Normal labour

Question 1

• To obtain an understanding of the process of normal labour and its associated problems
• To describe the process of normal labour
• To describe methods of assessing progress in labour
• To apply knowledge of the methods of anaesthesia and analgesia used in labour, their advantages and disadvantages

Answer 1

.

Question 2

Labour is the process in which the …, … and … are expelled

It is normally …, occurring at … weeks gestation

Answer 2

foetus, placenta and membranes are expelled

37-42 wks gestation

Question 3

Normal

• lie
• presentation

Answer 3

Longitudinal

Cephalic/vertex

Question 4

The initiation of labour is due to many physiological factors that are not fully understood

But some of the key physiological changes to allow expulsion are … (3)

Answer 4

Cervix softens

Myometrial tone changes to allow for coordinated contractions

Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate

Question 5

How many stages of labour

Answer 5

3

Question 6

Describe stage 1 of labour (3 partxs)

Answer 6

1st part is the LATENT PHASE where cervix softens and you may start feeling irregular contractions

2nd part is ESTABLISHED PHASE/ACTIVE PHASE when cervix dilates to at least 4cm from more regular and strong contractions

3rd part is TRANSITION PHASE towards the end of stage 1 labour when cervix is almost fully dilated; contractions are even more strong and frequent to dilate to 10cm

Question 7

What does the cervix have to do during labour (4)

Answer 7

move forward, soften, efface, dilate

Question 8

Describe stage II of labour

Answer 8

From full cervix dilation to pushing baby out of vagina

Involves the passive second stage where you may not feel an urge to push straightaway

Becomes the active second stage when you have the urge to push

Question 9

For a primigravida birth (first time pregnancy), birth would be expected within how many hours of the ACTIVE SECOND STAGE

Answer 9

2 hours

Question 10

For a multigravida birth (at least second time pregnancy), birth would be expected within how many hours of the ACTIVE SECOND STAGE

Answer 10

1 hour

Question 11

Describe stage III of labour

Answer 11

Begins once your baby is born, and ends when you deliver the placenta and the empty bag of waters that are attached to the placenta (membranes)

Question 12

Stage III of labour can even be actively managed or physiologically managed
-what does active management involve

Answer 12

routine use of uterotonic drugs, optimal cord clamping, controlled cord traction

Question 13

Stage III of labour can even be actively managed or

-what does physiological management involve

Answer 13

no routine use of uterotonics, no cord clamping until pulsation has stopped, delivery of the placenta by maternal effort

Question 14

Stage III is prolonged if it’s not completed within how long of active management, or within how long of physiological management

Answer 14

30 mins

60 mins

Question 15

Methods of assessing progress in labour

Answer 15

Maternal observations

Abdo palpation - lie, presentation, engagement

Vaginal examination

Monitoring of amniotic fluid - should be clear

Auscultate foetal heart

Palpation of uterine contractions

Question 16

Continuous monitoring of labour could be done with

Answer 16

Cardiotocograph - monitors foetal HR and strength of contractions

Question 17

Preferred position of baby’s head

Answer 17

Occiput anterior

-left OA has reputation for being best to help baby be in smallest diameter to fit through pelvis

Question 18

Mechanism of labour (9)

Answer 18

Descent
Engagement
Neck flexion
Internal rotation of head
Crowning
Extension of the presenting part (head)
Restitution + external rotation
Internal rotation of shoulders
Lateral flexion

Question 19

Describe the mechanism of labour

• descent
• engagement

Answer 19

Head descends through pelvic inlet to pelvic floor

Engagement occurs when the largest diameter of the fetal head descends into the maternal pelvis; engaged when 3/5 or less palpable in abdo. As head engages, it moves toward pelvic brim in either left/right occipito-transverse position

Question 20

Describe the mechanism of labour following descent + engagement

• neck flexion
• internal rotation of head
• crowning

Answer 20

When the occiput comes into contact with pelvic floor, foetal neck flexes (chin to chest) which allows smallest diameter through pelvis

Head rotates from left/right occipito-transverse to occipito-anterior

When the widest diameter of the foetal head successfully goes through the narrowest part of the maternal bony pelvis, the foetal head is considered to be ‘crowning’. (when head is visible at vulva and no longer retreats back between contractions)

Question 21

Describe the mechanism of labour following descent, engagement, neck flexion, internal rotation + crowning

• extension
• restitution
• internal rotation of shoulders

Answer 21

Occiput slips out beneath suprapubic arch allowing head to extend

Baby will naturally align its head with the shoulders (restitution) by externally rotating the face to face left or right medial thigh

Once the shoulders have reached pelvic floor, they will complete rotation from transverse to anterior-posterior

Question 22

Analgesia used in labour

Answer 22

TENS

Paracetamol/dihydrocodeince

Entonox (nitrous oxide + oxygen, ‘gas + air’)

Opioids (morphine etc)

Remifentanil patient controlled - press button to deliver dose

Epidural