Stages of labour

Question 1

What is ‘normal’ labour? (2)

Answer 1

Normal labour starts between 37 and 42 weeks of pregnancy.
It is the cephalic delivery of a healthy infant.

Question 2

How many stages of labour are there?

Answer 2

Three.

Question 3

What are the two stages that occur within the first stage of labour? (2)

Answer 3

Latent first stage
Established first stage

Question 4

What is the latent stage of labour? (3)

Answer 4

The latent stage of labour involves painful contractions. Cervical changes occur such as cervical effacement.
The cervix will dilate up to 4-5cm.

Question 5

What is the established first stage of labour?

Answer 5

Regular painful contractions
Progressive cervical dilatation
This stage ends with full dilatation of the cervix at 10cm

Question 6

Approximately how long does the established stage of labour last?

Answer 6

In primips, it usually does not usually exceed 12 hours
In multips, it does not usually exceed 10 hours

Question 7

What causes cervical effacement, dilatation, and fetal descent?

Answer 7

Effective uterine contractions

Question 8

Where do uterine contractions start?

Answer 8

At the fundus of the uterus

Question 9

When can spontaneous rupture of membrane (SROM) occur?

Answer 9

At anytime

Question 10

What is ARM?

Answer 10

Artificial rupture of membranes

Question 11

What should be checked when membranes have ruptured?

Answer 11

The colour of the liquor (amniotic fluid)

Question 12

What are the two stages that occur within the second stage of labour?

Answer 12

Passive second stage of labour
Active second stage of labour

Question 13

What is the passive second stage of labour?

Answer 13

This is where full dilatation of the cervix occurs before or in the absence of involuntary expulsive contractions

Question 14

What is the active second stage of labour?

Answer 14

The period of time between full cervical dilatation and birth of the baby
The woman has an involuntary urge to bear down due to expulsive uterine contractions

Question 15

Approximately how long does the second stage of labour take?

Answer 15

In primips, within 3 hours
In multips, within 2 hours

Question 16

Physiology of second stage of labour (4)

Answer 16

Contractions change in character
Ferguson’s reflex- surge of oxytocin
Membranes can rupture if not already
Soft tissue displacement

Question 17

Name four signs that birth is imminent

Answer 17

Nausea and vomiting due to vagal stimulation
Uncontrollable urge to push due to contractions
Bulging of the perineum due to the presence of the fetal head
Feeling of burning due to the perineum being stretched by fetal head

Question 18

What is the rhombus of Michaelis?

Answer 18

A kite-shaped area of the lower spine that moves backwards as the second stage of labour begins to increase the diameter of the pelvis

Question 19

Name five factors that can impact on the length and success of the second stage of labour

Answer 19

Parity
Type of pelvis
Size of fetus
Fetal position
Regional analgesia
Uterine contraction activity
Maternal pushing efforts
Pain
Fear/anxiety
Fetal station at complete cervical dilatation
First stage of labour

Question 20

What is the third stage of labour?

Answer 20

This is the stage from the birth of the baby until the delivery of the placenta and membranes

Question 21

What happens during the third stage of labour?

Answer 21

The placenta separates, living ligatures contract and the placenta is expelled from the uterus

Question 22

When is the third stage classed as prolonged with active management?

Answer 22

30 minutes

Question 23

When is the third stage of labour classed as prolonged with physiological management?

Answer 23

60 minutes