MID2003 FIRST STAGE OF LABOUR

Flashcards covering key vocabulary and concepts related to the first stage of labor.

First Stage of Labour

Includes the latent, active, and transition phase, leading up to full cervical dilation.

Signs of Pre-labor (Spurious Labor)

Braxton hicks, loosening or loss of mucus plug, increase in clear vaginal discharge, and nesting.

What initiates labour

uterine changes, cervical changes and hormonal influences (eg oxytocin)

Latent Phase

Painful contractions and cervical change, including effacement and dilation up to 5cm.

Transition Phase

Occurs just before full dilatation (8-9cm) and can be physically and emotionally intense.

Cervical Changes in Latent Phase

The cervix softens, shortens (effaces), and begins to dilate.

Active Phase

Regular, longer, and stronger contractions that lead to cervical dilation from 5cm to 10cm.

Contraction

the uterine muscle that results in the dilatation of the cervix and expulsion of the fetus.

Fundal Dominance

Each uterine contraction commences in the fundus and spreads across and downwards.

Fetal Axis Pressure

The force of the fundal contraction is transmitted down the birth canal

Retraction Ring

A ridge that forms between the upper and lower uterine segments during labor. (upper segment contracts and lower thins)

Fluid Pressure and Rupture of Membranes

if waters have not ruptured, the pressure on the fetus is even over the entire fetal body

Active Phase Progress

Dilation is usually ≥ 2 cm in four hours.

Role of oxytocin

stimulates uterine contractions during labor, promoting cervical dilation and facilitating the progression of delivery.

Factors Influencing Length of Active First Stage

1. Parity

2. birth interval

3. presentation & position

4. pelvic shape & size

5. fetal size

6. psychological state and activity

Midwifery Emotional Care during First Stage

1. Support

2. advocacy

3. calmness

4. confidence

5. comfort

Midwifery Physical Care during First Stage

1. Assessment of progress

2. Monitoring of maternal and fetal wellbeing.

Benefits of Staying Home in Early Labor

1. Sense of control

2. reduced intervention

3. reduced analgesia use

4. increased incidence of spontaneous vaginal birth

5. improved maternal and neonatal outcomes.

Baseline Observations on initial presentation

Abdominal assessment, maternal observations, fetal assessment, contractions, and vaginal loss.

Admission CTGs

Commonly used screening test that may increase rates of caesarean section.

Observations done very 30 minutes in 1st stage

Uterine activity (palpated over 10 mins), maternal HR, vaginal loss, Fetal HR

Observations done every 2 hours

Abdominal palpation

Observations done every 4 hours

1. RR

2. BP

3. Temp

4. VE to assess progress

Intermittent Auscultation

Listening to the fetal heart rate every 15-30 mins after a contraction

Continuous Fetal Surveillance

External fetal monitoring or fetal scalp electrode that simultaneously monitors maternal heart rate.

Obstetric Risk Factors for Early Onset GBS Infection

1. Preterm labor

2. ROM ≥18 hours prior to birth

3. maternal temperature ≥38 degrees

4. GBS colonisation/bacteriuria

5. previous baby with invasive GBS infection.

Progress in the First Stage

1. Cervical dilatation

2. cervical effacement

3. descent of the presenting part

4. increasing strength, frequency and duration of contractions.

How the Midwife Assesses Progress

1. Assess woman’s change in behaviour

2. palpation of uterine activity

3. abdominal palpation

4. vaginal examination.

Vaginal Examinations Purpose

Assess labor progress by determining

1. dilatation

2. effacement

3. position

4. station

5. presence of membranes.

Indications of Vaginal Exams

1. prior to analgesia

2. confirm full dilation before pushing

3. maternal request

4. management in emergency cases

Vaginal Examinations Contraindications

1. Vaginal bleeding

2. placenta praevia

3. early rupture of membranes (not in labour)

4. preterm labor.

Vaginal Examinations Practice Notes

Explain procedure, ensure privacy, dignity and comfort, ensure empty bladder.

Vaginal Examinations Post Procedure

1. Listen to FH and record

2. settle women into a comfortable position

3. report findings to appropriate RMO’s/senior midwife

4. document all findings

Vaginal Examinations Findings: External Genitalia

• Lesions (active genital herpes)

• oedema

• scarring

• female genital mutilation

• discharge

• odour

Vaginal Examinations Findings: Position of Cervix

The position of the cervix is documented as posterior, mid-position, or anterior.

Vaginal Examinations Findings: Effacement of Cervix

Describes the length of the cervix, usually documented in centimetres.

Vaginal Examinations Findings: Dilatation of Cervix

Describes how open the cervix is, determined by measuring the distance between the two edges of the cervix.

Notes Documented During First Stage

Any interventions, changes in condition or management, or escalation of concerns.

Partogram

To record maternal observations, fetal heart rate, cervical dilatation & station, abdominal station, colour of amniotic fluid, contractions, rate of oxytocin (if applicable)