Normal Labor

The Challenge

• Description: Labor is the rhythmic contraction of the uterus that leads to progressive cervical effacement and dilatation. When effective, this leads to descent and eventual expulsion of the fetus. Labor may or may not culminate in the delivery of the fetus. It is generally divided into three stages: first stage—from the onset of labor to complete cervical dilation, although the exact time of onset is almost impossible to establish; second stage—from complete cervical dilation to the delivery of the fetus; and third stage—from fetal delivery to expulsion of the placenta. Some add a fourth stage, recovery, which spans the time from delivery to 1 hour after. The first stage of labor is often subdivided into a latent phase (to cervical dilation of 3–4 cm) and an active phase (from 4 cm to complete), although these remain inconsistently defined and difficult to pinpoint. Labor is anticipated to follow a predictable sequence and time course. However, factors such as active labor management and pain control have raised concern about using traditional standards.

• Scope of the Problem: Unless cesarean delivery is performed in advance, all pregnant women eventually go into labor.

Objectives of Management: To safely monitor and manage the processes of labor to ensure the health and safety of the mother and baby.