If a woman was in labour or giving birth unexpectedly, what you would do to support her in the different stages of labour whilst waiting for help to arrive?

What would be your key priorities during each stage?

FIRST stage of labour (regular contractions)

• Reassure: Keep calm, speak gently and quietly
• Request help: Consider the most appropriate source of help/transfer depending on location
• Protect the space: Prevent an audience, protect the woman’s privacy and dignity
• Position: Encourage the woman to adopt a comfortable position, lying flat should be avoided
• Observe: Note if/when the membranes rupture, it is important to notice the colour of the amniotic fluid and the time of rupture. Coloured amniotic fluid (brown or green) may indicate that the baby has opened its bowels whist in-utero, whilst offensive smelling fluid may be suggestive of an infection.

SECOND stage of labour (pushing)

• Reassure: Keep calm, speak gently and quietly. The aim of care in the second stage of labour is to facilitate a slow and controlled birth. Do not ask the woman to push harder or hold her breath and push but to follow her own instincts.
• Request help: Consider the most appropriate source of help depending on location
• Protect the space: Prevent an audience, protect the woman’s privacy and dignity
• Position: Encourage the woman to adopt a comfortable position; kneeling on all fours or lying on the left side are often comfortable positions for this stage.
• Observe: Look at the woman’s vulval area, if birth is imminent the vulva will be bulging and you may see the baby’s head. Encourage the woman to breathe or pant rather than push to allow the perineal tissues to stretch and enable the baby’s head to adapt to the birth canal. Do not touch the woman’s perineum or the baby’s head. Encourage the woman to reach down and support the baby as it births, bringing it onto her abdomen (skin to skin). Immediately cover the baby with blankets, towels or clothing to prevent heat loss whilst ensuring skin to skin contact. Occasionally the membranes do not break spontaneously and the baby may be born with them completely intact and covering their face. In this case, gently break the membranes with your fingers. The cord should not be clamped or cut but left intact. Dry the baby, remove wet towels/blankets/clothing and recover with dry ones.

THIRD stage of labour (placenta)

• Reassure: Continue to reassure the woman, keep calm and offer support
• Request help: If help has not yet arrived – request it again!
• Protect the space: Prevent an audience, and continue to protect the woman’s privacy and dignity. It is easy to forget that the birth process isn’t over and there will be those who want to see the baby and congratulate the mother. Protected space is important until the placenta is expelled and the mother and baby are observed to be well.
• Position: Close mother and baby contact will encourage the continued release of oxytocin in the maternal system to maintain uterine contractions, expel the placenta and prevent haemorrhage. Encourage the mother to put the baby to the breast.
• Observe: Look for the umbilical cord lengthening and the placenta appearing at the vulva. Encourage the woman to bear down to expel the placenta and membranes when you can see it. Do not pull on the cord or attempt to remove the placenta. Observe for blood loss. Remember ABC if excessive blood loss and maternal collapse.