1.What is the latent phase (onset) of labour?Cervical dilation from 0-3/4cm

2.Describe the nature of contractions during the latent phase of the 1st stage of labour.May be irregular, perhaps every 15-20mins and sometimes stop, gradually increasing in frequency. By the end (3-4cm) 2:10 minutes, increasingly regular lasting 20-40secs.Start painless/mild, gradually become painful but bearable

3.What is the active (established) phase of labour?Begins at 3-4cm dilatation up to full dilatations

4.Describe the nature of contractions during the active 1st stage.Contractions are rhythmic and regular.4-7cm 3:10mins (2min intervals), lasting 60secs 7-9cm 3-4:10mins (2min intervals), lasting 60secs9-10cm 4-5:10mins (1min intervals) sometimes almost continuousIncreasingly painful and very powerful by end of active stage.

5.What is normal maternal B.P.?Systolic: 100-140 mmHgDiastolic: 60-90 mmHg

6.When is maternal B.P. measured?Tested on admission as baseline and then 4 hourly.

7.What is the normal range for maternal pulse rate?55-90bpm

8.When is maternal pulse rate taken?Tested on admission then hourly when checking the fetal heart.

9.What is the normal maternal temperature?35.8-37.3C

10.When is maternal temperature measured?Tested at admission then 4 hourly.

11.What can hypertension be caused by?Anxiety and painGeneral anaesthesiaPre-eclampsia

12.What can hypotension be caused by?An epidural/top-upAortocaval occlusion due to lying supineHaemorrhage and hypovolaemic shock

13.What is tachycardia and what are the possible causes?100bpmAnxiety, pain, hyperventilationDehydration, pyrexiaExertionObstructed labourHaemorrhage, anaemia, shock

14.What is bradycardia and what are the possible causes?55bpmRest and relaxationInjury and shockMyocardial infarction

15.What is pyrexia and what are the possible cause?>37CInfectionEpidural usually low grade but rises with timeDehydrationOverheated birthpool

16.What are baseline observations?B.P., pulse, and temperature, respirations

17.What are the features of the initial assessment of a woman in suspected labour?Listening to her story, considering her emotional + physical needs and reviewing her clinical records.Physical observations: B.P., pulse, temp, respirations, urinalysisLength , strength and frequency of contractionsAbdominal palpation- Fundal height, lie, presentation, position and station.Vaginal loss- show, liquor, bloodAssessment of the womans pain, including her wishes for coping with labour and range of options for pain relief.FHR should auscultated for 1min immediately after a contraction. Maternal pulse palpated to differentiate between the 2.Vaginal examination if woman is in established labour, if she isnt after a period it may be helpful to offer one.

18.What actions should be taken after pre-labour rupture of membranes?No need to carry out speculum exam with a certain history. Women with an uncertain history should be offered speculum examination to confirm (digital exam in absence of contractions should be avoided).Ask women about LIQUORAmount, colour, smell. Should be clear, straw coloured or pink. Bloodstained: if mucoid present its probably a show. Smell Offensive= may indicate infection. Meconium-stained: less of a concern if its light staining but dark green, black and/or thick means its fresh and could be more serious.Advise woman that she can wait for the onset of labour in the comfort of her hoe (away from possible infection or intervention) and advise that 60% go into labour within 24 hours.Advise 1% risk of infection and thus to check temp every 4 hours (can be done at home). Suggest avoiding sex or putting anything in vagina, and wiping from front to back when opening bowel to avoid infection.Advise her to report any reduced fetal movements, uterine tenderness, pyrexia, feverish symptoms.Ask her to come back after 24hrs if labour hasnt started.

19.What are the non-pharmacological options for pain relief?Massage and touchDistractionPosition changes(TENS- not advised by nice)Acupuncture, acupressure, hypnosisBreathing and relaxation techniques (not provided but not prevented))WaterMusic

20.What are the pharmacological options for pain relief?EntonoxOpioids e.g. pethidine, diamorphineRegional analgesia i.e. epidural analgesia, spinal analgesia, combined epidural-spinal analgesia

21.What should women be advised about entonox?That is might make them feel nauseous and/or light-headed.

22.What should women be advised about opioids?That they will provide pain relief only to a certain extent.That they carry side effects both for woman (drowsiness, nausea and vomiting) and baby (short-term respiratory depression and drowsiness which may last a few days). Advise that this might interfere with breastfeeding.

23.What should be given alongside IV/IM opioids? Antiemetics e.g. metoclopramide

24.Whats the normal respiration rate?12-20 times in minute.

25.What should women be advised about the risks and benefits of epidural analgesia?It provides more effective pain relief than opioids.It is associated with a longer 2nd stage and an increased chance of instrumental birth.Can cause pyrexia, leg weaknessAccompanied by more intensive level of monitoringModern epidural solutions contain opioids which cross the placenta and in larger doses (greater than 100mg) can cause short term respiratory depression and make the baby drowsy.

26.What are the observations undertaken for women with regional analgesia?During establishment of regional analgesia or after boluses (10ml or more of low-dose solutions) B.P. should be measured every 5 minutes for 15 minutes.If the woman isnt pain free 30 minutes after each administration of local anaesthetic/opioid solution, the anaesthetist should be recalled.Hourly assessment of the level of sensory block be undertaken.CTG for 30 mins following establishment of block and following bolus administration (top-up) Regular position changes and non-supine (NICE) side lying or all fours (if possible)Bladder care: regular (in and out) catheter or continuous drainageAvoidance of aortocaval compression

27.What is the average length of the 1st stage of labour?1st labour 8 hours on average (unlikely to last over 18 hours)2nd + labours 5 hours on average (unlikely to last over 12 hours)

28.What are the observations during the 1st stage of labour?4 hourly temperature and blood pressureHourly pulseHalf-hourly documentation of frequency of contractionsFrequency of emptying the bladderVE offered 4 hourly or where there is concern about progress or in response to womans wishes (after palpation and assessment of vaginal loss)Intermittent auscultation for a minute at least every 15 mins

29.When is the fetal heart assessed?At 1st contact in early labour and at each further assessment undertaken to determine whether labour has become established.Once established labour is confirmed, intermittent auscultation of fetal heart after a contraction for 1m every 15mins. (Remember palpation of maternal pulse).

30.What is the transition period?Period between full dilatation and the time when active maternal pushing efforts start.Contractions may be almost continuous or space out a little.Characterised by maternal restlessness, discomfort, desire for pain relief, a sense that the process is never-ending and demand to get it over withDistressed or panicky statementsNon-verbal sounds grunting, groaningWithdrawing from the activities and conversation of people around.

31.What features of care are especially important during the transitional period?Support birth partners- they can become tired and stressed.Keep it calm change dynamics if the woman panics e.g. suggest a walk to the toilet, position change, focus on breathingAvoid temptation of VE likely to yield disappointment of 8-9 dilated.

32.What is the 2nd stage of labourPassive second stage: finding full dilatation prior to or in the absence of involuntary expulsive contractions.Onset of active 2nd stage: Baby is visibleExpulsive contractions with a finding of full dilatation of the cervix or other signs of full dilatation of the cervixActive maternal effort following confirmation of full dilation of the cervix in the absence of expulsive contractions

33.What is the average dilatation of the second stage?Nulliparous- Birth expected within 3hrs of the start of active 2nd stageParous- Birth expected within 2hrs of the start of the active 2nd stage

34.What are the characteristics of 2nd stage?Vomiting- often accompanied by involuntary pushingShow- or bright red vaginal lossSROM- can occur at any tire but often at full dilatationSlowing of FH- at the peak of contraction, usually due to head compressionPurple line- a line which gradually extends from the anus to the nape of the buttocks once it reaches nape = full dilatationUrge to push- Powerful, expulsive contractions every 2-3mins, lasting