Normal labor is regular contractions that cause progressive cervical change and lead to vaginal birth at term, between 37 and 42 weeks. It has three stages: dilation of the cervix, birth of the baby and delivery of the placenta.
Key symptoms
- Regular contractions that become stronger and closer together
- Low back pain and pelvic pressure
- Bloody show (mucus with a little blood)
- Rupture of membranes with clear fluid
- Urge to push in the second stage
What you find on exam
- Maternal vital signs and contraction pattern
- Leopold maneuvers for fetal position
- Cervical exam: dilation, effacement and station
- Fluid color if membranes are ruptured
Tests
- Fetal heart rate monitoring, intermittent or continuous
- Blood count, blood type and screen
- Review group B streptococcus, HIV, hepatitis B and syphilis results
- Track progress: active phase starts at about 6 cm
Treatment basics
- Support, movement, hydration and comfort measures
- Pain relief: epidural or IV opioids
- Penicillin during labor if group B strep positive
- Coach pushing and support a controlled birth of the head
- Active management of the third stage with oxytocin after birth
Red flags
- Heavy bleeding before or after birth
- Abnormal fetal heart rate tracing or thick meconium
- Fever, cord prolapse or labor that stops progressing
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.