Normal Labour

Question 1

what is the definition of labour?

Answer 1

physiological process during which the foetus, membranes, umbilical cord and placenta are expelled from uterus

associated with regular, painful uterine contractions with increasing frequency, intensity and duration

Question 2

what are the 3 options of where a woman can give birth?

Answer 2

consultant led unit
midwife led unit
homebirth

Question 3

what is a birth plan?

Answer 3

record of what the women would like to happen during her labour and after the birth

discuss adverse situations and her plans for this

allows woman to understand what may happen in labour - can identify her feelings and priorities

Question 4

what physiological changes help to initiate labour?

Answer 4

change in the oestrogen / progesterone ratio

myometrial stretch increases excitability of myometrial fibres

mechanical stretch of cervix and stripping / rupture of foetal membranes

Question 5

why does an increasing oestrogen : progesterone ratio causes initiation of labour?

Answer 5

oestrogen

• promotes uterine contraction
• promotes prostaglandin production

progesterone

• keeps the uterus settles
• hinders the contractibility

Question 6

how does oxytocin help in the initiation of labour?

Answer 6

initiates and sustains contractions

promotes prostaglandin release

synthesised straight into maternal and placental tissue

number of oxytocin receptors increases near end of pregnancy

Question 7

what physiological processes in the foetus help to initiate labour?

Answer 7

pulmonary surfactant secreted into amniotic fluid stimulates prostaglandin synthesis

foetal cortisol stimulates increase in maternal estriol

Question 8

when can membrane rupture occur?

Answer 8

pre-term
pre-labour
first stage 
second stage 
born in a caul (baby born in sac)

Question 9

what is the job of the liquor surrounding the foetus?

Answer 9

nurtures and protects foetus

facilitates movement

Question 10

how does the cervix change during labour?

Answer 10

increase in hyaluronic acid

increases number of molecules between collagen fibres - decreases bridging between fibres which causes cervix to soften

Question 11

what score is used to assess if it is safe enough to induce labour?

Answer 11

bishop score

• dilatation (how open cervix is)
• effacement (how thin cervix is)
• station in pelvis (babys head in relation to ischial spines)
• cervical consistency
• cervical position

Question 12

a lower bishop score indicates a women is close to active labour - true or false?

Answer 12

false

• higher score = more active labour
• lower score = patient is struggling and may eventually have to be induced

Question 13

what are the 3 stages of labour?

Answer 13

1st

• latent phase (up to 3-4cms dilatation)
• active stage (4cm-10cm)

2nd
- full dilatation and delivery

3rd
- expulsion of placenta

Question 14

the latent phase of labour can last up to a few days - true or false?

Answer 14

true

Question 15

after what length of time would the second stage of labour be considered prolonged?

Answer 15

women having their first child (ie no previous births)

• > 3 hours if regional analgesia
• > 2 hours without

women having a subsequent child

• > 2 hours with regional analgesia
• > 1 hour without

Question 16

how long does the 3rd stage of labour normally last and after what point would surgical removal of the placenta be considered?

Answer 16

average duration 10 mins

after 1 hour, preparation made for removal under GA

Question 17

why is an “active” 3rd stage of labour preferred to a physiological 3rd stage?

Answer 17

active management - use of oxytoxic drugs in active 3rd stage

+ controlled cord traction

this lowers risk of post partum haemorrhage

Question 18

what are braxton hicks contractions?

Answer 18

false labour

tightening of uterine muscles, helps body prepare for birth
usually felt in 3rd trimester
irregular, do not increase in frequency or intensity
relatively painless

Question 19

how can you tell if a patient is experiencing true labour contractions as opposed to braxton hicks?

Answer 19

timing of true contractions become evenly spaced
time between them gets shorter
length of contraction time increases (10sec-45sec)
gets more intense and painful over time

Question 20

describe the path of a contraction in pregnancy?

Answer 20

density of myocytes highest at fundus

wave starts at fundus and spreads symmetrically downward

Question 21

a baby in a normal presenting position is born with its head in the occipito-anterior position - true or false?

Answer 21

true

can also be born occipito-posterior (usually if it has been in previous abnormal position)

Question 22

what landmarks on a baby’s skull can be used to determine their position?

Answer 22

frontanelles

• anterior = larger and more diamond shaped
• posterior = smaller and triangular

Question 23

what are the various types of analgesia that can be used during pregnancy?

Answer 23

paracetomal / co-codamol 
TENS
entonox (gas and air)
diamorphine 
epidural 
remifenatyl 
combined spinal / epidural

Question 24

what is recorded on a partogram?

Answer 24

graphic record of key data (maternal and foetal)

assess progress of labour (cervical dilatation, foetal heart rate)

Question 25

what 7 cardinal movements make up the mechanisms of labour?

Answer 25

1. engagement
2. decent
3. flexion
4. internal rotation
5. crowning and extension
6. restitution and external rotation (head adopts optimal position for shoulder)
7. expulsion, anterior shoulder first

Question 26

when is the foetal head considered to be engaged?

Answer 26

when the widest diameter of the head has entered the brim of the pelvis

3/5 of the foetal head have entered (as it cannot move backwards from this point)

Question 27

how often should vaginal examinations be carried out during a normal labour?

Answer 27

approx 4 hourly

Question 28

what is meant by crowning?

Answer 28

appearance of a large segment of foetal head at the introitus

labia are stretched to full capacity

largest diameter of the foetal head is encircled by vulval ring

burning and stinging feeling for the mother

Question 29

what is meant by delayed cord clamping?

Answer 29

umbilical cord is not clamped for at least 60 seconds after baby is born

this allows blood flow from mother to continue and for baby to get enough iron

Question 30

what is meant by skin to skin contact time?

Answer 30

early placing of naked baby on the mothers chest

• this keeps babies warm and calm
• improves other aspects of babys transition to life outside the womb

Question 31

how long should skin to skin contact time between a mother and her baby last for?

Answer 31

current recommendation and practise is for uninterrupted SSC for 1 hour following birth

Question 32

what sings are present if a woman is at her 3rd stage of labour?

Answer 32

uterus contracts, hardens and rises
umbilical cord lengthens
frequently a gush of blood, variable in amount
placenta and membranes appear at introitus

Question 33

what is done during active management of the third stage of labour?

Answer 33

syntometerine 1ml
or oxytocin 10 units

cord clamping and cutting
controlled cord traction
bladder emptying

Question 34

explain how the uterus expels the placenta?

Answer 34

uterus contracts and decreases its surface area (both to stop bleeding and shear off placenta)

as the placenta cannot shrink in size, it comes away from the wall of the uterus and is expelled out

*methods of separation - “matthew duncan” (most common) and Schultz (separation from central aspect)

Question 35

what amount of blood loss in labour is normal?

Answer 35

<500mls

• above 800ml is abnormal
• blood loss in labour prior to delivery is considered abnormal

Question 36

how is haemostasis achieved after blood loss after labour?

Answer 36

tonic contraction - lattice pattern of uterine muscles strangulates the blood vessels

thrombosis of the torn vessel end - pregnancy is a hyper-coaguable state

Question 37

what is the puerperium and how long does it last?

Answer 37

return of tissues to non-pregnant state (6 weeks)

Question 38

bloodstained discharge is common during the puerperium - true or false?

Answer 38

true

bloodstained discharge lasts for about 10-14 days following birth

Question 39

how does the uterus change during the puerperium?

Answer 39

uterine involution

weight reduces 1000 -> 50-100g

fundal height reduces in 2 weeks

endometrium regenerated by end of a week (except placental site)

Question 40

what stimulates lactation after childbirth?

Answer 40

initiated by placental expulsion

decrease in oestrogen and progesterone

Question 41

what is colostrum?

Answer 41

first milk production

rich in immunoglobulin to protect baby