Labor and Delivery

Managing labor safely to ensure positive birth outcomes

Labor and delivery is a natural, physiological process that occurs at term, characterized by rhythmic uterine contractions that increase in frequency and intensity, leading to the progressive dilation and effacement of the cervix. This process allows for the descent and birth of the baby, followed by the expulsion of the placenta and membranes, ensuring a safe outcome for both mother and newborn.

Understanding the physiology and stages of labor allows healthcare providers to support safe and respectful childbirth experiences, ensuring positive outcomes for both mother and baby.

What Are the Benefits of a Safe Labor & Delivery?

How to Implement

Four Stages of Labor

First Stage

Patient history

Examination

Palpation

Auscultation

Vaginal examination

Fetal monitoring

Second Stage

Managing the 2nd Stage

Immediate Newborn Care

Third Stage

Fourth Stage

Four Stages of Labor

Labor is divided into four distinct stages, each playing a crucial role in the birth process:

First Stage: Begins with the onset of labor and continues until full cervical dilation (10 cm). This stage includes latent and active phases, with contractions becoming stronger and more frequent.
Second Stage: Starts from full cervical dilation to the birth of the baby. The mother experiences the urge to push, leading to the expulsion of the fetus.
Third Stage: Covers the period from birth of the baby to the delivery of the placenta and membranes. Proper management at this stage helps prevent postpartum hemorrhage (PPH).
Fourth Stage: The first hour after placenta expulsion, a critical period for maternal monitoring, ensuring uterine contraction, stable vital signs, and early detection of complications.

First Stage of Labor

1st Stage: Patient history

1st Stage: Examination

1st Stage: Palpation

1st Stage: Auscultation

1st Stage: Vaginal examination

1st Stage: Fetal monitoring

Second Stage of Labor

2nd Stage: Management

2nd Stage: Immediate Newborn Care

Third Stage of Labor

Fourth Stage of Labor

Key Indicators

These are overall indicators (i.e., outcome and impact indicators) to monitor and may vary based on the setting. Consider your country-specific indicators as this list is exhaustive and your country may monitor additional indicators.

Proportion of healthcare providers trained on emergency obstetrics and newborn care.
Skilled birth attendance.
Maternal deaths.
Newborn deaths.
Perinatal deaths.
Incidence of macerated stillbirths.
Incidence of fresh stillbirths.
Incidence of maternal complications, including PPH, sepsis for both mothers and newborns, and pre-eclampsia/eclampsia.
Incidence of premature births.
Percentage of women who received uterotonics within one minute of delivery.
Incidence of disrespect and abuse.
Rate of early breastfeeding initiation within the first hour of birth.
Facility readiness in terms of essential supplies, trained personnel, and emergency protocols.
Caesarian section rate.

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Labor & Delivery Interventions

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Tips

Ensure availability of essential supplies (gloves, sterile instruments, uterotonics, newborn resuscitation equipment).
Ensure adequate staffing levels with staff trained/skilled in emergency obstetrics and newborn care.
Encourage mobility during the first stage of labor.
Ensure adequate pain management.
Have a fetal heart surveillance champion in the labor unit.
Have an emergency medical team in case of emergencies.
Ensure every woman has a partograph or labor care guide initiated to monitor the mother and fetal heart rate during labor.
Prepare by having emergency equipment and drugs to manage any maternal and newborn complications.

Challenges

Limited Resources: Optimize available commodities, supplies and equipment, and advocate for improved infrastructure.
Staff Shortages: Implement task shifting and support midwifery-led care models.
Inconsistent Adherence to Guidelines: Conduct regular audits and training sessions.
Insufficient Training: Conduct regular maternal and perinatal audits. Also offer CME courses and/or mentorships when needed.