1. Normal Birth The Mechanism of Normal labour
KATIE ADAMS
Midwifery Practice Facilitator / Labour Suite Manager
April 2015

2. Normal Birth Where labour is spontaneous at full term, not induced or augmented and where normal progress is made without the use of pharmacology. The infant delivers with maternal effort, no episiotomy or intervention with instruments or caesarean section
What is Normal?

3. Signs of labour -Latent phase
The body starts to prepare for labour.
Varies between individuals
Irregular painful contractions, period type pain, back pain
Sleeplessness, nausea, hunger / cravings, constipation, diarrhoea
Excitement / Nesting
Lasts for several hours / days
Emotional support and reassurance

4. When the waters break or Spontaneous rupture of the membranes
Waters can break at any time – does not mean labour or childbirth is imminent
Clear in colour
Meconium stained liquour
Umbilical cord
Presenting part
When the waters break or Spontaneous rupture of the membranes

5. Three stages of labour First Stage:
The onset of regular painful uterine contractions accompanied by progressive dilatation of the cervix through the transitional phase to full cervical dilation of 10 cm.
Second Stage:
Full cervical dilatation to the delivery of the baby.  
Third Stage:
Time of birth to the delivery of the placenta and control of bleeding.
Three stages of labour

6. Bishops score

7. Pain Relief Natural Endorphines Immersion in Water
Breathing Techniques
Hypnosis
Reflexology
Massage
TENS
N2O+O2
Simple Analgesia (Paracetamol)
Narcotics (Pethidine)
Epidural
Spinal GA
Pain Relief

8. Occurs towards the end of 1st stage, leads into 2nd stage
the Ferguson reflex: as pressure on the cervix increases, the Ferguson reflex increases uterine contractions so that the second stage can go ahead.
Behavioural changes
Loss of control; panic
Negative thoughts
Nausea and vomiting
Slowing of contractions
Heavy show, bowels opened
Restful stage – don’t jump in!
Urge to bear down
Purple Line
'Push Off' stage
Transitional phase

9. The strength of the pushing urge varies in intensity but will become more consistent
Characteristic grunting noise
Thinks she needs to empty her bowels / bowels open
Signs of full dilatation: heavy show, anal dilatation, perineum bulges and stretches.
The presenting part will become progressively more visible
Expulsive phases

10. Labour will progress if
The fetus is of average size
With a normally positioned head
In a normal labour
In a woman with an average sized gynaecoid pelvis
If contractions are adequate
Labour will progress if

11. Mechanisms of Normal Labour
Descent
Flexion
Internal rotation of head
Crowning
Extension
Restitution -Internal rotation of the shoulders
External rotation of the head
Lateral flexion
Mechanisms of Normal Labour

12. The fetal head engages and descends into the pelvis in an OT (occiput transverse) position.
The widest part of the fetal skull into the widest diameter of the pelvis.
Descent

13. Descent

14. As the fetus descends the head flexes so that the fetal chin is touching the fetal chest.
Thereby creating the smallest diameter to pass through the pelvis.
Flexion

15. Internal rotation of the head
With good uterine contractions and maternal expulsive effort the occiput reaches the pelvic floor.
As it reaches the resistance of the pelvic floor, it rotates forward through 45 degrees into OA (occiput anterior) position.
The head emerges through the widest diameter of the pelvic outlet – anteroposterior diameter.

16. As head descends it meets the muscles of the pelvic floor and rotates anteriorly
Internal rotation

17. The occiput escapes under the pubic arch and the head is crowned.
The head no longer recedes between contractions.
Crowning

18. The forehead, face and chin sweep the perineum and the head is born.
Extension

19. Extension

20. When the head is born it will turn right or left righting itself with the shoulders.
The shoulders rotate internally to lie in the AP diameter of the pelvis.
Rotation follows the same direction as restitution.
Restitution

21. External rotation

22. The Anterior shoulder is born under the pubic arch first
The posterior shoulder passes over the perineum
The natural curve of the birth canal causes the baby to flex sideways
Lateral flexion

23. Complete Expulsion or Delivery

24. Placenta Physiological Do nothing Active Breast feed
Observe blood loss
Maternal observations
Can take one hour or more
Pass urine
Sit up right
Placenta
Active
Clamp and cut cord
Oxytocic drugs
Signs of separation
CCT
Contracted uterus?
Average 5 minutes

25. Skin to skin & Breast feeding
4th Stage of labour
Promotes bonding / Feelings of wellbeing
Thermoregulat ion
Comforts baby
Promotes early breast feeding
Expels placenta

26. UHCW Lucina Birth Centre Division of B2B training Birthing Pools
Dedicated supervisor of Midwives Team
Specialist Midwives Roles
Birthing outside of Guidance
Low Risk Policies and Guidelines
Large birthing rooms
UHCW

27. CAN WE IMPROVE ? ? CEASAREAN SECTION RATE ? NORMAL BIRTH RATE
? WATERBIRTH RATE
? INSTRUMENTAL
CAN WE IMPROVE ?

29. Any Questions?