Stages of Labour

Question 1

Define the 1st stage of labour

Answer 1

From the onset of regular contractions along with effacement and dilatation of the cervix until dialatation

Question 2

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

Answer 2

Irregular contractions, cervix beginning to efface and dilate

Question 3

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

Answer 3

Regular contractions and the cervix being dilated more than 4cm

Question 4

As progesterone falls in the 1st stage, which hormones rise?

Answer 4

Oestrogen, fetal cortisol and prostaglandins

Question 5

What are gap junctions?

Answer 5

Cell-to-cell communication channels that allow contractions to spread harmoniously

Question 6

Where do contractions start?

Answer 6

In the fundus (fundal dominance) and spread outwards and downwards

Question 7

Explain contraction and retraction

Answer 7

Myometrial cells contract and do not return to their size pre-contraction. Upper segment becomes shorter and thicker

Question 8

How do the 2 segments harmonise to expel the fetus?

Answer 8

Polarity

Question 9

Describe general fluid pressure

Answer 9

Whilst the membranes are intact the pressure of each contraction is exerted on the amniotic fluid

Question 10

Explain Ferguson’s Reflex

Answer 10

Pressure on cervix → triggers oxytocin production in the hypothalamus → causes contractions → more pressure on cervix → positive feedback loop

Question 11

What is transition?

Answer 11

The phase between the 1st and 2nd stage of labour

Question 12

What are the signs of transition?

Answer 12

Lull in contractions/ uterine activity, restlessness, early pushing, emotional changes

Question 13

What is low neo-cortal stimulation?

Answer 13

A method used to prevent the production of stress hormones

Question 14

How is low neo-cortal stimulation achieved?

Answer 14

Low lighting, music, freedom to move around, warm room

Question 15

What are some factors that need to be considered for social and cultural care?

Answer 15

Practitioner gender preference, need for an interpretor, preservation of dignity

Question 16

How often is blood pressure and temperature checked during the first stage?

Answer 16

Every 4 hours

Question 17

How often is maternal pulse recorded during the first stage?

Answer 17

Every hour

Question 18

How often is the fetal heart recorded during the first stage?

Answer 18

Every 15 minutes for 1 full minute after a contraction

Question 19

List four characteristics each of the passive and active phase of the second stage of labour

Answer 19

Passive: full dilatation of the cervix, lull in uterine activity, fetal head not fully descended, fetal head not visible, some pressure on rectum and perineum, fetal head not visible.
Active: more pressure on rectum and perineum, visible fetal head, strong urges to push, fetal head fully descended

Question 20

How do the contractions change in the second stage of labour?

Answer 20

Contractions become much more intense, happen every 2 to 3 minutes and last for between 60 and 70 seconds

Question 21

How would you recognise the onset of the second stage of labour?

Answer 21

Bulging perineum, congestion of vulva, gaping anus, involuntary pushing, rupture of forewaters, low guttural noises, vertex visible

Question 22

How is maternal and fetal wellbeing monitored in the second stage of labour?
Where is this documented?

Answer 22

FHR asculation every 5 minutes for a full minute following a contraction
Check mat pulse every 15 minutes to differentiate between maternal and fetal heart rate
Half hourly documentation of frequency of contractions
Hourly BP
4 hourly temp
Hourly VE
Recorded on MEWS chart

Question 23

How long does NICE recommend for the second stage of labour, for primips and multips?

Answer 23

Primip: should take place within 3 hours of start of the active stage, suspect delay if progress is inadequate after 1 hour of active second stage
Multip: should take place within 2 hours of the start of the active stage, suspect delay if progress is inadequate after 30 minutes of active second stage

Question 24

How can the normal physiological processes be supported in the second stage of labour?

Answer 24

Hands on or hands poised, observe for advancing head, gentle counter pressure with fingers, observe for rotation of the head, observe for shoulder rotation, support baby to be lifted upwards towards mothers abdomen, delayed cord clamping, skin-to-skin, keep baby dry and warm

Question 25

Consider the actions that can be taken to help prevent third and fourth degree tears from occurring

Answer 25

No routine episiotomy’s, hands on (one hand on fetal occiput to control speed) or hands poised, warm compress on perineum