Intrapartum Care and Management of Normal Labor
Core concepts
Labor is diagnosed by regular painful contractions with progressive cervical change. Understand the stages: first (latent and active phases), second (full dilatation to birth), third (birth to placental delivery), and fourth (first 1–2 hours). Know the partograph - plotting dilatation, descent, contractions, fetal heart rate, and maternal observations - and its action lines. Understand the mechanism of normal birth: engagement, descent, flexion, internal rotation, extension, restitution, external rotation, expulsion.
Monitoring
Intermittent auscultation of the fetal heart rate (typically every 15–30 minutes in the first stage, every 5 minutes or after each contraction in the second) is the standard for low-risk labor. Recognize normal baseline (110–160 bpm), variability, accelerations, and the significance of decelerations: early (head compression, benign), variable (cord compression), and late (uteroplacental insufficiency - ominous).
Supportive care
Continuous companionship, freedom of position, oral fluids, privacy, and non-pharmacological pain relief are evidence-based. Avoid routine episiotomy, routine amniotomy, and supine birthing position.
Active management of the third stage
Use a uterotonic (oxytocin 10 IU IM), controlled cord traction, and uterine massage to prevent postpartum hemorrhage.
Traps
Latent-phase prolongation is not the same as active-phase arrest. Do not interpret a single deceleration without context. Remember that pushing before full dilatation risks cervical injury.
Rule of thumb
In the active phase, cervical dilatation of less than 1 cm per hour, or no progress over 2 hours despite adequate contractions, signals the need for reassessment and referral.