Post on 31-May-2020
Mother Initiative Tutorial
Normal labor: The first stage
Margaret Fisher Associate Professor in Midwifery
Plymouth University and The Royal College of Midwives,
United Kingdom
This tutorial is designed to re-inforce previous training – and should,
therefore, not be regared as sufficient guidance by itself 1
What is labor?
A physiological (normal) process
which starts when the mother
begins to feel regular, painful,
rhythmical contractions of the
uterus (muscles of the womb
tighten and relax)
These contractions cause the
cervix (neck of the womb) to
dilate (open) and efface (shorten)
The baby is born and the
placenta (afterbirth) and
membranes (bag around the
fetus) are completely expelled out
of the mother’s body
2
How might you know the woman is in labor?
She may have a ‘show’ (a plug of
mucus from the vagina) – but this
may happen several days before
she starts labor
She may feel her membranes
rupture (waters around the baby
break). She may, or may not, be
having contractions of the uterus
She may begin to feel regular,
painful, rhythmical contractions
of the uterus (womb tightens and
relaxes)
Note: These signs may happen in
any order 3
Stages of labor (1)
First stage of labor
Starts when the mother feels
regular, painful, rhythmical
contractions of the uterus
(muscles of the womb tighten
and relax)
Finishes when the cervix
(neck of the womb) reaches
full dilatation (10 cm)
4
Stages of labor (2)
Second stage of labor
Starts from when the cervix
(neck of the womb) has dilated
to 10cm
Finishes when the baby is born
5
Stages of labor (3)
Third stage of labor
Starts from when the baby
is born
Finishes when the placenta
(afterbirth) has come away
from the mother, and when
her bleeding stops
6
What happens in the first stage of labor? (1)
During the first stage the
fetus goes down
(descends) into the
mother’s pelvis, pushed
down by the contractions
of the uterus
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What happens in the first stage of labor? (2)
As the fetus descends, it
moves to make best use
of the space in the
mother’s pelvis. This is
called ‘the mechanism of
labour’
8
What happens in the first stage of labor? (3)
At the same time that the
baby is going down
towards the mother’s
pelvis, the cervix (neck of
the womb) begins to open
from being closed to
10cm wide (dilatation of
the cervix). The cervix
also becomes softer and
shorter (effacement)
The first stage of labor is
now complete
9
Monitoring progress of normal labor (1)
Maternal signs
Watch the mother and listen to
the sounds she makes
As labor makes progress she
will show that she is feeling the
contractions stronger and will
probably stop what she is doing
or stop talking to breathe
through these
Listen for sounds
Observe contractions
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Monitoring progress of normal delivery (2)
The woman may move her
body and pelvis or change
position when she is having
contractions
She may make some sounds
as her cervix reaches 10cm
dilated – these can sound like
grunts or pushes
She may change her
behaviour, becoming quiet or
else shout or scream
Movement
Grunts
Distress sounds
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Monitoring progress of normal labor (3)
Other signs of progress
If the mother’s membranes have not
ruptured (the water from round her baby
has not broken) earlier, this may happen
as her contractions get stronger
If she has not had a ‘show’ (blood-
stained mucus from her vagina) earlier,
this may happen
The mother’s contractions should get
stronger and last longer – watch her
and feel the top of her abdomen with
your hand. It should relax between
contractions
12
Monitoring progress of normal labor (4)
Abdominal palpation
Check that the fetus is
descending into the pelvis by
feeling the mother’s abdomen
(abdominal palpation)
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Monitoring progress of normal labor (5)
Vaginal examination
By inserting two fingers gently
into the woman’s vagina you
should feel the cervix opening
wider from 1cm – 10 cm dilated;
becoming shorter (effacing);
becoming softer and thinner
You should feel the presenting
part getting lower in the pelvis
The presenting part should be
the crown of the head (vertex) or
breech (bottom)
14
Monitoring progress of normal labor (6)
Checking mother’s wellbeing
It is important to make sure that
the mother is coping with labor
and is healthy:
Check her blood pressure and
pulse every hour
Check her temperature every
4 hours
Check that she is passing urine
every 4 hours
Check that she does not seem
dehydrated or exhausted
Exhaustion
15
Monitoring progress of normal labor (7)
Checking fetal wellbeing
It is important to make sure that
the fetus (baby) is coping with
labor and is healthy:
Listen to the fetal heartbeat
every 15-30 minutes. The rate
should be 110-160 beats per
minute; you should hear it get
faster (accelerate) when there
are contractions or when it
moves and you should not hear
it slow down in the first stage of
labor.
160
110
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Using the partograph
You can use the partograph to
record all these observations in
labor. This will mean that you
and anyone else can easily see
if normal progress is being
made. It makes it easier to see
if there are any problems.
17
Other care in labor (1)
Support the mother
emotionally – help her keep
control; encourage and praise
her
Support the mother physically
– help her get comfortable; rub
her back; wipe her face and
hands; hold her hand when she
is having a contraction; help
her into the position she
chooses
Support emotionally
Support physically
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Other care in labor (2)
Give her drinks frequently
Give her food if she wants this
Encourage her to pass urine
Help keep her clean – wipe or
pour water over her vulva if she
likes this
Help her to keep control with
her breathing during
contractions
Give her pain relief if she
wants this
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Problems to look for (1)
The mother may need to be
taken to medical assistance if:
She shows sign of infection
(her pulse and temperature
increase; the fetal heart rate
becomes very fast)
Her blood pressure increases
consistently to 150/90 or more
or she has a headache (risk of
pre-eclampsia)
Progress is not being made
(contractions slow or stop, the
fetus does not descend, the
cervix does not dilate)
Infections
Signs:
Raised pulse
Raised temperature
Raised fetal heart rate
Pre-eclampsia
Signs:
Headache
Raised blood pressure
Swelling
Protein in urine
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Problems to look for (2)
There are signs that the fetus
(baby) is becoming stressed by
labor – fetal heart base rate
more than 160 bpm; fetal heart
rate slows down for a minute or
more
The liquor (fluid from around
the fetus) is green (meconium-
stained) or pink/ red (blood-
stained) or clots are passed
Fetal distress
Colored vaginal
discharge
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Problems to look for (3)
The contractions become very
strong and the mother’s
abdomen does not relax in
between, causing her a lot of
pain. The fetal heart rate will
probably become very fast or
slow down if this happens. It is
very important she is taken to
medical assistance as her
uterus (womb) may rupture
(burst)
Continuous contraction with severe
pain
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Problems to look for (4)
The presenting part is
not the crown of the
head (vertex), face or
breech (bottom). The
baby may not be able
to be born safely
vaginally, and if this is
the case the woman
needs to be taken to
medical assistance
urgently.
With transverse lie the
baby cannot be born
vaginally and urgent
medical assistance
must be sought. 23
SUMMARY
Labor is a normal physiological event
Monitor progress and maternal and fetal
wellbeing carefully
If problems arise seek medical assistance
as soon as possible
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