Labour consists of three stages: cervical dilatation stage (1st stage), delivery of the baby (2nd stage) and delivery of the placenta (3rd stage).
First stage: Start of contractions until full dilatation of the cervix
This stage lasts for about about 10-12 hours in first time mothers and 6-8 hours in multiparous women. The contractions observed at this stage are increasing gradually. These achieve the full dilatation of the cervix and the descent of the presenting part of the fetus towards the pelvic outlet. The rupture of membranes occurs normally at the end of the first stage or occasionally are ruptured by the obstetrician (artificial rupture of membranes) in cases where there is no significant progress with cervical dilatation. There various pain-relief options in order to reduce the intensity and sensation of pain during the first stage of labour, such as the administration of opioid injections (e.g., pethidine) or an epidural analgesia.
Second stage: The time period from full dilation of the cervix until the delivery of the baby
To assist the delivery of the fetal head, the change of maternal positions is required such as lithotomy position, or a sedentary position in special labour chairs, the abduction of her thighs to the chest and finally the active pushing towards the perineum. Women should achieve 2-3 pushes with every contraction. Active pushing should not last more than one hour.At this stage the frequency of the contractions should be 5 contractions in 10 minutes. When the fetal head is visible, measures should be undertaken to prevent rapid passage as this may cause trauma to the soft tissues. Hence, the perineum is supported by holding the fetal head with one hand whilst the perineum is protected with the other hand.Following the delivery of the baby, as long as the baby is born in good condition the umbilical cord should be clamped and cut. If there are any indications, such as fetal distress prior to delivery, instrumental delivery etc blood sample should be obtained from umbilical cord vessels in order to assess the gases of the baby.
Third stage: the time period from the delivery of the baby until the delivery of the placenta
The contractions following the delivery of the baby result into the separation of the placenta from the uterine wall. This stage lasts on average 10-30 min.To avoid relatively increased blood loss, active management of third stage should be undertaken with the administration of oxytocin to the mother and simultaneous controlled traction of the remaining part. If there is a suspicion of retained tissue within the uterus examination under anaesthetic should be undertaken to identify and remove any retained tissue.It is very important to mention that during labour, the fetus should be monitored continuously by the obstetrician and midwife, by recording the vital signs regularly (blood pressure, pulse, temperature, respiratory rate) and performing vaginal examination every four hours to assess the progression of labour.
