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During the normal labour process, the cervix opens for the baby’s head to descend into the birth canal. During labour, the mother experiences regular, painful contractions of the womb. Labour ends with the delivery of the baby and the placenta.
1st Stage of Labour
starts with contractions and ends with a fully dilated cervix.
Individual cases may require:
- Enema to empty the bowel
- Pain relief
- Mother: blood pressure, heart rate, and temperature monitoring, regular abdominal and vaginal examinations to track progress
- Baby: continuous fetal heart rate monitoring with the cardiotocograph (CTG) machine
2nd Stage of Labour
starts with full dilation of the cervix and ends with delivery of the baby
- Mother, in a comfortable position, starts to push with contractions
- Episiotomy: doctor may perform a cut at the perineum to create more space and prevent large and multiple tears in the vagina and anus
- Delivery without episiotomy may be possible, with some small vaginal or perineal tears
3rd Stage of Labour
starts after delivery and ends with delivery of the placenta
- The uterus is “rubbed” to encourage contractions and separation of placenta
- Placenta delivery expedited by gentle tugging on cord after uterus has contracted
- Stitches may be needed to repair episiotomy
WHAT ARE THE RISKS OF LABOUR?
Labour is generally a safe and natural process for the mother and baby, but complications can occur.
- Shown via abnormalities in the CTG
- Meconium (baby’s bowel) staining the amniotic fluid may occur
- Delivery may be expedited by emergency C-section or assisted vaginal delivery
FAILURE TO PROGRESS
- Cervix not dilating well enough
- Baby’s head not descending into birth canal
- Delivery via C-section may be necessary
- Serious concern for mother’s health, i.e. extremely high blood pressure or collapse
- Requires urgent stabilisation of mother and rapid delivery of baby
WHAT ARE THE RISKS OF LABOUR?
PERINEAL & VAGINAL TEARS
- First-degree tear: skin deep, may heal naturally.
- Second-degree tear: affects the superficial muscles and requires stitches.
- Third degree & fourth degree tear.
- 3rd degree: involves anal sphincter
- 4th degree: deeper tear in the lining of uterus or rectum
- can lead to incontinence in later life
- This is a type of obstructed labour in which the baby’s head is delivered, but the shoulders cannot pass through or requires significant manipulation.
- This condition is an obstetric emergency, and the baby’s health can be significantly compromised if the baby is not delivered. This occurs rarely, in 0.3-1% of vaginal births.
- The placenta may not separate from the uterus, which can lead to increased bleeding.
- Surgical removal of placenta under general anaesthetic may be needed.
POSTPARTUM HAEMORRHAGE (PPH)
- Blood loss greater than 500 mL post-delivery.
- Common cause: uterine atony, meaning uterus remains soft and relaxed after delivery.
- Other causes: retained bits of the placenta, vaginal tears, and bleeding disorders.
- A Large bruise that can arise with vaginal tears.
- Small haematomas may heal in a few weeks, but large haematomas may cause severe pain and excessive blood loss, which require a surgical stoppage procedure.
- May occur in the womb or with vaginal tears.
- Usually manifests via fever, vaginal discharge, or pain in the lower abdomen or vagina a few days after delivery.