UNCONTROLLED WHEN PRINTED
Quick Chart
Introduction
The physiological process by which the foetus, placenta and membranes are expelled through the birth canal.
- Spontaneous onset between 37 and 42 weeks gestation.
- The progress of labour is within acceptable limits.
Clinical Presentation
Signs of imminent birth
- Loss of operculum plug (bloody show) occurs when the cervix dilates and the mucous plug dislodges
- Increasing frequency and severity of contractions (3-5 contractions in a 10-minute period)
- Urge to push or open bowels
- Bulging perineum/anal pouting
- Crowning/presentation of part of the baby
- Spontaneous rupture of membranes can occur during the 1st or 2nd stage of labour
Exclusion Criteria
Exclusion Criteria
Risk Assessment
Stages of labour
- 1st Stage from the start of labour until the cervix is fully dilated (several to many hours).
- 2nd Stage full dilation of the cervix until the birth of the baby (few minutes to several hours).
- 3rd Stage after birth of the baby until the placenta and membranes have delivered (few minutes to an hour).
- 4th Stage the first few hours after birth
- Consider vehicle for back-up.
- Be prepared to stop the vehicle for delivery.
- Fentanyl may provide limited relief of pain during labour. Where possible obtain mothers consent and advice of possible effects on both mother and baby, which may last several days. Fentanyl use may also interfere with breastfeeding. Document accordingly.
- Suction is not routinely recommended with newborns and may cause bradycardia and airway damage. Only suction if there is a clear indication for its use (e.g. meconium or blood clots in airway). Refer to Airway Suction clinical skill.
Management
Primary Care
- Primary Survey
- Offer continuous support and reassurance
- Position patient appropriately in a position of comfort (avoid supine positioning due to aortocaval compression)
- Perform maternal vital sign survey
- Consider oxygen if indicated as per CPG
Intermediate Care (EMT / Level 2)
- Apply cardiac monitor if trained and authorised
- Consider pain relief; methoxyflurane is not contraindicated in labour, and should only be withheld if the mother gets too drowsy
- Consider anti-emetic
- Exclude cord prolapse
- Assess stage of labour, if birth imminent, prepare for delivery guidelines adjacent, and as per Childbirth clinical skill
- Do not attempt delivery of malpresentation unless imminent
- Do NOT pull on the cord
- Prepare for newborn resuscitation
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
- Apply cardiac monitor
- Establish vascular access
- Consider pain relief; methoxyflurane is not contraindicated in labour, and should only be withheld if the mother gets too drowsy
- Consider anti-emetic
- Exclude cord prolapse
- Assess stage of labour, if birth imminent, prepare for delivery guidelines adjacent, and as per Childbirth clinical skill
- Do not attempt delivery of malpresentation unless imminent
- Do NOT pull on the cord
- Prepare for newborn resuscitation
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport
- Priority 1 to nearest obstetric unit if patient time critical
- To booked obstetric unit if patient stable
- Pre-notify receiving facility in both circumstances
Critical & Extended Care (CCP, PSO)
- As per Advanced Care (AP) guidelines
Additional Information
Management of active labour
1st Stage Labour
- Observe all maternal vital signs
- Assess stage of labour, if birth imminent, prepare for delivery as per Childbirth clinical skill
Care of the Newborn
- Record time of delivery
- Stimulate the baby to induce crying e.g. rubbing towel on the baby’s back.
- Place the baby onto the mothers abdomen and encourage skin to skin contact.
- Place a dry towel on top and allow the baby to suckle to assist with the release of oxytocin and delivery of the placenta
- Assess APGAR at 1 minute, 5 and 10 minutes after birth
- Clamp and cut the umbilical cord with two cord clamps. Place the first clamp 4 fingers from the baby’s body, place the second 2 fingers from the first clamp. Wait for the cord to stop pulsating and cut the cord in between the 2 clamps. If bleeding present, apply a third clamp.
- Refer to Newborn Life Support CPG.
3rd Stage Labour
- Apply pad to vagina and ensure no excessive blood loss has occurred. Refer to CPG Post Birth Complications
- Suckling of the newborn will induce the delivery of the placenta. The mother will experience the same contractions as with delivery of the baby
- Do not try to deliver the placenta
- If the placenta delivers spontaneously, place in a biohazard bag and transport with the mother
- Cover mother and keep warm
- Monitor mother and baby en route to hospital
| Score | 0 | 1 | 2 |
|---|---|---|---|
| Appearance | Blue all over | Blue extremities | Normal colour |
| Pulse | No pulse | < 100 bpm | > 100 bpm |
| Grimace | No response to stimulation | Grimace or feeble cry when stimulated | Crying/moving when stimulated |
| Activity | Limp | Some movement | Active movement |
| Respirations | No breathing | Slow / irregular breathing | Strong cry |
Potential complications:
- Haemorrhage during pregnancy
- Pre term labour
- Pre-eclampsia/Eclampsia
- Shoulder dystocia
- Breech presentation
- Cord prolapse
- PPH
References
References
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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