Labour is most normal until u dont disturb the process and if needed any assistance only need help the woman- labor stages.pptx

the learners gain knowledge on signs of normal labor and progression

1. IDENTIFICATION OF SIGNS OF NORMAL LABOUR PROGRESSION Mallika

2. Learning outcomes: At the end of the session, the learners will be able to : D efine normal labour progression Enlist the different stages of normal labour and its duration. R ecognize the signs and symptoms of the progression of normal labour Summarize WHO recommendations about the progression of various stages of labour I dentify the signs of progression of labour apart from vaginal examination

3. Definition of labour Normal labor is low risk throughout spontaneous onset with the fetus presenting by the vertex, culminating in the mother and infant being in good condition following birth. -WHO “ Labour is a process of onset of painful regular uterine contractions with progressive cervical effacement and dilatation .”

4. Stages of labour

5. First stage of labour The first stage is normally recognized by the onset of regular uterine contractions an accompanying effacement and 10 cm dilatation of the cervix. The average duration of is 12 hours in primi gravid and 6 hours in multiparas.

6. Second stage of labour The second stage of labor has been regarded as the phase between full dilatation of the cervical os and the birth of the baby. The average duration is 2 hours in primi and 30 minutes in multiparas women.

7. Third stage of labour The third stage of labor can be defined as the period from the birth of the baby to the complete expulsion of the placenta and membranes. Usually lasts between 5 & and 15 minutes, but any period up to 1 hour may be considered as normal.

8. Fourth stage of labour The fourth stage lasts for 2 hours postpartum after the expulsion of the placenta.

9. Signs and Symptoms of impending normal labour Regular contraction Backaches Diarrhoea Lightening Bloody show Urge to go to the toilet Water break or release of water Burst of energy

10. WHO RECOMMENDATIONS

11. RECOMMENDED Women should be informed that a standard duration of the latent first stage has not been established and can vary widely from one woman to another. However, the duration of the active first stage ( from 5 cm until full cervical dilatation ) usually does not extend beyond 12 hours in first labors, and usually does not extend beyond 10 hours in subsequent labor.

12. NOT RECOMMENDED For pregnant women with spontaneous labour onset, the cervical dilatation rate threshold of 1 cm/hour during the active first stage (as depicted by the partograph alert line) is inaccurate in identifying women at risk of adverse birth outcomes and is therefore not recommended for this purpose.

13. NOT RECOMMENDED A minimum cervical dilatation rate of 1 cm/hour throughout the active first stage is unrealistically fast for some women and is therefore not recommended for identification of normal labor progression. A slower than 1 cm/hour cervical dilatation rate alone should not be a routine indication for obstetric intervention .

14. NOT RECOMMENDED Labour may not naturally accelerate until a cervical dilatation threshold of 5 cm is reached. Therefore the use of medical interventions to accelerate labor and birth (such as oxytocin augmentation or cesarean section) before this threshold is not recommended, provided fetal and maternal conditions are reassuring.

15. RECOMMENDED For women in the second stage of labor, techniques to reduce perineal trauma and facilitate spontaneous birth (including perineal massage, warm compresses and a “hands-on” guarding of the perineum) are recommended, based on a woman’s preferences and available options . ,

16. NOT RECOMMENDED Application of manual fundal pressure to facilitate childbirth during the second stage of labor is not recommended.

17. RECOMMENDED Women in the expulsive phase of the second stage of labour should be encouraged and supported to follow their urge to push. labor

18. Signs of progression of labor apart from the vaginal examination.. Physical signs; Frequent change of position by the mother Feeling pressure in the perineum Sweating Passing motion Heavy breathing 0/5 th palpable Perineal bulging Vulval opening with waves

19. Si gns of progression of labour Behavioral signs Avoiding food and fluids Restlessness Urge to bear down Quiet and less interacting Groaning and moaning  

20. REFERENCES : 1. https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf. 2. https://my.clevelandclinic.org/health/articles/9676-labor/delivery. 3. https://www.mayoclinc.org/healthy-lifestyle/labor-and-delvery/in-depth/stages-of-labor/ art- 20046545 4. Marshall E Jayne, Raynor D Maureen., Myles Textbook for Midwives. India: Elsevier Ltd, publishers. 17 th edn . 2020. Pp: 448, 501, 536.