• 37th – 42nd week of pregnancy
• singleton pregnancy
• position of the fetus longitudinally with the head presentation
• preserved amniotic fluid or flowing clear amniotic fluid no longer than 24 hours 
• absence of major vaginal bleeding (staining from the progression of vaginal findings is physiological)
• maternal vital functions within norm
• fetal heart rate within norm
• absence of uterine operations and cesarean sections in the anamnesis

Basic assessment of the woman's condition upon arrival in the delivery room

• anamnesis 
• evaluation of a woman's vital functions 
• Blood pressure (BP), Pulse (P), Body Temperature (BT) 
• the nature of the contractions
• fetal monitoring 
• external examination 
• internal examination 
• amniotic fluid 
• bleeding  

1. anamnesis

• determine whether prenatal care was carried out 
• pregnancy / parity 
• date of the first day of the last period -> calculate the due date   (1st day of the last period + 7 days – 3 months 
• calculate gestational age (wheel, mobile app, calendar) 
• absence of uterine operations and cesarean sections 
• complications in previous pregnancies 
• chronic diseases of the pregnant woman

2. the nature of contractions 

• Type (messengers, contractions with opening effect) 
• Frequency (regular x irregular) 
• Intensity 
• Length

• early detection of intrauterine fetal distress 
• fetal movements – (increased perception, decreased perception or absence of fetal movement) 
• heart action of the fetus – auscultation (stethoscope, Doppler fetal monitor), cardiotocograph

Physiological CTG recording: 

• Basal frequency 100-160 t/min 
• Variability 5-25 t/min 
• Acceleration 2 and above 
• No decelerations 
• Fetal movements +

• visual evaluation of the abdomen – scars, stretch marks, umbilical pit 
• measure the height of the uterine fundus 
• fetal presentation and lie 
• rise of the fetus in the pelvis 
• number of fetuses 

• vaginal findings
• external genitalia without pathological findings – varicose veins, herpes genitalis
• head position of the fetus
• preserved amniotic fluid or flowing clear amniotic fluid no longer than 24 hours
•  fetal presentation centric, synclitic and indifferent

  

6. amniotic fluid

• colour – clear, slightly cloudy, cloudy
• quantity – oligohydramnios, euhydramnios, polyhydramnios
• preserved / drained amniotic fluid

7. bleeding

• nature of bleeding – fresh light blood / dark old blood
• amount – estimate of blood loss
• source of bleeding

X

• bleeding from the progression of the vaginal finding

• the woman does not meet the criteria for the active phase
• preserved amniotic fluid
• small vaginal finding 
• messengers or irregular contractions
• shower, bath and time

Latent  or active phase of labour?Active phase of labour:

• the woman has regular contractions with an opening effect
• advanced vaginal findings

Active phase of labour

I. stage
= Onset of regular uterine activity with an opening effect -> disappeared birth cervix (10 cm)

•  Preparation for childbirth 
  • Shower, endem
• Do not attempt to induce labour with oxytocin or amniotomy (AROM) providing the condition of the woman and the fetus is good and the finding is progressingMonitoring of the woman and fetus
  • BP, P, BT of the woman à 2 hours
  • continuous CTG monitoring of the fetus / listening to the echoes of the fetus à 15 minutes
  • vaginal examination – à 2 hours, fetal entry into the pelvis
  • contractions
  • amniotic fluid
  • bleeding
  • fetal movements
  • emptying the bladder
  • liquids
  • positioning of the woman

II. stage

= birth cervix disappeared – 10 cm (the woman indicates pressure on the anus) -> delivery of the fetus
 

• educate how and when to push (birth cervix disappeared, head is fully rotated, head is sufficiently deep in the pelvis)
• selection of position
• the midwife should have her hands washed and disinfected, a face mask, gloves and glasses or a face shield (protection against infections)
• ensure as much privacy as possible, cleanness and sufficient heat

Monitoring of the woman and fetus:

• fetal echo monitoring after each contraction or continuous CTG recording
• make sure the bladder is empty
• education of the mother how to breathe and how to push

III. stage = delivery of the fetus -> delivery of the placenta

MOTHER

• checking of BP, P, BT
• administer uterotonics to prevent postpartum haemorrhage
• delivery of the placenta – progress, signs of separation 
• physiological blood loss – 500 ml

CHILD

• dry the newborn and keep him warm
• check breathing, colour, tone, heartbeat (Apgar score)
• let the umbilical finish pulsing (1-3 min)
• tie the umbilical cord -> separate the newborn
• skin-to-skin on mother's belly (cap, blanket)
• if the child is not breathing or the woman is bleeding profusely, call for help and perform the ligation of the umbilical cord immediately

Postpartum period = 2 hours after delivery, intensive monitoring of the mother is necessary

• Physiologically, the woman should have her uterus retracted after delivery with minimal bleeding, 
  • pulse 60-110/min and blood pressure 90-139/60-89 mmHg, newborn should be pink with good muscle tone and heartbeat
• Every 30 minutes: 
  • woman - uterine retraction, BP, P, bleeding and BT
  • newborn - breathing, colour, pulse and BT
• Attaching the newborn to the mother's breast
• Hygiene and rest