Normal Labour

Stages of Labour

  • 1st Stage

    • cervical change and regular painful contraction to full dilatation,

    • 1cm/hr, up to 12 hours primips, 1.2 cm, 4-8 hours multips

  • 2nd Stage
    • full dilatation until delivery of baby
      up to 1 hour in primigravida
    • change in nature of contractions with feeling of needing to bear down
  • 3rd Stage
    • from delivery baby to delivery placenta (15 mins.)

Recognition of Labour

  • Palpable uterine contractions
    • 10 minutes or less
  • 'Show'
    • blood and mucus discharged
  • Dilatation of cervix

Normal Progress of Labour

  • Uterine action
    • retraction of muscle fibres
  • Cervical effacement
    • junction of upper and lower segments is physiological retraction ring
    • shortening of upper segment fibres leads to opening of internal os of cervix
    • most striking in primigravida
    • in parous patient tends to occur with cervical dilatation
  • Cervical dilatation
  • 'Show' formation of forewaters
    • loosening of membranes from internal os leads to slight bleeding
    • operculum released
    • amniotic sac pushes against cervix (forewaters)
  • 1st Stage labour
    • start to full dilatation of cervix (10cm)
    • foetus descending through pelvis
    • birth canal formed by dilatation of cervix and vagina and stretching of pelvic floor muscles
    • bladder pulled above symphysis pubis
    • urethra stretched
    • bowel compressed
  • Presentation
    • identification of presenting part
    • identification of presenting diameter
    • asynclitism (one or other parietal bone leading)
  • Descent

    • Contractions encourage descent and flexion of chin onto chest

  • Engagement
    • descent of the presenting diameters through pelvic brim
    • leading part (vertex) near level of ischial spines
  • Internal Rotation
    • foetal part which first comes in contact with pelvic floor rotates anteriorly
  • Delivery of head
  • Restitution
    • head rotates to return to line of shoulders
  • External rotation
  • Anterior shoulder delivered

  • Gentle downward traction of head / neck to allow anterior then posterior shoulder to deliver / followed by rest of body

  • Baby delivered

  • Clamping and cutting of cord

  • Either allow 5-10 mins for natural separation or Brandt-Andrews controlled cord traction for delivery of placenta

Gauging Progress

  • Increasing strength, frequency and duration of uterine contractions
    • palpation
    • external abdominal transducer
    • intrauterine catheter
  • Dilatation of cervix
    • vaginal examination
    • degree of dilatation and effacement
    • presence of forewaters
    • state of liquor
    • position of presenting part
      • suture lines & fontanelles
    • level of presenting part
  • Descent of the presenting part
 

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