Normal labour

Question 1

Define what normal birth is

What characteristics make a birth ‘normal’?

Answer 1

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)

Question 2

What physiological changes happen to allow normal birth?

Answer 2

The cervix softens

Myometrial tone changes to allow coordinated contractions

Hormonal changes:

• Progesterone decreases
• Oxytocin & prostaglandins increase

Question 3

Give an overview of the stages of labour

Answer 3

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

Question 4

Describe what happens in the first stage of labour

Answer 4

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

Question 5

What happens in the 2nd stage of labour?

What are its features?

Answer 5

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

Question 6

How long is the second stage of labour?

Answer 6

2-3 hours but depends whether woman is nulliparous or multiparous

Question 7

Define what the third stage of labour is?

Answer 7

From the birth of the baby to the expulsion of the placenta ad membranes

Question 8

The third stage of labour can be managed physiologically or actively

What do these mean?

Answer 8

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

Question 9

Which is faster, active or physiological management of the third stage of labour?

Answer 9

Active (ie using drugs) is quicker - 30 mins

Physiological - 60 mins

Question 10

What are the mechanisms (stages) of vertex presentation of birth

Answer 10

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

Question 11

What are the types of fetal ‘lie’?

Answer 11

Longitudinal

Oblique

Transverse

Question 12

What are the types of fetal presentation?

Answer 12

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

Question 13

What are the different types of fetal positions?

Answer 13

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

Question 14

Identify the parts of the fetal skull

Answer 14

Question 15

How is fetal weelbeing assessed in labour?

What equipment can be used?

Answer 15

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)

Question 16

How can the mother be monitored during labour?

Answer 16

Maternal observations (incl HR, resp rate etc)

Abdominal examination

Vaginal examination

Monitoring of liquor

Palpation of contractions

External signs (eg Rhomboid of Michaelis and anal cleft line)

Question 17

What support options are available for women during labour?

Answer 17

maternal position and mobility

breathing and hypnobirthing techniques

massage

aromatherapy

TENS machine

oral analgesia

water baths

Entonox

opioids

Remifentanil PCA

epidural