Stages of Labour

Question 1

Explain how gestational age is calculated and used?

Answer 1

• Time zero = first day of last menstrual period
• Expressed in completed weeks plus days i.e. 6+4/40
• Used clinically

Question 2

What changes occur over 24h in pregnant women?

Answer 2

Pregnancy to labour to instigation of lactation

Question 3

What is parturition?

Answer 3

The process of giving birth - to be in labour

Question 4

What does parturition involve?

Answer 4

• Softening and effacement (start dilating) of the cervix
• Development of uterine contractions which helps cervix dilate
• Rupture of membranes not essential

Question 5

What process is not essential/does not always happens in labour?

Answer 5

Rupture of membranes

Question 6

Describe the progression of contractions in labour

Answer 6

1) Contractions build up gradually over days
2) In 3rd stage of labour there are powerful contractions to push out the placenta
3) Contractions slow down to prevent postpartum haemorrhage

Question 7

What happens to the uterus/contractions after delivery?

Answer 7

1) Uterus resolves down
2) Smooth muscle reabsorbed
3) Uterus goes back down to slightly bigger than pre-pregnant state

Question 8

How many contractions occur in 10 mins in early labour/puerperium (after delivery)?

Answer 8

< 1 every 10 mins

Question 9

How many contractions occur in the late (active) first stage and 2nd stage of labour?

Answer 9

2-3 every 10 mins

Question 10

How many contractions occur in the 3rd stage of labour?

Answer 10

1-2 every 10 mins

Question 11

Summarise the stages of labour

Answer 11

1) Latent/passive first stage (days) - contractions develop, cervix softens and effaces
2) Active first stage (hours) - regular contractions, steady dilation of the cervix (3-4cm to 10cm), partogram starts
3) 2nd stage - cervix fully dilated (10cm), strong propulsive contractions, 1-2 hours to expel fetus, lots of interventions
4) 3rd stage - placenta delivered (oxytocin important), clamp umbilical cord

Question 12

Why might you need interventions in the 2nd stage of labour?

Answer 12

• If baby gets stuck, dangerous phase where want to get baby out as quickly as possible
• Can give oxytocin

Question 13

What is it called when the baby’s head starts coming out?

Answer 13

Crowing of the head

Question 14

What are the two ways the placenta can be delivered?

Answer 14

1) Physiological - uterus contracts downs and delivers placenta
2) Often intervene and give a drug related to oxytocin to make the delivery of the placenta much quicker to limit PPH

Question 15

What is cervical effacement?

Answer 15

When the cervix goes from being thick to paper thin

Question 16

What is the passive first stage/early labour?

Answer 16

A period of time, not necessarily continuous where there are painful contractions and there is some cervical change incl. cervical effacement and dilation up to 4 cm
- Can last a long time

Question 17

What is the difference in the passive first stage of labour in first time mums vs woman who have had a baby before?

Answer 17

In first time mums, effacement happens before dilation but in women who have had a baby before it can happen simultaneously

Question 18

What are the features of the passive first stage of labour?

Answer 18

1) Cervical effacement
2) Cervical dilation up to 4cm
3) Irregular contractions (5-30 mins apart)
4) Rupture of membranes
5) Bloody mucus show
6) Mucus plug comes away. water breaks, back pain first sign

Question 19

How much does the cervix dilate in the passive first stage of labour?

Answer 19

4cm

Question 20

What is used to monitor labour?

Answer 20

Partogram

Question 21

What happens in the active first stage of labour?

Answer 21

1) There are regular painful contractions that become longer and stronger
2) There is progressive cervical dilation from 4cm to 10cm (fully dilated)
3) Partogram is used
4) Women can move around, eat and drink throughout this stage with or without pain relief

Question 22

What is considered normal progress in the active first stage of labour?

Answer 22

Cervix dilation of at least 0.5cm per hour

- Not linear, varies, more or less per hour

Question 23

What are 7 signs that the women is progressing into the second stage of labour?

Answer 23

1) An uncontrollable urge to push
2) Holding breath or grunting during contractions
3) Profuse sweating
4) Mood changes - more sleepy or more focused, grumpy
5) External genitals or anus begin to bulge out during contractions (obvious)
6) She feels the baby’s head begin to move into the vagina (full feeling down below)
7) A purple line between the mother’s buttocks as they spread apart from the pressure of the baby’s head above affects the skin

Question 24

What difference will having an epidural make in the transition between the first and second stages of labour?

Answer 24

• Epidural raises basal temperature

- So women can appear to be hotter than women without an epidural (more sweaty)

Question 25

What happens in the passive second stage of labour?

Answer 25

1) Full dilation of the cervix prior to or in the absence of involuntary expulsive contractions
2) The “rest and be thankful” stage - contractions decrease a bit, body tries to recover from first stage before they have to start pushing
3) Can ask woman to start pushing now but much more difficult

Question 26

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

Answer 26

Usually around 1 hour (varies)

Question 27

What is the average length of the first stage of labour for a first time mother?

Answer 27

11-17 hours

Question 28

What happens in the active second stage of labour?

Answer 28

The baby is visible - expulsive contractions with a finding of full cervix dilation or other signs of full dilation

Question 29

What happens to the fetus in the second stage of labour?

Answer 29

1) Head floating, before engagement
2) Engagement - flexion, descent
3) Further descent, internal rotation
4) Complete rotation, beginning extension
5) Complete extension
6) Restitution, (external rotation)
7) Delivery of anterior shoulder
8) Delivery of posterior shoulder

Question 30

What should diagnosis of delay in the second stage of labour be made?

Answer 30

1) Nulliparous women - when it has lasted 2 hours (she has been pushing for 2 hours)
2) Parous women - when it has lasted 1 hour

Question 31

What do you do if there is a prolonged second stage of labour?

Answer 31

• If mum and baby are well might be able to let them go on longer if all is normal (unusual) - max 4/5 hours
• Little ground for intervention while maternal and fetal conditions are satisfactory and there is clear progress with the descent of the presenting part (baby’s head)
• Difficult to assess the significance of prolonged second stage

Question 32

How should women push?

Answer 32

• No evidence to suggest that women need to be taught when and how to push
• However if women just scream, putting effort and energy into air instead of into pushing (hold breath and push down below - not really teaching just refocusing)

Question 33

What happens in the third stage of labour?

Answer 33

Placental separation from the uterine wall and its descent to the lower segment and finally its expulsion with the membranes

Question 34

Describe the contractions in the third stage of labour

Answer 34

• May be painful (tummy cramp)

- But the placenta usually slides out very easily compared to the baby - just fullness and uncomfortable

Question 35

What can be done to induce the third stage of labour?

Answer 35

Breastfeeding

- It can stimulate a contraction and help the placenta separate from the womb

Question 36

After what will the mother often feel an urge to push (third stage)?

Answer 36

After a few minutes after birth when the cord stops pulsating - the placenta knows its job is done so then the mother will feel an urge to push shortly after this