Labour

Labour is the process of childbirth, starting with the onset of regular uterine contractions and ending with the delivery of the baby and placenta.

• First Stage: Latent phase (cervical dilation up to 4 cm with regular contractions) and active phase (cervical dilation from 4 cm to 10 cm).
• Second Stage: From full dilation of the cervix (10 cm) to the delivery of the baby.
• Third Stage: Delivery of the placenta and membranes.
• Fourth Stage: Immediate postpartum period (first hour after delivery), monitoring for complications.

• True Labour: Regular contractions that increase in intensity and frequency, cervical dilation, and effacement.
• False Labour (Braxton Hicks contractions): Irregular contractions that do not lead to cervical changes, often relieved by rest or hydration.

• Preterm Labour: Labour that occurs before 37 weeks of gestation.
• Prolonged Labour: Labour lasting more than 20 hours for first-time mothers (nulliparous) or more than 14 hours for mothers who have given birth before (multiparous).
• Obstructed Labour: When the baby cannot progress through the birth canal despite strong contractions, often due to cephalopelvic disproportion.
• Fetal Distress: Signs such as abnormal fetal heart rate patterns indicating the fetus is not well.
• Shoulder Dystocia: Difficulty delivering the baby’s shoulders after the head has been delivered.
• Postpartum Hemorrhage: Excessive bleeding after delivery of the baby and placenta.
• Amniotic Fluid Embolism: Rare but serious complication where amniotic fluid enters the mother’s bloodstream.

• Gestational Age: Confirm the gestational age to assess for preterm or term labour.
• Onset of Contractions: Time, frequency, duration, and intensity of contractions.
• Rupture of Membranes: Time and characteristics of the fluid (clear, meconium-stained, or bloody).
• Bleeding: Any vaginal bleeding and its amount.
• Fetal Movements: Changes in fetal activity, especially decrease in movement.
• Past Obstetric History: Previous labours, mode of deliveries, and any complications.
• Medical History: Hypertension, diabetes, or other conditions that could impact labour.
• Social History: Support systems, living conditions, and access to care.
• Birth Plan: Discuss preferences for pain relief, delivery method, and other aspects of labour.
• Psychosocial Factors: Anxiety, fear, and emotional readiness for labour.
• Drug History: Current medications, allergies, and any substance use.

• Vaginal Examination: To assess cervical dilation, effacement, station, and position of the fetus.
• Fetal Heart Monitoring: Continuous or intermittent monitoring to assess fetal well-being.
• Abdominal Palpation: To assess fetal lie, presentation, and engagement.
• Blood Pressure Monitoring: To detect pre-eclampsia or other hypertensive disorders.
• Urinalysis: To check for proteinuria, glucose, or signs of infection.
• Blood Tests: Full blood count, blood group, and screen, coagulation profile if indicated.

• Ultrasound: To assess fetal position, placental location, and amniotic fluid volume.
• Pelvic X-ray or MRI: Rarely used, but may be indicated in cases of suspected cephalopelvic disproportion.