Normal Labour and Delivery

Question 1

What is the definition of labour?

Answer 1

Normal physiologic process during which the foetus, membranes, umbilical cord and placenta are expelled from the uterus - most women experience without complications

Question 2

What is the WHO definition of normal labour?

Answer 2

Spontaneous in onset, low risk at the start of labour and remaining so throughout labour and delivery, the infant being born spontaneously in the vertex position between 37-42 completed weeks of pregnancy

Question 3

What is a low risk labour?

Answer 3

Labour in a woman without a pre-existing medical condition

Question 4

What labours does ‘spontaneous’ (in the WHO definition of normal labour) rule out?

Answer 4

Induced labours

Question 5

What is the normal labour time for prims?

Answer 5

12-18 hours

Question 6

What is the normal labour time for multips?

Answer 6

6-8 hours

Question 7

What might be mistaken for labour starting, but does not actually indicate the start of labour?

Answer 7

Braxton Hicks contractions - irregular, do not increase in frequency or intensity, “practice contractions”, don’t make any change to the cervix and are not sustained

Show - blood mucous plug from cervix, does not indicate start of labour, labour can occur weeks after this is expelled

PROM - pre-labour rupture of membranes, “waters broken”, can be a day or more before labour starts, or weeks if pre-term
Not all women will rupture membranes, some will deliver baby in the sac, some will rupture at the same time as giving birth

Question 8

What are the physiological factors that cause the initiation of labour?

Answer 8

Largely unknown

Question 9

When does labour occur?

Answer 9

When factors which inhibit contraction and maintain a closed cervix diminish and are succeeded by the actions of factors which do the opposite

Question 10

What brings about contractions?

Answer 10

An increase in intracellular free calcium

Question 11

What increase intracellular free calcium and therefore stimulate uterine contraction?

Answer 11

Prostaglandins and oxytocin

Question 12

What are the places where labour commonly occurs?

Answer 12

Labour ward - high intervention, acute medical setting, generally women are monitored, IV access
Midwives unit - low risk, low intervention, analgesia, pool births possible, intermittent auscultation, encourage mobility
Home - midwife has to attend
BBA

Question 13

What is the first stage of labour?

Answer 13

Begins with regular contractions and ends at full dilatation

Question 14

What is the second stage of labour?

Answer 14

Starts with full cervical dilatation and ends with the delivery of the foetus

Question 15

What is the third stage of labour?

Answer 15

Period between the delivery of the foetus and the delivery of the placenta and foetal membranes, can take 10 minutes-1 hour

Question 16

What is needed in order to labour effectively?

Answer 16

At least 4 strong contractions, lasting at least 40 seconds, in 10 minutes

Question 17

What are mild tone contractions?

Answer 17

Contractions lasting < 20 seconds

Question 18

What are moderate tone contractions?

Answer 18

Contractions lasting < 40 seconds

Question 19

What are you examining for when examining the station of the baby’s head?

Answer 19

Relation of baby’s head to ischial spine

Position of baby’s head - needs to be in the correct position for delivery

Question 20

What are the phases of the first stage of labour?

Answer 20

Latent

Active

Question 21

What is the latent phase of the first stage of labour?

Answer 21

Involves contractions which shorten the cervix and start dilatation

Question 22

What is involved in the initial evaluation of a woman in the first stage of labour?

Answer 22

Due date
When contractions started - frequency and pain
Any bleeding 
Movement of baby 
Observations
Foetal heart rate
Urinalysis 
Cx
Membranes 
Colour of liquor
Meconium

Question 23

What is the passing of meconium associated with?

Answer 23

Foetal distress and poor prognosis

Question 24

What are the phases of the second stage of labour?

Answer 24

Passive

Active

Question 25

What is the passive phase of the second stage of labour?

Answer 25

Where patient is fully dilated but waiting for powerful contractions to cause the baby to descend through pelvis and vagina, can carry on for as long as needed

Question 26

What is the active phase of the second stage of labour?

Answer 26

Delivery by extension
Restitution and external rotation
Expulsion and delivery of shoulders

Question 27

What prolongs the second stage of delivery and when is this not good?

Answer 27

Use of epidural anaesthesia

Not good in CV patients

Question 28

What is involved in the third stage of labour?

Answer 28

The separation of the placenta, its descent to the lower segment and its expulsion with the membranes
Gush of blood, cord lengthening, rising fundus
Controlled cord clamping
(physiological or active)