Normal labour Flashcards
Define what normal birth is
What characteristics make a birth ‘normal’?
The process in which the fetus, placenta and membranes are expelled via the birth canal
To be normal:
- Spontaneous
- 37-42 weeks gestation
- Fetus presenting by the vertex
- Results in spontaneous vaginal birth (SVD)
What physiological changes happen to allow normal birth?
The cervix softens
Myometrial tone changes to allow coordinated contractions
Hormonal changes:
- Progesterone decreases
- Oxytocin & prostaglandins increase
Give an overview of the stages of labour
There are three stages of labour, which are subdivided further:
- First stage:
- Latent phase
- Active first stage
- Transition
- Second stage:
- Passive & Active element
- Third part:
- active or physiological
Describe what happens in the first stage of labour
Latent phase (aka early labour):
- can be the longest part (days)
- Irregular contractions
- Cervical dilation up to 4cm
Active phase:
- 8-12 hours
- Regular, painful contractions
- Cervix is now 4-10cm
Transition:
- Transition to 2nd stage of labour
- Cervix 8-10cm
- The mother will experience physical changes - shaking, need to vomit/empty bowels
- May express they can no longer cope
What happens in the 2nd stage of labour?
What are its features?
Birthing stage - will have active and/or passive element
Passive - fully dilated but with no involuntary expulsive contractions
Active - is when either:
- part of the baby is presented
- there are expulsive contractions
- there is maternal effort
How long is the second stage of labour?
2-3 hours but depends whether woman is nulliparous or multiparous
Define what the third stage of labour is?
From the birth of the baby to the expulsion of the placenta ad membranes
The third stage of labour can be managed physiologically or actively
What do these mean?
Physiolgical management:
- No uterotonics
- No chord clamping (until pulsation has stopped)
Active management:
- Use of uterotonics such as:
- Syntocinon (synthetic oxytocin)
- Syntometrine ( “ oxytocin/ergometrine mix)
- Optimal chord clamping
Which is faster, active or physiological management of the third stage of labour?
Active (ie using drugs) is quicker - 30 mins
Physiological - 60 mins
What are the mechanisms (stages) of vertex presentation of birth
Before engagement (would be latent stage of labour)
Engagement & descent, Flexion
Internal rotation of the head
Crowning & extension of the head
Restitution (external rotation)
Delivery of anterior shoulder
Delivery of posterior shoulder
What are the types of fetal ‘lie’?
Longitudinal
Oblique
Transverse
What are the types of fetal presentation?
Cephalic (head first)
Breech (bottom first)
Shoulder (have a guess)
Note there are different types within this - Vertex (a type of cephalic) is the most common/normal
What are the different types of fetal positions?
These describe how the fetus is rotated within the uterus:
- Occipitoposterior R/L
- fetus faces anterolateral
- Occipitotransverse R/L
- faces lateral
- Occipitoanterior R/L
- faces posterolateral
Identify the parts of the fetal skull
How is fetal weelbeing assessed in labour?
What equipment can be used?
Monitoring fetal heart rate is important
This is done either intermittently (low risk) or continuououosly (higher risk)
Equipment:
Pinard’s stethoscope (intermittent)
Hand held doppler (intermittent)
Cardiotocograph - CTG (continuous)
