Labour, birth, and the newborn
Labour and birth are physically intense events. Nurses support the birthing person and assess the newborn's transition to life outside the womb. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
Stages of labour
The first stage runs from the onset of regular contractions to full cervical dilation at about 10 cm; it has latent and active phases. The second stage is from full dilation to the birth of the baby. The third stage is delivery of the placenta. Some sources add a fourth stage, the first hours of recovery after birth.
Monitoring in labour
Nurses monitor contractions (frequency, duration, intensity), cervical progress, maternal vital signs, and the fetal heart rate. Fetal heart rate patterns help assess the baby's wellbeing: some decelerations are benign, while others suggest reduced oxygen and require intervention.
Pain relief in labour
Options include non-drug methods (movement, breathing, massage, warm water, continuous support), nitrous oxide in some settings, opioids, and epidural analgesia. Epidurals provide effective relief but can lower blood pressure, so nurses monitor maternal BP and fetal heart rate closely.
Postpartum haemorrhage
Postpartum haemorrhage is excessive bleeding after birth and a leading cause of maternal death worldwide. The most common cause is uterine atony, when the uterus fails to contract firmly. Nurses assess fundal firmness and bleeding regularly; a boggy uterus is massaged, and medications such as oxytocin are given as ordered.
The Apgar score
The Apgar score assesses the newborn at 1 and 5 minutes on five criteria, each scored 0-2: Appearance (colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Total scores of 7-10 are generally reassuring; lower scores indicate need for support.
Newborn care
Routine newborn care includes drying and warming (skin-to-skin contact helps), vitamin K injection to prevent bleeding, eye prophylaxis in many places, newborn screening blood tests, hearing screening, and checking feeding, urine, and stools. Safe sleep teaching: babies should sleep on their backs, on a firm flat surface, without loose bedding.
Newborn jaundice and breastfeeding
Many newborns develop mild jaundice in the first days as bilirubin builds up; it usually resolves but very high levels need treatment such as phototherapy. Breastfeeding provides ideal nutrition and antibodies; the WHO recommends exclusive breastfeeding for about six months where possible. Nurses help with positioning and latch.
Worked example
One minute after birth, a baby has a pink body with blue hands and feet (1), heart rate 120 (2), grimaces when suctioned (1), some flexion of limbs (1), and a weak cry (1). The Apgar score is 6. With drying, warmth, and stimulation, the 5-minute score rises to 8.
Key takeaways
Labour has three stages: dilation to 10 cm, birth, and placenta delivery. Monitor contractions, progress, maternal signs, and fetal heart rate. Pain relief ranges from support to epidurals, which need BP monitoring. Postpartum haemorrhage, often from uterine atony, is a leading cause of maternal death; check fundal firmness. Apgar scores at 1 and 5 minutes assess newborns. Newborn care includes warmth, vitamin K, screening, and back-sleeping.
Flashcard
Onset to full dilation (10 cm)
Check your understanding
After birth, a mother's uterus feels soft and boggy and she is bleeding heavily. What is the most likely cause?