normal labour

🩺 Introduction

Labour is the culmination of pregnancy and marks the beginning of motherhood. As future nurses, understanding every phase and aspect of normal labour is essential to support safe, evidence-based maternal care.

Definition:Labour is the physiological process where the fetus, placenta, and membranes are expelled through the birth canal under the influence of uterine contractions.

✅ Normal labour is spontaneous, at term (37–42 weeks), vertex presentation, and ends with vaginal delivery without complications.

⏳ Phases & Stages of Normal Labour

Labour has 4 well-defined stages:

🔹 1st Stage: Cervical Dilation

Duration:

• Primigravida: 12–14 hrs

• Multigravida: 6–8 hrs

Phases:

1. Latent Phase – 0 to 3 cm

   • Irregular mild contractions

   • Lasts hours

2. Active Phase – 4 to 7 cm

   • Moderate to strong contractions every 3–5 mins

3. Transition Phase – 8 to 10 cm

   • Intense, frequent contractions (2–3 mins)

Nursing Responsibilities:

• Monitor FHR every 30 mins

• Provide breathing support, hydration

• Encourage urination every 2 hrs

• Maintain privacy and explain procedures

🔹 2nd Stage: Delivery of Baby

Duration:

• Primigravida: 30–60 mins

• Multigravida: 15–30 mins

Key Events:

• Full dilation (10 cm)

• Maternal pushing efforts

• Delivery of baby

Nursing Responsibilities:

• Position mother (lithotomy/squatting)

• Support perineum

• Monitor FHR after each contraction

• Prepare for neonatal care and APGAR scoring

🔹 3rd Stage: Placenta Expulsion

Duration: 5–15 mins

Signs of Separation:

• Gush of blood

• Cord lengthens

• Fundus rises and becomes firm

Mechanism:

• Schultze (shiny) or Duncan (dirty) method

Nursing Responsibilities:

• Administer 10 IU oxytocin IM

• Inspect placenta for completeness

• Monitor bleeding and uterine tone

🔹 4th Stage: Recovery

Duration: First 1–2 hours postpartum

Nursing Responsibilities:

• Monitor BP, pulse, uterus tone every 15 mins

• Check vaginal bleeding

• Initiate skin-to-skin and breastfeeding

• Observe for PPH, bladder distension

⚙️ Mechanism of Labour (Cardinal Movements)

1. Engagement

2. Descent

3. Flexion

4. Internal Rotation

5. Extension

6. External Rotation

7. Expulsion

🧠 Mnemonic: Every Darn Fool In Egypt Eats Raw Eggs

🛠️ Assessment Tools in Labour

Tool	Purpose
Partograph	Track dilation, contractions, vitals
Leopold’s Maneuvers	Fetal lie, presentation, position
Vaginal Exam	Cervical dilation, effacement
Fetal Monitoring	FHR variability and distress

🧷 Nurse’s Role in Normal Labour

• Supportive care and emotional encouragement

• Pain management: breathing, massage, position changes

• Monitor labour progress & fetal wellbeing

• Ensure aseptic technique

• Document findings (partograph, notes)

• Assist with delivery and newborn care

⚠️ Warning Signs to Report Immediately

• FHR <110 or >160 bpm

• Prolonged or obstructed labour

• Meconium-stained liquor

• Cord prolapse

• Uterine rupture signs (sudden pain, fetal parts palpable easily)

🍼 Post-Delivery Care (Mother & Baby)

• Promote early breastfeeding (within 1 hour)

• Monitor PPH signs, lochia, and vitals

• Educate on perineal hygiene, rest, nutrition

• Support mother-infant bonding

📊 Summary Table: Normal Labour

Parameter	Normal Labour
Onset	Spontaneous
Term	37–42 weeks
Presentation	Cephalic (vertex)
Duration	Avg. 12–14 hrs (primigravida)
Outcome	Vaginal delivery, no complications

🎓 Exam Booster Tips

🧠 Use flowcharts for stages

🧠 Add mnemonics like “Every Darn Fool…”

🧠 Draw labelled diagrams for mechanisms

🧠 Practice partograph interpretation

✅ Mechanism of Normal Labour (Cardinal Movements)

The mechanism of labour refers to the series of movements the fetus undergoes during its journey through the birth canal to ensure a safe vaginal delivery. These are called cardinal movements.

There are seven sequential movements that occur during the second stage of labour, especially in vertex presentation (head-first). Each movement helps the fetus adapt to the shape and size of the maternal pelvis.

🔄 7 Cardinal Movements of Labour

📌 Mnemonic: Every Darn Fool In Egypt Eats Raw Eggs

Step	Movement	Description
1️⃣	Engagement	The widest part of the fetal head (biparietal diameter) passes through the pelvic inlet.
2️⃣	Descent	The fetal head moves down through the pelvis due to uterine contractions and pressure.
3️⃣	Flexion	The fetal chin tucks toward the chest, allowing a smaller diameter (suboccipitobregmatic) to present.
4️⃣	Internal Rotation	The head rotates to align with the maternal pelvic outlet (usually from transverse to anterior).
5️⃣	Extension	As the head reaches the vulva, it extends to pass under the pubic symphysis and out of the birth canal.
6️⃣	External Rotation (Restitution)	After the head is born, it rotates to align with the shoulders (returns to original position).
7️⃣	Expulsion	The anterior shoulder slips under the pubic bone, followed by the posterior shoulder and the rest of the body.

🔍 Detailed View of Each Movement

1. Engagement

• Occurs when the fetal head enters the pelvic brim.

• Biparietal diameter (~9.5 cm) is the presenting diameter.

• Confirms that the fetal head fits in the pelvis (pelvic adequacy).

2. Descent

• Continuous downward movement through the birth canal.

• Aided by:

  • Uterine contractions

  • Maternal pushing

  • Straightening of the fetal body

3. Flexion

• Head flexes so the smallest diameter enters the pelvis.

• Chin touches the chest → head becomes more compact.

• Essential for smooth passage.

4. Internal Rotation

• Head rotates 90° from transverse (sideways) to anteroposterior (front-back).

• Aligns fetal head with maternal pelvis outlet.

5. Extension

• Once the head reaches the perineum, it extends.

• Allows the head to pass under the pubic arch.

• Crowning occurs here (head visible at the vulva).

6. External Rotation (Restitution)

• After the head is born, it realigns with the shoulders.

• Head turns slightly to the side (usually toward mother’s thigh).

• Allows correct positioning for shoulder delivery.

7. Expulsion

• Shoulders and the rest of the body are delivered.

• Anterior shoulder slips out first, followed by the posterior one.

• Baby is born completely.

🧠 Clinical Importance for Nurses

• Observe each step carefully to identify normal vs. abnormal labour.

• Delay or absence of these movements may indicate obstructed labour or malpresentation.

• Nurses should:

  • Monitor fetal descent (station)

  • Support perineum during extension

  • Be prepared to assist in case of shoulder dystocia

📌 Quick Summary Chart

Step	Action	Purpose
Engagement	Head enters pelvis	Fit assessment
Descent	Moves downward	Progression
Flexion	Chin to chest	Smaller diameter presents
Internal Rotation	Align with outlet	Easier passage
Extension	Under pubic bone	Head emerges
External Rotation	Align shoulders	Facilitates shoulder delivery
Expulsion	Body is delivered	Completion of birth