Normal Labor in Pregnancy: How to Prepare for a Smooth Delivery
Normal labour is one of the most natural yet crucial processes in maternal healthcare. As nurses, it is essential to master every detail, from the first contraction to the last push. This blog post is a complete guide for nursing students and professionals who want to build their skills and confidence in managing normal labor effectively.
What is Normal Labour?
Normal Labor is a process in which a healthy pregnant woman has a vaginal delivery after a full-term pregnancy (around 37-42 weeks) through a natural process, without any medical or surgical intervention.In this process the uterus contracts, the cervix gradually opens, and the baby emerges from the birth canal.
Stages of Normal Labor Explained
Normal Labor is mainly divided into 3 stages:
1. First Stage – Cervical Dilatation
Duration: 8-12 hours (primigravida); 6-8 hours (multigravida)
Begins with true labor pains and ends with full dilatation (10 cm)
Cervix softens and opens gradually
Pain can be moderate to severe.
Nursing Role:
fetal heart rate monitor
By checking cervical dilatation
Hydration and emotional support do
First Stage of Labor – Physiological Process
First stage of labour is the stage when regular uterine contractions start and the cervix is fully dilated up to 10 cm. This stage is divided into two phases:
1. Latent Phase (Initial Phase)
- cervix dilation: 0 to 4 cm.
- Contractions are mild, irregular but gradually become strong and regular.
- Duration: It may take longer in primigravida (first time mother) women.
2. Active Phase
- Cervix dilation: 4 to 10 cm.
- Contractions are strong, painful, and frequent (every 3-5 minutes, duration 45-60 seconds).
- Fetus begins to descend into the pelvis.
Physiological Changes (Body Changes):
- Uterine contractions help the cervix to efface (thin) and dilate (open).
- Cervical effacement & dilation: Cervix becomes soft, short, and gradually opens.
- Fetal descent: Baby moves into the pelvic cavity.
- Rupture of membranes (water rupture): This can happen naturally or can be done artificially by a doctor (amniotomy).
Management of First Stage of Labour
Monitoring & Assessment:
Vital signs: Check BP, pulse, temperature every 4 hours or as required.
Uterine contractions: Check their frequency (how often), duration (for how long), and intensity.
Fetal Heart Rate (FHR): Check with Doppler or CTG every 15–30 minutes.
Vaginal Examination (VE): Check cervix dilation every 4 hours or as required.
Urine output: Send patient to toilet every 2 hours.
Supportive Care:
- Provide emotional support, maintain a calm environment.
- Give mother the option to walk, change position.
- Teaching breathing techniques.
- Pain Relief:
- Non-pharmacological: Massage, music, warm bath, relaxation, breathing.
Pharmacological::
- Pethidine, Entonox (gas & air), Epidural (if available).
- Nutrition & Hydration:
- If the patient is allowed to have light snacks and drink water.
- Otherwise administer IV fluids.
Documentation:
Partograph filling: Cervical dilation, contraction timing, maternal & fetal status record with timing and date
2. Second Stage – Delivery of Baby
Duration: 30 minutes to 2 hours
Starts from full dilatation and ends with baby’s delivery
Patient has to do active pushing
Nursing Role:
By ensuring sterile environment
Perineal support do
By observing fetal head descent
Prepare for neonatal resuscitation
Second Stage of Labour – Physiological Process
The second stage begins when the cervix is fully dilated (10 cm) and ends when the baby is born.
Duration:
Primigravida (first-time mother): approximately 30 mins to 2 hours.
Multigravida (experienced mother): 15 mins to 1 hour.
Physiological Changes:
- Strong uterine contractions occur every 2–3 minutes, lasting 60–90 seconds.
- Urge to push: Mother naturally feels like pushing.
- Fetal descent: Baby emerges from the birth canal.
- Crowning: When the baby’s head is visible at the opening of the vagina.
- Delivery of baby: Head is delivered first, then the rest of the body.
Management of First Stage of Labour
Monitoring:Fetal Heart Rate: Listen after every contraction.
Maternal vitals: Check BP, pulse every 15-30 minutes.
Progress: Observe baby’s descent and head position.
Positioning:Give comfortable and effective pushing position (e.g., squatting, semi-sitting).
Encourage mother to push with her contractions.
Support & Guidance:Teach mother breathing and pushing technique.Give calm and confident environment.
Perineal Care:Use clean area, gloves, and sterile drapes.
Episiotomy if necessary (if perineum is tight or baby is in distress).
Baby Delivery:
- Let the baby’s head be delivered slowly (controlled delivery).
- Check the umbilical cord (whether it is around the neck or not).
- After delivery, clamp the cord and cut it.
Immediate Newborn Care:
- Dry the baby, keep him warm.
- Assess the APGAR score (at 1 and 5 minutes).
- Promote skin-to-skin contact and early breastfeeding.
3. Third Stage – Delivery of Placenta
- Duration: 5-30 minutes
- Starts after baby is born and ends with placenta expulsion
- Risk of bleeding increases
Nursing Role:
- With uterine contraction monitor
- Placenta should be checked for completeness.
- Administer Oxytocin (if ordered)
- observe viginal bleeding
Third Stage of Labour – Physiological Process
The third stage of labour begins immediately after the baby’s birth and ends when the placenta (nacha) and membranes are completely delivered.
Duration:
Normally lasts from 5 to 30 minutes.
Physiological Changes:
Uterine Contractions:
- After the baby is born, the uterus contracts again.
- These contractions separate the placenta from the uterus wall.
Placental Separation:Contractions separate the placenta from the uterus wall.
There are some signs like:
- sudden gush of blood
- umbilical cord lengthening
- uterus becomes firm and rises up.
Placental Expulsion:
The placenta comes out of the uterus and into the birth canal (naturally or by controlled traction).
Uterine Retraction:
The uterus becomes smaller and firmer so that bleeding can be controlled.
Active Management of Third Stage of Labour (AMTSL):
Uterotonic Drug Administration:
- Oxytocin 10 units IM (intramuscular) within 1 minute of baby birth.
- This contracts the uterus and reduces bleeding.
Controlled Cord Traction (CCT):
- When signs of placental separation are seen, the placenta is removed by gently pulling the umbilical cord.
- The uterus is supported by hand to avoid inversion.
Uterine Massage:
- After placenta delivery, the uterus is gently massaged to keep it firm and contracted.
- This helps to control bleeding.
Monitoring During Third Stage:
Placenta Check: Is it complete or is any part left? Incomplete ho to signs of retained placenta.
Bleeding Assessment: Observe approximate blood loss (usually <500 ml).
Vital Signs Monitoring: BP, pulse every 15 minutes.
Uterus Tone: Check whether the uterus is firm or boggy (soft), if it is soft then massage it.
Documentation:
- Placenta delivery time.
- Uterotonic drug name, dose and time.
- Blood loss estimate.
- Maternal condition and vitals.
