Management of second stage of labour pdf free

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. An iv infusion of ringers lactate may be started, preferably using a largebore indwelling catheter inserted into a vein in the hand or forearm. A decision about curtailing the second stage of labour should be. Where processes differ between campuses, those that refer to the sandringham campus are differentiated by pink text or have the heading. At the start of labour, your cervix starts to soften so it can open. The second stage of childbirth involves pushing and the delivery of your baby. 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. The use of episiotomy emerged with the advent of modern obstetrics.

Pushingbearing down methods for the second stage of labour. It includes events clinical course management of 2 nd stage of labour events in 2 nd stage of labour begins with complete dilatation of cervix and ends with expulsion of fetus. In the management of woman in labour, partograph search to validated the normal progress of labour and to facilitate early identification of deviation from normal pattern. Pdf the second stage of labor begins with full dilatation of cervix. A free powerpoint ppt presentation displayed as a flash slide show on id. Stages of labour chart midwives collective of toronto. Recommendations intrapartum care for healthy women and. Request pdf womans position during second stage of labour for centuries, there has been controversy around whether being upright sitting, birthing stools, chairs, squatting or lying down. The second stage of labor is regarded as the climax of the birth by the delivering woman, her partner, and the care provider. The principles of management of this stage are a to ensure birth of a healthy baby, b to prevent damage to the maternal tissues. Advanced second stage skills management of 2nd stage of labour. 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.

Nice 2007 advocates that the duration of the second stage 2nd stage should be 2 h in primigravidae and 1 h in multiparous women. The delay and complications in second stage of labour path for the intrapartum care pathway. Ppt the second stage of labour powerpoint presentation. Midwives have an important responsibility to safeguard the interests of maternal and fetal health during labour and birth. Do not sent time limits for the second stage as long as progress is being made. They appear to be influenced by fear and anxiety levels, experience with prior childbirth, cultural ideas of childbirth and pain, mobility during labour, and the support received during labour. 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. Acogs liberation of the second stage of labor from a strict time limit mirrors practice demonstrated by midwives whose. The most prominent sign of labour is strong repetitive uterine contractions. The infusion prevents dehydration during labor and subsequent hemoconcentration and maintains an adequate. Midwives management during the second stage of labor in. If the third stage of labor lasts longer that 18 minutes, it is associated with a significant risk of pph. The pain at this stage of labour has a different quality, as the cervix is now fully dilated figs.

Poor progress in labour and incorrect use of partograph 0. The character of contractions in the second stage of labour is different from those in the. The college of midwives cmbc offers this guideline to assist midwives with assessment and informed decisionmaking in the second stage of labour. Optimal obstetric management of second stage is an ongoing challenge to reduce rates of emergency cesarean deliveries and to avoid adverse. The use of the following definitions of the latent and active first stages of labour is recommended for practice. 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. This is the longest stage of labor and can last 12 to 17 hours. Starts with the onset of true labor and lasts until the cervix is completely dilated to 10 cm. Management of the third stage of labor the third stage of labor may be managed expectantly or actively. For the purposes of this guidance, use the following definitions. The character of contractions in the second stage of labour is different from those in the first stage. We will look at the research to see if epidurals lengthen the second stage or make no difference. The latent first stage is a period of time characterized by painful uterine contractions and variable changes of the cervix, including some degree of effacement and slower progression of dilatation up to 5 cm for first and subsequent labours.

Again, they included only firsttime mothers giving birth to a live singleton child at term in headfirst position. Overall, there is a lack of literature on midwifery practice and management of the second stage of labour in women with epidural analgesia, with little research on midwives attitude and practice towards epidural analgesia barasinski et al. Active management of the third stage of labour consists of interventions designed to. This stage is concerned with descent,delivery of fetus through birth canal. During the passive part you might get chance to have a welcome breather and be able to rest and prep for the tougher. Le ray et al reported that manual rotation of fetuses who were in occiput posterior or occiput transverse position at full dilatation was associated with reduced rates. Placental expulsion also called afterbirth occurs when the placenta comes out of the birth canal after childbirth. There was a real difference, however, in terms of the length of the third stage. The womans position and pushing in the second stage. Purpose in accordance with the icmfigo joint statement ref the womens policy is to use active management of the third stage of labour 1,2.

Failure to progress in the second stage of labour request pdf. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. However, women can be unpredictable and may have a second stage that lasts only a few minutes. Stages of labour first stage of labour second stage of labour third stage of labour while every labour is unique and unpredictable, two signs that labour has started are contractions becoming longer, stronger and closer together and the rupture of membranes waters breaking.

Stages of labor as you near the birth of your baby, it is helpful to learn about the 3 stages of labor. 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. Management of the first stage of labor can affect the risk for. The relaxation and opening of the cervix relaxing also relates to the free flow of wood gb 30, lv 3, gb 21. Prolonged second stage of labour with no intervention 1. About 15 million were born before 37 weeks of gestation, while between 3 and 12 percent were born after 42 weeks. The volume of the uterine cavity is thereby reduced. However, there is a transitional period between the first stage of labour and the actual time when active maternal pushing efforts begin. Implementing awhonns evidence based guidelines for.

Few of the benefits attributed to it have been sustained by scientific study. Second stage labor keep the fetus safe careful surveillance avoid tachysystole maternal versus fetal heart rate intrauterine resuscitation as needed second stage labor keep the fetus safe passive fetal descent minimize active pushing phase know when to choose cesarean second stage labor avoid perineal trauma passive fetal descent avoid perineal stretching. Management of the second stage of labor 2012 international. Who recommendation on definitions of the latent and active. This stage is divided into early labor, active labor and transition. The influence of different maternal pushing positions on birth outcomes at the second stage of labour in nulliparous women. Management of normal labor msd manual professional edition. Definitions what is the evidence that interventions are useful in the 2nd stage. Effect of spontaneous pushing versus valsalva pushing in the second stage of labour on mother and fetus.

Not all women feel the urge to push straight away in the second stage so its divided into passive and active stages nice, 2017. Management of the second stage of labor uw medicine. Current american college of obstetricians and gynecologists definition of prolonged second stage diagnoses 10% to 14% of nulliparous and 3% to 3. Natural selection produced a smaller pelvis, which more efficiently transmits forces from the hind legs to the spine. Contractions are the muscles of the uterus working to move. 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. 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. In 1997, the world health organization defined normal birth as spontaneous in onset, lowrisk at the start of labor and remaining so throughout labor and delivery. After birth, mother and infant are in good condition 1. Durations of second stage of labor and pushing, and adverse. Managing a woman with an abnormal fetal heart rate. Management of normal labor gynecology and obstetrics. The typical techniques for vaginal breech delivery are illustrated in the who manual 11 p.

Our ancestors, the australopithecines, adopted the upright posture about five million years ago. Management of the third stage delivery of the placenta and control of uterine bleeding. With the full dilatation of the cervix, the membranes usually rupture and there is escape liquor amnii. 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. The maternal pulse and blood pressure are recorded. The second stage of labour starts when your cervix is open dilated 10cm and ends when your baby is born. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Implementing awhonns evidence based guidelines for managing. Management of the first stage and passive second stage. Although prolonged second stage is associated with increased risk of maternal morbidity, conflicting data exist regarding the duration of second stage and associated. Simultaneously, uterine contraction and retraction become stronger and longer but may be less.

Fetal heart rate is counted and recorded after every contraction. This is an important topic about the length of the second stage of labor because longer second stages have been linked with worse health outcomes for the mother, including a higher risk of infection, a higher risk of having a severe tear, a higher risk of post partum hemorrhage, and a higher risk of needing forcepsvacuum or cesarean. Characteristics of the second stage of labour pain in the second stage. This is called the latent phase and you may feel irregular contractions. Max brinsmead phd franzcog march 20 subjects to be covered. During the 1st stage of labour, contractions make your cervix gradually open dilate. Delay in medical personnel calling for expert assistance 0. Surgical management of otitis media with effusion in children. The number of contraction in 10 min and duration of each contaction in second are recorded in the partograph. Labour, care for women with existing medical conditions see intrapartum care for women with existing medical conditions. 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 progression of labor in modern obstetrics may have deviated from the current labor norms established in the 1950s, likely due to differences in obstetric population characteristics and. Continues after the cervix is dilated to 10 cm until the delivery of your baby. The first stage of labor the first stage is the start of labor and lasts until the cervix is fully open at 10 centimeters.

Scribd is the worlds largest social reading and publishing site. A decision about curtailing the second stage of labour should be based on surveillance 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. Contents introduction definitions mechanism aims principles 1st stage 2nd stage 3rd stage 4th stage 3. In 2015, there were about 5 million births globally. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect.

Optimal management of the second stage in women with and without epidural remains debatable. What position should the woman be in for delivery during a vaginal breech birth. The authors acknowledged that this can be an important amount of time, not so much for the woman, but for the management of busy labour and delivery units. Heavy birth weight significantly influenced a prolonged late first stage or 6. Until this point, your body has been doing all the work for you. Hence, the management of the second stage of labor depends on the assisting midwifes experience, knowledge, and preferences. Management of the second stage of labour in women with. Labour is more difficult in humans than in most other mammals. Womans position during second stage of labour request pdf.

The second stage of labor lasts from the end of the first stage, when the cervix has. Feb 20, 2018 todays video is all about the effects of epidurals on the second stage of labor, or the pushing phase. Physiology and management of normal labour the bmj. Who recommendation on definition and duration of the. Women who utilise upright positions during labour, have a shorter duration of the first and second stage of labour, experience less intervention, and report less severe pain and increased. 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 threatening during this period ensure all.

Adequate descent of the breech in the passive second stage is a prerequisite for encouragement of the active second stage. 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 infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. The setting of a time limit for the second stage in the presence of progress and absence of. Jan 15, 2014 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. The author of this article explores the interrelationship between episiotomy and other interventions in the second stage of labour and makes a plea for a reassessment of our management of this. The second stage of labor is defined as the time from complete dilation to delivery of the infant. Nov 14, 2016 hence, the management of the second stage of labor depends on the assisting midwifes experience, knowledge, and preferences. During early labor, the cervix dilates from 0 to 3 centimeters. Jul 30, 2015 nursing management of second stage of labour 1. To avoid confusion of maternal and fetal heart rates, maternal pulse should be counted. Otherwise maternal tachycardia may be wrongly treated as fetal heart rate.

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. During a normal labor of 6 to 10 hours, women should be given 500 to ml of this solution. The time allowed by midwives for the passive phase of the second stage of labour ranged from zero to two hours, with some of them avoiding vaginal examinations to delay the. The distress levels reported by labouring women vary widely. The use of the following definition and duration of the second stage of labour is recommended for practice.