Management of second stage of labour pdf download

Otherwise maternal tachycardia may be wrongly treated as fetal heart rate. International health policy and programming have placed emphasis on the first stage of labor, including appropriate use of the partogram and identification of hypertension or sepsis, and have also focused on the third stage of labor with active. Management of occiput posterior position in the second. With the full dilatation of the cervix, the membranes usually rupture and there is escape liquor amnii. The second stage is that of expulsion of the fetus. Durations of second stage of labor and pushing, and. During the second stage of labour, you will push your baby down and out of your vagina the birth canal, and meet him or her for the first time. Simultaneously, uterine contraction and retraction become stronger and longer but may be less. Simple interventions would be welcome, but lidocaine spray on the perineum does not reduce pain i n this weeks bmj, sanders and colleagues report a randomised controlled trial of an easy noninvasive intervention in labour. The first stage of labor the first stage is the start of labor and lasts until the cervix is fully open at 10 centimeters.

Stages of labour chart midwives collective of toronto. The third stage of labour is the time from the birth of the baby to the expulsion of the placenta and membranes. Common underlying causes include inefficient uterine contractions, abnormal fetal presentation or position, inadequate bony pelvis or soft tissue abnormalities of the mother. The maternal pulse and blood pressure are recorded. Listing a study does not mean it has been evaluated by the u. Considerable controversy exists in the current obstetric and midwifery literature concerning the appropriate management of this stage. A score of 11 indicates the onset of the active phase of labour, during which the average rate of cervical dilatation in women in their first labour is 1 cmh. Management of the second stage of labor uw medicine. Active management this is advised for all women in the medium to high risk categories with the consultant as the lead professional. The second stage of childbirth involves pushing and the delivery of your baby. Cd002006 january 2000 with 195 reads how we measure reads. Womans position during second stage of labour request pdf. The active phase of second stage begins after full dilation of the cervix accompanied with regular contractions and an urge to push.

Our ancestors, the australopithecines, adopted the upright posture about five million years ago. Multicenter randomized trial omss the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The management of the occiput posterior op position has been controversial for many years. The principles of management of this stage are a to ensure birth of a healthy baby, b to prevent damage to the maternal tissues. Who recommendation on definition and duration of the second. Continues after the cervix is dilated to 10 cm until the delivery of your baby. Stages of labor as you near the birth of your baby, it is helpful to learn about the 3 stages of labor. Management of prolonged second stage of labor international. The view that the second stage of labour is of high risk, and needs to be. The second stage of labour has traditionally been defined as the phase between full dilatation of the cervical os and the birth of the baby. The typical techniques for vaginal breech delivery are illustrated in the who manual 11 p37 onward. Management of the 4th stage of labor 2 hours post delivery the woman must remain in the delivery room until the midwife is satisfied that the condition is satisfactory to exclude any conditions which could be life. Fhr along with its rhythm and intensity should be noted every half hour in the first stage and every 15 min in second stage or following rupture of the membrane.

Contractions 25 mins apart, lasting 6070 secs pushing 10 mins3 hours pressure in rectum and perineum urge to push stretching or burning sensation the babys head moving down position changes can help with descent of the babys head listen to. In parous women the cervix dilates fasteron average 1. Who recommendations for augmentation of labour 3 executive summary introduction prolonged labour is an important cause of maternal and perinatal mortality and morbidity. The pain at this stage of labour has a different quality, as the cervix is now fully dilated figs. Stay connected to your students with prezi video, now in microsoft teams. Surgical management of otitis media with effusion in children. Who recommendation on definition and duration of the. Increase uterine contraction the character of the contraction in the 2nd stage of labor is different from those in the 1st stage with the full dilatation of the cervix, the membranes usually rupture and there is escape of good amount of liquor amni. Whether the mother should push immediately or delay pushing for 1 or more hours has been the subject of debate. For the purposes of this guidance, use the following definitions. Introduction the second stage of labor is regarded as the climax of the birth by the delivering woman, her partner, and the care provider.

During a normal labor of 6 to 10 hours, women should be given 500 to ml of this solution. Management of the second stage of labor in women with. In 2015, there were about 5 million births globally. Series of events that takes place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour 3. The infusion prevents dehydration during labor and subsequent hemoconcentration and maintains an adequate. Second stage of labor is defined as duration from fully dilated cervix until delivery of the infant. During the 2nd stage of labor, perineal massage with lubricants and warm compresses may soften and stretch the perineum and thus reduce the rate of 3rd and 4thdegree perineal tears 2. Details about 2nd stage of labour authorstream presentation. Manual rotation can be performed by midwives and could reduce cesarean sections and instrumental births.

Identifying such transitions enables maternity teams to perform. Management of normal labor gynecology and obstetrics. First stage is characterized by painful uterine contractions and progressive cervical dilation until. The second stage of labor is regarded as the climax of the birth by the delivering woman, her partner, and the care provider. Effect of spontaneous pushing versus valsalva pushing in the second stage of labour on mother and fetus. The second stage of labor is defined as that time from the completion of dilitation of the cervix to the delivery of the infant. Efforts to optimize cesarean delivery rates have prompted research regarding the optimal approach to the management of labor. Management of the second stage of labour citeseerx. Modifiers that affect the second stage length include factors such as parity, epidural anesthesia, delayed pushing, fetal station at complete dilation, maternal body mass index, fetal weight and occiput posterior op position.

Precautions should be taken to reduce risk of infection with perineal massage. The use of the following definition and duration of the second stage of labour is recommended for practice. Pdf the second stage of labor begins with full dilatation of cervix and ends with delivery of the fetus. Bearing down efforts its an additional voluntary expulsive effort appear during expulsive phase exerted by abd. An iv infusion of ringers lactate may be started, preferably using a largebore indwelling catheter inserted into a vein in the hand or forearm. Management of 4th stage of labor midwifery childbirth. The second stage is the period of time between full cervical dilatation and birth of the baby, during which the woman has an involuntary urge to bear down, as a result of expulsive uterine contractions.

Guideline for managing the second stage of labour page 2 of 6. Pain intensity increases gradually comes at an interval of 23min lasts for about 12min 2. This is the longest stage of labor and can last 12 to 17 hours. Second stage of labour recognition of normal progerss. Physiology and management of normal labour the bmj. Study of the anatomy and physiology of the body generally centers on.

Recognising the transition between the stages of labour proportion of the babies, the transition between the latent phase and the active phase of labour or that from the active phase of labour. Premature labour and birth see preterm labour and birth premature ovarian insufficiency see menopause. Figo safe motherhood and newborn health smnh committee 1 1. Peri jacobson, cnm, whnp, was enrolled in her final semester at columbia university, completing a cnmwhnp dual certification at the time the article was written. Events in second stage of labour the second stage begins with the complete dil this stage is concerned with descent and delivery of the fetus through the birth canal. The second stage of labour starts when your cervix is open dilated 10cm and ends when your baby is born. To avoid confusion of maternal and fetal heart rates, maternal pulse should be counted. Labour is more difficult in humans than in most other mammals. The delay and complications in second stage of labour path for the intrapartum care pathway. Characteristics of the second stage of labour pain in the second stage. However, women can be unpredictable and may have a second stage that lasts only a few minutes. Management of the second stage of labor in women with epidural analgesia. Manual rotation has the potential to reduce operative delivery for fetal malposition.

Active management of the third stage of labour consists of interventions designed to. Study suggests epidural does not slow second stage of labour. Patient a woman who is considered to be in the second stage of labour 3. These techniques are widely used by midwives and birth attendants. A free powerpoint ppt presentation displayed as a flash slide show on id. Irrespective of how we analyse, divide and measure the 2nd stage of labour, much physical effort is usually provided by the mother over a comparatively short period. Until this point, your body has been doing all the work for you. The character of contractions in the second stage of labour is different from those in the. The volume of the uterine cavity is thereby reduced. We aimed to determine current midwifery views, knowledge, and practice of manual rotation. The second stage of labor is defined as the time from complete dilation to delivery of the infant. A decision about curtailing the second stage of labour should be based on surveillance of. Care of healthy women and their babies during childbirth.

Physiology of normal puerperium pdf 14 carpbonhassback. Where processes differ between campuses, those that refer to the sandringham campus are differentiated by pink text or have the heading. Starts with the onset of true labor and lasts until the cervix is completely dilated to 10 cm. We commend this essay on the second stage of labour to all readers since it will encourage them to rethink their management of the patient who is in the second stage of labour, without evidence of fetal or maternal distress. There was a real difference, however, in terms of the length of the third stage.

Descent of second stage is well below the fifth percentile for a population in the active phase of labour, and is associated with an increased cesarean section rate. Nice 2007 advocates that the duration of the second stage 2nd stage should be 2 h in primigravidae and 1 h in multiparous women. Monitoring the progress of labour with the partograph latent and active phases of labour the first stage of labour is divided into the latent and active phases. Once your cervix is fully dilated, you may find that your contractions pause for a moment or are so weak that you might not notice them rcm 2012a, simkin and ancheta 2011. The four stages of labor kaiser permanente washington. Not all women feel the urge to push straight away in the second stage so its divided into passive and active stages nice, 2017. An important development in the management of labour was the introduction of the partogram. The editorial committee firmly agrees with the authorsbelief that midforceps delivery is a dangerous manoeuvre and should be performed only when. Research demonstrates this management has adverse effects upon the mother and baby. Pushingbearing down methods for the second stage of labour. International health policy and programming have placed emphasis on the. Immediate vs delayed pushing during the second stage of. This first stage of labor usually lasts about 12 to hours for a first baby, and 7 to 8 hours for a second child.

National institute for health and clinical excellence. Roberts a reconceptualization of the second stage of labor is proposed, with an early phase of descent and a later phase of active pushing, as the basis for nursing care related to direction or support of expectant mothers bearingdown efforts. To recognise and support normal second stage of labour to make a timely diagnosis of delay in the second stage of labour and recommend management that will increase the likelihood of a safe birth 2. Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies leaves the uterus by passing through the vagina or by caesarean section. During the passive part you might get chance to have a welcome breather and be able to rest and prep for the tougher. Natural selection produced a smaller pelvis, which more efficiently transmits forces from the hind legs to the spine. Describe appropriate management of normal and abnormal labour patterns. Issues in the management of the occipito posterior op position have been the subject of clinical controversy over decades. However, there is a transitional period between the first stage of labour and the actual time when active maternal pushing efforts begin. To determine the current obstetric practice with regard to manual rotation in the management of the second stage of labour.