Mother Initiative Tutorial

Normal labor: The first stage

Margaret Fisher Associate Professor in Midwifery

Plymouth University and The Royal College of Midwives,

United Kingdom

This tutorial is designed to re-inforce previous training – and should,

therefore, not be regared as sufficient guidance by itself 1

What is labor?

A physiological (normal) process

which starts when the mother

begins to feel regular, painful,

rhythmical contractions of the

uterus (muscles of the womb

tighten and relax)

These contractions cause the

cervix (neck of the womb) to

dilate (open) and efface (shorten)

The baby is born and the

placenta (afterbirth) and

membranes (bag around the

fetus) are completely expelled out

of the mother’s body

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How might you know the woman is in labor?

She may have a ‘show’ (a plug of

mucus from the vagina) – but this

may happen several days before

she starts labor

She may feel her membranes

rupture (waters around the baby

break). She may, or may not, be

having contractions of the uterus

She may begin to feel regular,

painful, rhythmical contractions

of the uterus (womb tightens and

relaxes)

Note: These signs may happen in

any order 3

Stages of labor (1)

First stage of labor

Starts when the mother feels

regular, painful, rhythmical

contractions of the uterus

(muscles of the womb tighten

and relax)

Finishes when the cervix

(neck of the womb) reaches

full dilatation (10 cm)

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Stages of labor (2)

Second stage of labor

Starts from when the cervix

(neck of the womb) has dilated

to 10cm

Finishes when the baby is born

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Stages of labor (3)

Third stage of labor

Starts from when the baby

is born

Finishes when the placenta

(afterbirth) has come away

from the mother, and when

her bleeding stops

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What happens in the first stage of labor? (1)

During the first stage the

fetus goes down

(descends) into the

mother’s pelvis, pushed

down by the contractions

of the uterus

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What happens in the first stage of labor? (2)

As the fetus descends, it

moves to make best use

of the space in the

mother’s pelvis. This is

called ‘the mechanism of

labour’

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What happens in the first stage of labor? (3)

At the same time that the

baby is going down

towards the mother’s

pelvis, the cervix (neck of

the womb) begins to open

from being closed to

10cm wide (dilatation of

the cervix). The cervix

also becomes softer and

shorter (effacement)

The first stage of labor is

now complete

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Monitoring progress of normal labor (1)

Maternal signs

Watch the mother and listen to

the sounds she makes

As labor makes progress she

will show that she is feeling the

contractions stronger and will

probably stop what she is doing

or stop talking to breathe

through these

Listen for sounds

Observe contractions

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Monitoring progress of normal delivery (2)

The woman may move her

body and pelvis or change

position when she is having

contractions

She may make some sounds

as her cervix reaches 10cm

dilated – these can sound like

grunts or pushes

She may change her

behaviour, becoming quiet or

else shout or scream

Movement

Grunts

Distress sounds

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Monitoring progress of normal labor (3)

Other signs of progress

If the mother’s membranes have not

ruptured (the water from round her baby

has not broken) earlier, this may happen

as her contractions get stronger

If she has not had a ‘show’ (blood-

stained mucus from her vagina) earlier,

this may happen

The mother’s contractions should get

stronger and last longer – watch her

and feel the top of her abdomen with

your hand. It should relax between

contractions

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Monitoring progress of normal labor (4)

Abdominal palpation

Check that the fetus is

descending into the pelvis by

feeling the mother’s abdomen

(abdominal palpation)

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Monitoring progress of normal labor (5)

Vaginal examination

By inserting two fingers gently

into the woman’s vagina you

should feel the cervix opening

wider from 1cm – 10 cm dilated;

becoming shorter (effacing);

becoming softer and thinner

You should feel the presenting

part getting lower in the pelvis

The presenting part should be

the crown of the head (vertex) or

breech (bottom)

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Monitoring progress of normal labor (6)

Checking mother’s wellbeing

It is important to make sure that

the mother is coping with labor

and is healthy:

Check her blood pressure and

pulse every hour

Check her temperature every

4 hours

Check that she is passing urine

every 4 hours

Check that she does not seem

dehydrated or exhausted

Exhaustion

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Monitoring progress of normal labor (7)

Checking fetal wellbeing

It is important to make sure that

the fetus (baby) is coping with

labor and is healthy:

Listen to the fetal heartbeat

every 15-30 minutes. The rate

should be 110-160 beats per

minute; you should hear it get

faster (accelerate) when there

are contractions or when it

moves and you should not hear

it slow down in the first stage of

labor.

160

110

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Using the partograph

You can use the partograph to

record all these observations in

labor. This will mean that you

and anyone else can easily see

if normal progress is being

made. It makes it easier to see

if there are any problems.

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Other care in labor (1)

Support the mother

emotionally – help her keep

control; encourage and praise

her

Support the mother physically

– help her get comfortable; rub

her back; wipe her face and

hands; hold her hand when she

is having a contraction; help

her into the position she

chooses

Support emotionally

Support physically

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Other care in labor (2)

Give her drinks frequently

Give her food if she wants this

Encourage her to pass urine

Help keep her clean – wipe or

pour water over her vulva if she

likes this

Help her to keep control with

her breathing during

contractions

Give her pain relief if she

wants this

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Problems to look for (1)

The mother may need to be

taken to medical assistance if:

She shows sign of infection

(her pulse and temperature

increase; the fetal heart rate

becomes very fast)

Her blood pressure increases

consistently to 150/90 or more

or she has a headache (risk of

pre-eclampsia)

Progress is not being made

(contractions slow or stop, the

fetus does not descend, the

cervix does not dilate)

Infections

Signs:

Raised pulse

Raised temperature

Raised fetal heart rate

Pre-eclampsia

Signs:

Headache

Raised blood pressure

Swelling

Protein in urine

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Problems to look for (2)

There are signs that the fetus

(baby) is becoming stressed by

labor – fetal heart base rate

more than 160 bpm; fetal heart

rate slows down for a minute or

more

The liquor (fluid from around

the fetus) is green (meconium-

stained) or pink/ red (blood-

stained) or clots are passed

Fetal distress

Colored vaginal

discharge

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Problems to look for (3)

The contractions become very

strong and the mother’s

abdomen does not relax in

between, causing her a lot of

pain. The fetal heart rate will

probably become very fast or

slow down if this happens. It is

very important she is taken to

medical assistance as her

uterus (womb) may rupture

(burst)

Continuous contraction with severe

pain

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Problems to look for (4)

The presenting part is

not the crown of the

head (vertex), face or

breech (bottom). The

baby may not be able

to be born safely

vaginally, and if this is

the case the woman

needs to be taken to

medical assistance

urgently.

With transverse lie the

baby cannot be born

vaginally and urgent

medical assistance

must be sought. 23

SUMMARY

Labor is a normal physiological event

Monitor progress and maternal and fetal

wellbeing carefully

If problems arise seek medical assistance

as soon as possible

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