What is the first stage of labour?

Answer 3

Begins when the cervix starts to dilate then ends when it is fully dilated
Can last from hours to days
Anticipated progress 0.5 – 1.0 cm per hour

Question 4

What is established early labour?

Answer 4

Cervix dilated to 5-6cm

Contractions coming 3-4 times in a ten minute period

Question 5

What is the second stage of labour?

Answer 5

From full cervical dilatation to the birth of the baby
Passive second stage of labour
Active second stage of labour-when see presenting parts or when women start pushing
Primagravida birth would be expected within two hours of active second stage
Multigravida birth would be expected within one hour of active second stage

Question 6

What is the third stage of labour?

Answer 6

The third stage of labour is the time from the birth of the baby to the expulsion of the placenta and membranes.
Active management of the third stage- speed up with oxytocin
Physiological management of the third stage- use gravity
Prolonged third stage of labour if it is not completed within 30 minutes of the birth with active management or within 60 minutes of the birth with physiological management.
Wait until cord goes white to clamp it

Question 7

How can labour be monitored?

Answer 7

Maternal observations
Abdominal palpation
Vaginal examination
Monitoring of liquor-smell and colour, look for blood and meconium
Auscultation of the fetal heart, every 15 mins in 1st stage then every 5 mins in 2nd stage
Palpation of uterine muscle contractions
External signs e.g. Rhomboid of Michaelis (coccyx moves for head so get diamond shape at top of buttocks) and anal cleft line (purple line moves from buttocks to spine base)

Question 8

What is the mechanism of labour?

Answer 8

Descent
Flexion
Internal rotation of the head
Crowning and extension of the head
Restitution
Internal rotation of the shoulders
External rotation of the head
Lateral flexion

Question 9

In relation to what foetal feature is position described?

Answer 9

Posterior fontanelle
Occiput posterior and anterior
Want baby ROA or LOA

Question 10

What analgesia can be used for labour?

Answer 10

Breathing, massage, TENS, paracetamol and dihydrocodeine
Water
Entonox (inhalational nitrous oxide and oxygen)
Opioids (morphine, diamorphine, pethidine)
Remifentanil patient controlled analgesia
Epidural
Consider maternal position and mobility as means of reducing pain and facilitating progress in labour