Normal Labor

A

Active first stage:

Is a period of time characterized by regular painful uterine contractions, a substantial degree of cervical effacement and more rapid cervical dilatation from 5 cm until full dilatation for first and subsequent labors.

Active management

An approach to third stage labor that involves the use of uterotonic drugs, controlled cord traction, and cord clamping. It is further classified according to the timing of cord clamping:

–       Delayed cord clamping (modified active management): Cord clamping is performed after a short delay (usually 1–3 minutes or until cord pulsations cease), allowing additional placental transfusion to the newborn.

–       Early cord clamping (often referred to as ‘active management’): Cord clamping is performed soon after birth (<1 minute after birth), as part of traditional active management protocols

Amniotomy (Artificial Rupture of Membranes)

Intentional rupture of the amniotic sac to augment or accelerate labor.

Analgesia
Relief from pain without loss of consciousness. May be non-pharmacological (e.g., breathing, massage) or pharmacological (e.g., inhalational agents, opioids, epidural).

Anesthesia
A medically induced loss of sensation with or without loss of consciousness. Includes local, regional (spinal or epidural), and general anesthesia depending on the procedure.

Auscultation
Listening to fetal heart sounds using a Pinard stethoscope or Doppler device to assess fetal well-being.

B

Birth Position

The posture a woman adopts for giving birth. Upright or chosen positions are encouraged unless contraindicated.

C

Caput Succedaneum

Localized swelling of the fetal scalp caused by pressure during labor; typically resolves within a few days after birth.

Cardiotocography (CTG)

Electronic recording of fetal heart rate and uterine contractions.

Cervical Dilatation

The gradual opening of the cervix from 0 cm to 10 cm. Full dilatation marks the end of the first stage of labor.

Clinical Pelvimetry

Manual assessment of pelvic dimensions to evaluate capacity for vaginal delivery. Routine pelvimetry in normal labor is not recommended.

Controlled Cord Traction (CCT)

Gentle traction applied to the umbilical cord with counter-pressure on the uterus to assist in placental delivery.

E

Effacement
Thinning and shortening of the cervix during labor, expressed as a percentage (0–100%).

Epidural Analgesia

Regional pain relief achieved by injecting a local anesthetic and/or opioid into the epidural space through a catheter. Provides effective pain relief while allowing the woman to remain awake.

Enema
Introduction of fluid into the rectum to stimulate bowel evacuation.

Engagement

The point during labor (or sometimes before labor in primigravidae) when the widest transverse diameter of the fetal presenting part (usually the biparietal diameter of the fetal head) has passed through the plane of the maternal pelvic inlet (brim).

Episiotomy
Surgical incision of the perineum to enlarge the vaginal opening during childbirth.

F

Fetal Heart Rate (FHR)

The number of fetal heartbeats per minute (normally 110–160 bpm). Monitored to assess fetal well-being.

Fundal Height

Measurement from the symphysis pubis to the uterine fundus, used to assess fetal growth and position.

Fundal Pressure

Manual pressure applied to the uterine fundus during the second stage of labor to assist delivery.

H

High-Risk Labor

Labor with identified maternal, fetal, or obstetric complications (e.g., pre-eclampsia, multiple pregnancy, meconium, abnormal FHR) requiring continuous monitoring and senior supervision.

I

Inhalational Analgesia

Pain relief through inhalation of gases, most commonly Entonox (50% nitrous oxide + 50% oxygen). Provides moderate pain relief with rapid onset; may cause dizziness or nausea.

L

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 labors.

Liquor (Amniotic Fluid)

Fluid surrounding the fetus in the amniotic sac; assessment of its color, odor, and consistency helps determine fetal condition.

Low-Risk Labor

Labor in a healthy woman with no maternal or fetal complications (singleton, vertex presentation, 37–41 weeks, spontaneous onset).

M

Meconium
Fetal stool sometimes passed into the amniotic fluid before birth; its presence may indicate fetal compromise.

Membrane Rupture

Breaking of the amniotic membranes, either spontaneously (SROM) or artificially (AROM/amniotomy).

Moulding
Overlapping of fetal skull bones during labor to facilitate passage through the birth canal; mild moulding is normal.

N

Normal labor is labor that:

–       Occurs between 37+0 and 42+0 weeks completed weeks

–       Spontaneous onset

–       Singleton gestation

–       Vertex presentation

–       Normal labor progress

–       Spontaneous vaginal birth

–       No maternal or fetal complications or risk factors

O

Oxytocin
A uterotonic hormone used for induction, augmentation, or prevention of postpartum hemorrhage (10 IU IM/IV recommended by WHO).

P

Partogram

Graphical record of key observations during labor (cervical dilatation, contractions, maternal and fetal parameters) to monitor progress and detect delay.

Perineal Trauma

Tearing of the perineal tissues during birth, graded from first to fourth degree according to the depth of injury.

Perineal tears

Perineal or genital trauma caused by either tearing or episiotomy:

·       first degree – injury to skin only

·       second degree – injury to the perineal muscles but not the anal sphincter

·       third degree – injury to the perineum involving the anal sphincter complex:

–   3a – less than 50% of external anal sphincter thickness torn
–   3b – more than 50% of external anal sphincter thickness torn
–   3c – internal anal sphincter torn

·       fourth degree – injury to the perineum involving the anal sphincter complex (external and internal anal sphincter) and anal epithelium.

Physiological Third Stage of Labor

Placental delivery that occurs naturally without uterotonics or traction, relying on uterine contractions.

Placenta Previa

Placental implantation in the lower uterine segment near or covering the cervical os; contraindication to vaginal examination.

Protracted Labor

Slower-than-expected cervical dilatation in the active phase (less than 2 cm in 4 hours).

R

Retained Placenta

Placenta not delivered within 30 minutes (active management) or 60 minutes (physiological management) after birth.

S
Second stage of labor

The second stage defined as full cervical dilatation until the birth of the baby. There are two identified phases of the second stage—passive and active. Progress of labor in the second stage includes flexion, rotation and descent of the fetal head.

Station

The level of the fetal presenting part relative to the maternal ischial spines, recorded from –3 (above spines) to +3 (on perineum).

T
Third stage of labor

The third stage of labor is the time from the birth of the baby to the expulsion of the placenta and membranes.

U

Uterine Atony

Failure of the uterus to contract effectively after birth, leading to postpartum hemorrhage.

Uterine Tonus Assessment

Palpation of the uterus after birth to ensure it is firm and contracted to prevent bleeding.

Uterotonic

A drug that stimulates contraction of the uterine muscle, used to prevent or treat postpartum hemorrhage. Examples: oxytocin, ergometrine, misoprostol, or fixed-dose combinations.

V

Vaginal Examination (VE)

Digital examination of the cervix and presenting part to assess dilatation, effacement, position, and station. Should be performed only when indicated.

Vertex Presentation

The most common and favorable cephalic presentation in which the fetal head is flexed, so that the occiput (back of the head) leads and the vertex (area between the anterior and posterior fontanelles) is the presenting part.

Voluntary and Involuntary Pushing

Involuntary pushing results from the natural urge during the second stage; women should be supported to follow their own urge rather than directed pushing.

Venous Thromboembolism (VTE) Risk Assessment

Evaluation of the mother’s risk of developing blood clots postpartum to guide preventive management