the learners gain knowledge on signs of normal labor and progression

1. IDENTIFICATION OF SIGNS OF NORMAL
LABOUR PROGRESSION
Mallika

2. Learning outcomes:
At the end of the session, the learners will be able to :
 Define normal labour progression
 Enlist the different stages of normal labour and its duration.
 Recognize the signs and symptoms of the progression of normal labour
 Summarize WHO recommendations about the progression of various
stages of labour
 Identify the signs of progression of labour apart from vaginal
examination

3. Definition of labour
Normal labor is low risk throughout spontaneous onset with the
fetus presenting by the vertex, culminating in the mother and
infant being in good condition following birth.
-WHO
“Labour is a process of onset of painful regular uterine
contractions with progressive cervical effacement and
dilatation.”

4. Stages of
labour

5. First stage of labour
 The first stage is normally recognized by the onset
of regular uterine contractions an accompanying effacement
and 10 cm dilatation of the cervix. The average duration of
is 12 hours in primi gravid and 6 hours in multiparas.

6. Second stage of labour
 The second stage of labor has been regarded as
the phase between full dilatation of the cervical os
and the birth of the baby. The average duration is
2 hours in primi and 30 minutes in multiparas
women.

7. Third stage of labour
 The third stage of labor can be defined as the period
from the birth of the baby to the complete expulsion
of the placenta and membranes.
 Usually lasts between 5 & and 15 minutes, but any
period up to 1 hour may be considered as normal.

8. Fourth stage of labour
 The fourth stage lasts for 2 hours postpartum after
the expulsion of the placenta.

9. Signs and Symptoms of impending
normal labour
 Regular contraction
 Backaches
 Diarrhoea
 Lightening
 Bloody show
 Urge to go to the toilet
 Water break or release of water
 Burst of energy

10. WHO
RECOMMENDATIONS

11.  RECOMMENDED
 Women should be informed that a standard duration of the latent
first stage has not been established and can vary widely from
one woman to another. However, the duration of the active first stage
(from 5 cm until full cervical dilatation) usually does not extend
beyond 12 hours in first labors, and usually does not extend
beyond 10 hours in subsequent labor.

12. • NOT RECOMMENDED
 For pregnant women with spontaneous labour onset, the cervical
dilatation rate threshold of 1 cm/hour during the active first stage (as
depicted by the partograph alert line) is inaccurate in identifying women
at risk of adverse birth outcomes and is therefore not recommended for
this purpose.

13. • NOT RECOMMENDED
 A minimum cervical dilatation rate of 1 cm/hour throughout
the active first stage is unrealistically fast for some women and
is therefore not recommended for identification of normal
labor progression. A slower than 1 cm/hour cervical dilatation
rate alone should not be a routine indication for obstetric
intervention.

14. • NOT RECOMMENDED
 Labour may not naturally accelerate until a cervical dilatation
threshold of 5 cm is reached. Therefore the use of medical
interventions to accelerate labor and birth (such as oxytocin
augmentation or cesarean section) before this threshold is
not recommended, provided fetal and maternal conditions are
reassuring.

15.  RECOMMENDED
 For women in the second stage of labor, techniques to reduce
perineal trauma and facilitate spontaneous birth (including
perineal massage, warm compresses and a “hands-on” guarding
of the perineum) are recommended, based on a woman’s
preferences and available options. ,

16. • NOT RECOMMENDED
 Application of manual fundal pressure
to facilitate childbirth during the second stage of labor
is not recommended.

17.  RECOMMENDED
 Women in the expulsive phase of the second stage of
labour should be encouraged and supported to follow
their urge to push. labor

18. Signs of progression of labor apart from
the vaginal examination..
Physical signs;
 Frequent change of position by the mother
 Feeling pressure in the perineum
 Sweating
 Passing motion
 Heavy breathing
 0/5th palpable
 Perineal bulging
 Vulval opening with waves

19. Signs of progression of labour
Behavioral signs
 Avoiding food and fluids
 Restlessness
 Urge to bear down
 Quiet and less interacting
 Groaning and moaning

20. REFERENCES :
1. https://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf.
2. https://my.clevelandclinic.org/health/articles/9676-labor/delivery.
3. https://www.mayoclinc.org/healthy-lifestyle/labor-and-delvery/in-depth/stages-of-labor/art-
20046545
4. Marshall E Jayne, Raynor D Maureen., Myles Textbook for Midwives. India: Elsevier Ltd,
publishers. 17th edn. 2020. Pp: 448, 501, 536.