Normal Labour

Question 1

What is normal labour?

Answer 1

It is the process in the foetus, placenta and membranes are expelled via the birth canal

Question 2

Normal labour is said to be…

Answer 2

Spontaneous (spontaneous vaginal birth)

Question 3

After what period of gestation should labour occur?

Answer 3

37-42 weeks gestation

Question 4

How should the foetus present?

Answer 4

By the vertex

Question 5

What is known about the physiosological factors which allow for labour to start?

Answer 5

• Cervix softens
• Myometrial tone changes to allow for coordinated contractions
• Progesterone decreases whilst oxytocin and prostaglandins increase to allow for labour to initiate

myometrium - middle layer of uterine wall

Question 6

How many stages of labour are there?

Answer 6

3:
•First stage of labour - early/latent phase, active first stage and transition
•Second stage of labour - passive, active
•Third stage of labour - active or physiological

Question 7

Which 2 phases can the first stage of labour be divided into?

Answer 7

Latent (early) and active phases

Question 8

What occurs in the latent phase?

Answer 8

• Can be the longest part of labour
• Irregular contractions
• Cervical changes and dilatation up to 4cm

Question 9

What occurs in the active phase?

Answer 9

• Length of active labour can vary from 8-12hrs - depends parity
• Regular, painful contractions
• Cervix is 4-10cm

Question 10

What is the transition stage?

Answer 10

• Between 1st and 2nd stages of labour
• Cervix is 8-10cm
• May experience physical changes such as shaking, vomiting or the need to empty her bowels
• May express that they can no longer cope

Question 11

What occurs in the second stage of labour?

Answer 11

• Can have passive and active
• Full dilatation to birth
• Passive second stage of labour
• Active second stage of labour
• Length will vary between 2-3hours depending on if woman is nulliparous or multiparous

Question 12

What occurs in the third stage of labour?

Answer 12

• From birth of the baby to the expulsion of the placenta and membranes
• Physiological management - no uterotonics, cord clamping, placenta is delivered by maternal effort (60mins)
• Active management - uterotonic drugs, clamp and cut the cord once blood has drained from the placenta (30mins)

Question 13

What are the mechanisms of labour?

Answer 13

• Engagement and descent
• Flexion
• Internal rotation of the head
• Crowning and extension of the head
• Restitution
• Internal rotation of the head and external rotation of the head
• Lateral flexion of shoulders

MECHANISMS OF LABOUR

Question 14

Name 3 foetal lies

Answer 14

• Cephalic
• Breech
• Transverse

FOETAL LIE

Question 15

Name 5 foetal presentations

Answer 15

• Face
• Brow
• Vertex
• Breech
• Shoulder

FOETAL PRESENTATION

Question 16

How is foetal wellbeing monitored during labour?

Answer 16

• Intermittent auscultation can be done using a Pinards stethoscope or a handheld dopplar
• Continuous monitoring is done using a cardiotocograph
• A normal foetal heartrate is between 110-160bpm, with good variability (>5bpm) and accelerations (15bpms).

Question 17

How is foetal wellbeing monitored during labour?

Answer 17

• Intermittent auscultation can be done using a Pinards stethoscope or a handheld dopplar
• Continuous monitoring is done using a cardiotocograph
• A normal foetal heartrate is between 110-160bpm, with good variability (>5bpm) and accelerations (15bpms).

Question 18

How is the woman monitored during labour?

Answer 18

• Maternal observations
• Abdominal palpation
• Vaginal examination
• Monitoring of liquor (amniotic fluid)
• Palpation of contractions
• External signs e.g Rhomboid of Michaelis and anal cleft line

Question 19

What are the pharmacological and non-pharmacological supports for a woman in labour?

Answer 19

• Maternal position and mobility
• Breathing and hypnobirthing techniques
• Massage
• Aromatherapy
• TENS - transcutaneous electrical nerve stimulation
• Oral analgesia
• Water
• Entonox - gas
• Opioids
• Remifentanil PCA - opioid, patient controlled
• Epidural