The document discusses how understanding the normal physiological processes of labour, including the contraction patterns and stages of labour, can help midwives support vaginal births and avoid unnecessary interventions. It emphasizes applying anatomy and physiology to assess each woman's individual situation based on factors like baby positioning and dilation. Recognizing the full spectrum of labour from latent to active phases and using non-medical approaches can result in higher rates of normal birth.

1. Contraction
Patterns of
Labour
How do they influence our
management of care to
support the normal process
of labour?

2. Know the
normal
Work with the abnormal to
make it normal

4. In the past quarter century,
advances in medical technology
have been accompanied by an
increase in
intervention-intensive labour and
birth
( Hamilton, Martin, & Ventura, 2006 ).

5. Nature ’ s simple
plan for birth has been replaced by a
maternity care
system that routinely interferes with the
normal physiological
process and in doing so introduces
unnecessary
risks for mother and baby.

6. Women no longer have confi -
dence in their ability to give birth without
technologic intervention.

7. The physiological mechanisms
of labour and childbirth
are NOT completely understood.

8. Intrinsic factors within the uterine muscle
affect contractions and progressive
cervical dilation. Thus,
spontaneous onset of term labour
signifies the baby’s
readiness to be born as well as the
mother ’s physiological
receptiveness to the process.

9. Don’t pick a plum before it is
ripe

10. The Cervix needs to be soft

11. With good observation applied
anatomy and physiology, and
critical thinking during the birthing
process it is possible to achieve
normal vaginal birth.

12.  One of my failings
as a midwife is my
inability to assess
the strength and
effectiveness of
uterine
contractions. I am
often asked
 How strong are her
contractions?
 How effective are
her contractions
Can we measure
the effectiveness
of contractions?

13. Failure to understand labour
 Early interventions
 Pain relief
 Epidurals
 Artificial rupture of membranes
 Oxytocinon/Syntocinon/Pitocin
 C section

14. There are Many theories
 Friedmann defined the three stages of
labour
 Latent and active
 Second stage
 Third stage

18. These theories do not have any
application to anatomy and
physiology or to the contraction
patterns of labour
they merely measure time
frames.

19. Failure to diagnose labour
 In 2013, researchers published a report of 38,484
first-time C-sections that occurred among a
national sample of women. The overall C-section
rate among first-time mothers was 30.8%. More
than 1 in 3 (35%) of these C-Sections were due to
a diagnosis of “failure to progress,” or slow
progress in labour. This means that 10%, or 1 in 10,
of all first-time mothers in the U.S. had a C- Section
for failure to progress during the years 2002-2008
(Boyle, Reddy et al. 2013).
 More than 4 in 10 of these women who had C-
sections for failure to progress had not even reached
5 cm dilation before they were taken to surgery. This
means that many of these women were still in very
early labour when they were told that they weren’t
dilating fast enough (Boyle, Reddy et al. 2013).

20. Progress and Time
 A substantial number of women have
unplanned C- Sections for failure to progress
during a medical induction. In a 2010 study
that included 233,844 new-borns born
between 2002 and 2008, researchers found
that about half of all induced women who
had C-sections for failure to progress had not
reached 6 cm yet (53%)– indicating that they
were still in very early labour when their
inductions were labelled as “failed”
 (Zhang et al., 2010b).

21.  The baby is the
passenger
presentation is
important
 Power of uterine
contractions are
they doing the
Job
 The Pelvis
Outdated 3 P’s
Passenger
Power
Passage
Friedmann 1955

22. Midwives
perspective
to look at
the bigger
picture and
plan care
to support
the normal
physiologic
al process
of child
birth
The 5 P’s
• Passenger
• Power
• Passage
• Psyche
• Preparation

23. The Art of Midwifery
 Consider the Five P’s
 Observe contraction
patterns
 Apply anatomy and
physiology to the six
stages of labour
 Know the birthing
hormones and
applied anatomy
and physiology
 Look at the bigger
picture then plan
yourcare/advice
And education to
get the best
outcomes for the
individual woman

24. Labour contractions can
increase and decrease in
frequency following admission
to hospital. This may be
associated with dilatation and
posture rather than anxiety
Midwifery 2009 June 25: (3)242-52 Epub2007 july 12

25. Missing from the
statement
No reference to applied anatomy and physiology
What is really Happening?

26. Clock watching and timing
X

27. Lack of understanding leads to
 Contractions are
slow
 Augmentation that is
in apropriatley
managed
 Need to know latent
and active phase
 Lets augment the
process
 Foetal distress
 Caesarean
 Neonatal units

28. Are there 6 stages of Labour?
 Descent
 Effacement
 Active
 Transition
 Second Stage
 Third stage

30. Descent
• The transverse
muscles of the
uterus contract to
facilitate the
descent of the
head into the
pelvis
Oestrogen levels begin
to fall and go over a
few weeks

31. Descent

32. The transverse muscles continue
to assist the head to descend into
the pelvis.
At some stage prostaglandin is
released.
The cervix softens.
The longitudinal muscle begins to
contract from the fundus to pull
back the cervix over the head.
This gives a picture of variable
contractions.
The rounded contractions giving
height as the longitudinal muscles
do their job.
 Short and sharp contractions as
the head continues to descend
into the pelvis
Effacement and
early dilation

33. Effacement

34. Regular coordinated
contractions as oxytocin is
released
The longitudinal muscles
pull s the cervix back over
the baby’s head
Usually greater than 5cm
on admission
Can stop for 1-2 hours prior
to transition
Endorphins are released to
assist with maternal pain
management.
Active
Phase

35. Dilation

36. Contraction patterns may
change
 The body knows what to do.
 If the baby is in posterior position there will be more
descent patterns of contractions with back pain.
 Babies sometimes rotate in and out of posterior
position as the baby corkscrews down into the pelvis
 If baby is moving from ROA to LOA.
 The mother needs to move position to help her baby
turn.
 Augmentation may drive down the Op baby and
cause obstruction if forced.
 In my experience forcing a baby down in the OP
position may weaken the uterus.

37.  Can’t do it
 Won’t do it
 Cut it out
 Give me an
epidural
 Get me out of
here
 It’s all your fault
 I hate you
Transition
Usually occurs
around 7-8cm
Adrenaline is
released the flight
and fight hormone
Can last around 20
minutes

38. Amy and Jo Worlds Apart
 Jo in a large
tertiary Hospital
 Opinions for child
birth
 No choices
 Not ambulant
 Augmentation
 Fetal Distress
 LSCS
 Amy in a midwifery
led unit
 Ambulant
 Choices
 Positioning
 Squatting
 Well informed
 Normal delivery
 Elated about her
experience

39. Case scenarios
 Mary home birth
 Rajeshri- induction
 Jo- Posterior birth
 Kshama -
Unprepared
 Noha- Waterbirth
 Picture perfect
 Tough love and
bargaining
 Positioning
 Tough
love/positioning
 Tough love

40. Early admission leads to
intervention
 Burnt out midwives
 More midwifery staff for one to one care.
 High intervention rates
 Increases the risk of LSCS
 Increased risk babies requiring intensive care
 Affects on breastfeeding
 Postnatal depression
 Increased staffing levels
 Exhausted obstetricians

41. The Birthing Environment
warm
safe
private
quiet
dark

42. Active Birth

43. Hospital Walking Garden

44.  Understand the
contraction
patterns of labour
 Understand and
apply anatomy
and physiology of
the uterus
 Take into account
the Five P’s when
making decisions
 Understand the
roles of birthing
hormones
Midwife’s
Role
To support the
normal
physiological
process of
childbirth

45. My intervention rate was much
higher.
I did not understand the normal physiological process of labour
I did not know how to manage the contraction patterns of labour
or manage care applied to the 5P’s with a midwifery perspective
I did not know how to educate and empower my women
I was not strong enough to provide tough love
 In the beginning I spent many of 16 hours with
women on delivery unit.
 Now I can drink tea. Usually only two to fours hours
on Delivery unit.

46. Thanks to the continuity of care,
reflection of practice, use of
complementary therapies, my vaginal
birth rate is around 95%. My epidural
rate is around 4%
“Very few women spend a long time in hospital and
have faith in childbirth. When midwives learn from
reflection, share knowledge and work as a team
the future for our families will be sound” Irene Chain
Midwife

47. Your Decisions
 Affect the woman for life
 Take into consideration the professional team
 If not sure Ask
 If you don’t apply the anatomy physiology,
mental state you will have longer times on
delivery maternal exhaustion and burnt out
colleagues
 We are a team with a wealth of knowledge
and experience

48. Recommendations
 Support the natural process
 Tough love where necessary
 Better antenatal education
 Ambient Rooms and acceptance for women who
have little support
 Support your colleagues/and better
communications
 On call sleep room for health professionals with
facilities.
 Empower women to take charge
 No CTG monitoring for low risk women