Stage 1

• Vaginal exam to assess cervical dilatation and feotal head position every 4 hours
• every 1 hour - pulse and temperature
• Discuss pain relief methods
• Perform intermittent auscultation immediately after a contraction for at least 1 minute every 15 minutes:
  • Findings to be charted on a partogram
  • Record accelerations or decelerations if heard
  • Palpate maternal pulse if foetal HR abnormality detected differentiates between the 2 rates
  • Advise continuous cardiotocography only if risk factors present or arise during labour

Stage 2

• Consider Episiotomy if needed

• Pain relief as needed

• Perform intermittent auscultation of foetal HR immediately after contraction for at least 1 minute, every 5 minutes

• Normal foetal HR – baseline: 110-160bpm, variability: >5bpm,

  decelerations: none (or early), accelerations: present

Stage 3

There are two options for the third stage:

• Physiological management - Placenta delivered by maternal effort without medications or cord traction
• Active management - dose of IM oxytocin to help uterus contract + careful traction to umbilical cord to guide placenta out of the uterus and vagina
  • Active management shortens the third stage and reduces the risk of bleeding, but can be associated with nausea and vomiting.

Active management is routinely offered to all women to reduce the risk of postpartum haemorrhage. It is also initiated if there is:

• Haemorrhage
• More than a 60-minute delay in delivery of the placenta (prolonged third stage)