First stage of labour

Place of birth
Explain to both multiparous and nulliparous women who are at
low risk of complications that giving birth is generally very
.safe for both the woman and her baby

Advise low-risk multiparous women that planning to give birth at

home or in amidwifery-led unit (freestanding or alongside) is
particularly suitable for them because the rate of
interventions is lower and the outcome for the baby is no
.different compared with an obstetric unit
Advise low-risk nulliparous women that planning to give birth in
a midwifery-led unit(freestanding or alongside) is particularly
suitable for them because the rate of interventions is lower
and the outcome for the baby is no different compared with
an obstetric unit. Explain that if they plan birth at home there
is a small increase in the risk of an adverse outcome for baby

planning birth in an obstetric unit is associated with a higher rate

of interventions, such as instrumental vaginal birth, caesarean
section and episiotomy, compared with planning birth in
other settings
 High risk women
 Grand multiparas
.History of previous postpartum haemorrhage
Antepartum haemorrhage
PTL
Suspected foetal macrosomia
IOL
Preeclampsia
Malpresentations
Multiple pregnancy
Anaemia (moderate and severe)
Women with medical disorders during pregnancy i.e. diabetes,
cardiac,…et
Previous C/S
 communications
o Greet the woman with a smile and a personal welcome

o introduce yourself and explain your role in her care.

o Knock and wait before entering the woman's room

o Ask her permission before all procedures and observations

o focusing on the woman rather than the technology or the

documentation

o When leaving the room, let her know when you will return.
Labor Support:
 Encourage the woman to have support from relatives.

Nutrition & fluids:

 Allow oral intakes of fluids, some candies& soft food.
 Encourage voiding every 2 hours.
 (Note: Catheterization is not mandatory unless indicated.)

Do not offer either H2-receptor antagonists or antacids routinely to low-risk

women.
Either H2-receptor antagonists or antacids should be considered for women
who receive opioids or who have or develop risk factors that make a general
anaesthetic more likely

Ambulation & Position:

 Encourage ambulation if continuous monitoring is not required.
 Encourage the woman to avoid lying in supine position.
 If lying down, encourage a left lateral tilt.
 First stage of labour
Latent first stage of labour : a period of time,
not necessarily continuous, when:
there are painful contractions and there is some
cervical change, including cervical effacement
and dilatation up to 4 cm.
Established first stage of labour – when:
there are regular painful contractions and
there is progressive cervical dilatation from 4
cm.
:Record fetal condition including
o Fetal heart rate Q (every) 30 minutes for low risk parturient
and Q15 minutes for high risk parturient
.o Amniotic fluid color
.o Moulding of the fetal head
:amniotic fluid
.o I = Intact membrane
o C = Clear liquor
.o B = Blood Stained
:o M = Meconuim staining.  Moulding
molding
.o Grade 0 = Bones normally separated
.o Grade + = Bones touching each others
.o Grade ++ = Bones overlapping but easily separated
.o Grade +++ = Bones overlapping but cannot be separated
: Record maternal condition
.o BP Q 4 hours
.o Pulse Q 1 hour
.o Temp. Q 4 hours
.o Urine output: Check & record all urine passed for albumin
.o Drugs administered including Oxytocin
.o IV fluids

:Record progress of labor

 Cervical dilatation (in cm): Q4 hours
 Descent of the head: abdominally (Fifths palpable per abdomen)
 Uterine contractions: Q 30 minutes showing strength: weak, moderate,
strong & frequency. (# of contractions in last 10 minute)
Weak: Less than 20 seconds -
Moderate: Between 20 & 40 seconds -
Strong: More than 40 seconds -
 Duration of the first stage
• first labours last on average 8 hours and are
unlikely to last over 18 hours

• second and subsequent labours last on

average 5 hours and are unlikely to last over
12 hours.
• In normally progressing labour, do not perform amniotomy
routinely.

• Do not use combined early amniotomy with use of oxytocin

routinely

• Do not routinely offer the package known as active

management of labour
(one-to-one continuous support; strict definition of established
labour; early routine amniotomy; routine 2-hourly vaginal
examination; oxytocin if labour becomes slow).
 Delay in the first stage
• cervical dilatation of less than 2 cm in 4 hours for first
labours

• descent and rotation of the baby's head

• changes in the strength, duration and frequency of

uterine contractions
If delay in the established first stage of labour is
suspected, amniotomy should be considered
for all women with intact membranes, after
explanation of the procedure and advice that
it will shorten her labour by about an hour
and may increase the strength and pain of her
contractions.

to have a vaginal examination 2 hours later, and

diagnose delay if progress is less than 1 cm.
-Inform the woman that oxytocin will increase the frequency
and strength of her
contractions and that its use will mean that her baby should
be monitored continuously.

-Increase oxytocin until there are 4–5 contractions in

10minutes.

-to have a vaginal examination 4 hours after starting oxytocin

-If cervical dilatation has increased by less than 2 cm after 4

hours of oxytocin, further obstetric review is required to
assess the need for caesarean section.
.o Starts at 1-2 mu/min
.o Increase by 1-2 mu/min every 30 minutes
o Maximum dose 36 mu/min

o Starts at 2-4 mu/min

o Increase 2-4 mu/min every 15 minutes
o Maximum dose is 36 mu/min

:Low dose regimen

:High dose regimen
Regard the following as concerning *
characteristics of variable decelerations:
lasting more than 60 seconds; reduced
baseline variability within the deceleration;
failure to return to baseline; biphasic (W)
shape; no shouldering
Methylergometrine is a smooth muscle constrictor that
uterus mostly acts on the

Methylergometrine is a partial agonist/antagonist on 

serotonergic, dopaminergic and alpha-adrenergic
 receptors. Its specific binding and activation pattern
on these receptors leads to a highly, if not completely,
specific contraction of smooth uterus muscle via 5-HT2A
 serotonin receptors,[7] while blood vessels are affected
to a lesser extent compared to other ergot alkaloids
Oxytocin works by increasing the concentration
of calcium inside muscle cells that control
contraction of the uterus. Increased calcium
increases contraction of the uterus