Birth imminent - normal delivery

Question 1

When does normal labour commence

Answer 1

37 to 41 weeks but up to 42 weeks

Question 2

Stages of labour

Answer 2

There are three stages of labour.

Labour is deemed normal when: it starts spontaneously after 37 completed weeks.

Babies head is down in the cephalic position.

Question 3

First stage of labour

Answer 3

Dilation of the cervix 0 to 10 cm.

Longest stage of labour. Last approximately 8 to 10 hours.

There may be a show: bloodstained mucus discharge. There should not be frank fresh blood at this stage.

Contractions become more frequent, regular and stronger.

Membranes may rupture (SROM), but not always, colour of liquor is important.

Often, at around 8 cm dilation, women may become very vocal, soon before onset of second stage, and then will become very focused.

Question 4

Membranes may rupture

Answer 4

Membranes may rupture (waters breaking), but not always, colour of liquor is important. The optimum time for waters to break is at the end of the first stage of labour, however the waters can break before this time during the first stage or even days before.

Clear: good does not smell

Bloodstained: concern. Especially dark red. Sign of abruption or previa.

Meconium stained: if overdue, can be normal (green tinged), is lumpy (pea soup) baby is distressed. MUST ALWAYS BE CONVEYED

Champagne: yellowy tinged/smelly ?Infection/could be urine.

Question 5

Second stage of labour

Answer 5

Birth of the baby.

Spontaneous rupture of membranes (if not already).

Cervix dilated fully.

Changes in contractions (transition - become expulsive). Three in 10 minutes indicates established labour.

Babies heads descends into the birth canal creating an urge to push.

Babies head becomes visible at the introitus, crowning.

Bulging of the vaginal entrance and anus.

Completed with delivery of the babies body.

Question 6

Crowning

Answer 6

Early crowning may only be visible when the patient is contracting.

Make sure this is checked for when the patient has a contraction.

Look for a stretching of the perineum and bulging of the anus.

Question 7

Stay and deliver on the scene if:

Answer 7

Regular contractions at 1 to 2 minute intervals.

An urge to push and/or there is a crowning or breach presentation.

Prepare for delivery and request a second crew, midwife and consider an APP

Question 8

Passive movement through the birth canal stages

Answer 8

Descent. 
Selection. 
Internal rotation. 
Crowning. 
Extension. 
Restitution.
External rotation. 
Delivery of body.

Question 9

Second stage of labour to do checklist

Answer 9

Reassure the mother and explain what you were doing.

Include her partner is present.

Prepare the delivery area: 
Incontinence pads. 
Maternity pack. 
Towels. 
Blankets. 
Turn the heat up, aim for 25°. 
Resuscitation area with PALS kit and BVM

Ensure additional help and midwife is on the way.

Question 10

Third stage - delivery of the placenta

Answer 10

Cord will lengthen

Contractions restart

Urge to bear down

Gush of blood 100-200ml is normal

Expulsion of the placenta

Document amount of blood loss.

Question 11

Expulsion of the placenta should be within?

Answer 11

20 minutes of birth.

If not, site IV access as there is evidence increased risk of PPH with delayed delivery of the placenta.

To assist with a physiological third stage, the woman can squat (as long as there is not excessive bleeding), breastfeed and be encouraged to pass urine (as the bladder can sometimes obstruct the descent of the placenta)

Question 12

Cord management

Answer 12

There is no rush to cut the cord, delaying called separation can provide an extra 80 mL of blood to the baby. that’s 1/3 of total blood volume.

The court can take 3 to 5 minutes to stop pulsating.

Wait for the umbilical cord to stop pulsating, apply 2 cord clamps:
One 15 cm from the umbilicus of the baby. Then the other cord clamp 3 cm from that.

You can also place a third clamp on the remaining cord, just outside the introitus to enable vision of the cord lengthening.

Ensure that the babies fingers and genitals are clear! Then cut between the clamps.

Question 13

Summary

Answer 13

Consent and reassurance.

Assessed for imminent birth, if time allows transport, is not prepared for delivery.

Call for backup: midwife and second crew.

Prepare environment.

Most babies will deliver themselves.

Note time of delivery of head, baby, placenta.

Keep the baby warm and assess both patients.

Document the midwifes details.

Individual PRFs for mum and baby.