🩺 Normal Labour

Course Overview

Normal Labour is a physiological process characterized by regular, painful uterine contractions that lead to progressive effacement and dilatation of the cervix, culminating in the expulsion of the fetus, placenta, and membranes through the birth canal.
This module equips learners with expert-level knowledge and practical steps in diagnosis, monitoring, and management of each stage of labour, aligning with evidence-based obstetric protocols.

Learning Objectives

At the end of this module, learners should be able to:

1. Define and describe the physiology of normal labour.

2. Distinguish the three stages of labour and outline key management steps for each.

3. Apply principles of maternal and fetal monitoring during labour.

4. Execute Active Management of the Third Stage of Labour (AMTSL) correctly.

5. Manage post-delivery maternal and neonatal care, including infection prevention and ART prophylaxis.

 INTRODUCTION

Definition

Normal labour is a physiological process defined by regular, painful uterine contractions leading to progressive cervical effacement and dilatation, culminating in delivery of the fetus and placenta without complications.

Key Features

 STAGES OF LABOUR

 FIRST STAGE OF LABOUR

Definition

From diagnosis of true labour to full cervical dilatation (10 cm).

Management Steps

1. Admission

   • Admit to lay-in ward (latent phase) or labour suite (active phase).

   • Encourage presence of a spouse/relative where possible.

   • Allow ambulation or left lateral rest as preferred by the patient.

2. Assessment

   • Review antenatal records and identify risk factors (e.g., previous C-section, preeclampsia).

   • General assessment: vitals, hydration, bladder fullness.

   • Cervical exam: dilatation, effacement, station, membranes, presentation, descent.

3. Supportive Care

   • Encourage regular emptying of bladder.

   • Allow liquid/semi-solid diet.

   • IV fluids (dextrose/saline) when indicated.

   • Analgesia:

     • Pethidine 100 mg IM or Fentanyl 100 mcg (if <6 cm dilated).

     • Promethazine 25 mg stat for nausea.

     • If pethidine given within 4 hours before delivery, administer Naloxone 10 mcg/kg to neonate if respiratory depression occurs.

4. Monitoring

   • Begin Partograph when in active labour.

   • Record contractions, FHR, cervical progress, BP, pulse, temperature, urine output.

   • Monitor fetal well-being continuously.

5. Preparations

   • Ensure delivery pack, resuscitaire, and NICU team are ready.

   • Obtain consent for underage or at-risk patients.

 SECOND STAGE OF LABOUR

Definition

From full cervical dilatation (10 cm) to delivery of the baby.

Management Steps

1. Preparation

   • Discuss and confirm preferred delivery position (usually lithotomy).

   • Aseptic precautions: wash hands, double-glove, clean and drape perineum.

   • Encourage effective pushing in synchrony with contractions.

2. Delivery Technique

   • As the head crowns, support perineum with the right hand (using a pad) while the left hand flexes the fetal head.

   • After head delivery:

     • Clear airway: wipe face or suction with penguin sucker (especially if meconium present).

     • Check for nuchal cord:

       • Loosen gently; if tight, double clamp and cut.

   • Following restitution and external rotation, apply gentle downward traction to deliver anterior shoulder, then posterior shoulder.

   • Place the baby on the mother’s abdomen (skin-to-skin contact).

   • Cover with a clean, warm cloth or nappy.

3. Delayed Cord Clamping

   • Clamp cord after 1 minute (Golden Minute) to allow optimal placental transfusion.

 THIRD STAGE OF LABOUR

Definition

From delivery of the baby to expulsion of placenta and membranes.

Management — Active Management of Third Stage of Labour (AMTSL)

Post-Delivery Inspection

• Inspect placenta and membranes for completeness (all cotyledons).

• Examine perineum, vagina, cervix for tears or lacerations.

• Estimate blood loss accurately.

 IMMEDIATE POSTPARTUM CARE

Maternal Monitoring

Neonatal Care

• Promote skin-to-skin contact (bonding within the first hour).

• Encourage early and exclusive breastfeeding (within 1 hour of birth).

• Keep the newborn warm and dry.

HIV Management

• Ensure mother continues cART.

• Administer ART prophylaxis to the neonate as per national protocol.

 SUMMARY TABLE — MANAGEMENT OF LABOUR

Mind Map: Normal Labour (Allstarmedics)

Normal Labour
├── Definition: Physiological uterine contractions → Cervical dilatation
├── Stages
│   ├── 1st Stage: Onset → 10 cm (Partograph, analgesia)
│   ├── 2nd Stage: Delivery of baby (support perineum, suction, delayed cord clamp)
│   └── 3rd Stage: Delivery of placenta (AMTSL)
├── Monitoring
│   ├── Maternal vitals
│   ├── Fetal heart rate
│   └── Progress on partograph
├── Immediate Care
│   ├── Skin-to-skin
│   ├── Early breastfeeding
│   └── HIV prophylaxis if indicated

Recommended References

1. WHO (2018). Intrapartum Care for a Positive Childbirth Experience.

2. Zambian MOH: Safe Motherhood and Labour Management Guidelines.

3. Williams Obstetrics, 27th Edition.

4. NICE Guideline NG201: Intrapartum Care (2021).