Makindo Medical Notes

Overview of Normal Labour

Labour is the physiological process by which the fetus is expelled from the uterus through the birth canal. Normal labour typically occurs between 37 and 42 weeks of gestation and is divided into three main stages: the first stage (dilation), the second stage (expulsion), and the third stage (placental delivery).

Physiological Changes During Labour

• Uterine Contractions: Contractions are involuntary and intermittent, increasing in strength and frequency as labour progresses. They are responsible for cervical dilation and effacement, as well as the descent of the fetus through the birth canal.
• Cervical Changes: The cervix undergoes effacement (thinning) and dilation (opening) to allow the passage of the fetus. These changes are facilitated by the hormonal influences of prostaglandins and oxytocin.
• Fetal Descent: The fetus moves through the birth canal, guided by the shape of the pelvis and the force of contractions. This process involves several cardinal movements, including engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

Stages of Labour

Cardinal Movements of Labour

• Engagement: The fetal head enters the pelvic inlet, usually in a transverse position.
• Descent:The fetal head moves downward through the pelvis.
• Flexion:The fetal chin moves toward the chest, allowing the smallest diameter of the head to pass through the pelvis.
• Internal Rotation: The fetal head rotates to align with the anteroposterior diameter of the pelvic outlet.
• Extension: The fetal head extends as it passes under the pubic symphysis and is delivered.
• External Rotation: The fetal head rotates back to its original position relative to the shoulders, which are then delivered.
• Expulsion:The rest of the fetal body is delivered.

Pain Management During Labour

• Non-Pharmacological Methods:
  • Breathing techniques and relaxation exercises.
  • Position changes and movement.
  • Hydrotherapy (e.g., warm baths or showers).
  • Massage and counterpressure.
  • Use of birthing balls and supportive devices.
• Pharmacological Methods:
  • Analgesics (e.g., opioids).
  • Regional anesthesia (e.g., epidural or spinal anesthesia).
  • Local anesthesia (e.g., for episiotomy or perineal repair).

Monitoring During Labour

• Fetal Monitoring:
  • Intermittent auscultation of the fetal heart rate.
  • Continuous electronic fetal monitoring (EFM) for high-risk pregnancies or if abnormalities are detected.
• Maternal Monitoring:
  • Regular assessment of maternal vital signs (blood pressure, pulse, temperature).
  • Monitoring the progress of labour through cervical examinations.
  • Assessment of uterine contractions (frequency, duration, intensity).

Complications of Labour

• Prolonged Labour: Labour that lasts longer than normal, which can lead to maternal and fetal complications.
• Fetal Distress: Signs of compromised fetal well-being, such as abnormal fetal heart rate patterns.
• Shoulder Dystocia: When the fetal shoulders become lodged behind the maternal pelvis during delivery.
• Postpartum Haemorrhage: Excessive bleeding after delivery, which can be life-threatening if not managed promptly.

Summary

Normal labour is a complex physiological process involving coordinated uterine contractions, cervical changes, and fetal movements. It is divided into three stages: dilation, expulsion, and placental delivery. Proper monitoring and management during labour are essential to ensure the safety and well-being of both the mother and the baby. Understanding the stages, physiological changes, and potential complications of labour is crucial for healthcare providers to support and manage the birthing process effectively.