With the Duchess of Cambridge being admitted to the Lindo Wing at St Mary’s Hospital, Paddington, London there is worldwide interest as to when the royal baby will arrive, especially as her husband the Duke of Cambridge was also born there. Isabel Healthcare which produced the Isabel clinical decision support system for Health Professionals and the Isabel Symptom Checker has strong links with St Mary’s Hospital in Paddington as it is where Isabel Maude was treated, at age 3, with Necrotizing Fasciitis on the Pediatric Intensive Care Unit (PICU) after being misdiagnosed at her local hospital. It is where Jason Maude and Clinicians from St Mary’s conceived the structure of what became the Isabel clinical decision support system. Further reading on how Isabel was developed can be found here.
Background and Overview:
Labor is the sequence of physiological events that results in a fetus being transported from the uterus through the birth canal to delivery as an Infant. Labor is a clinical diagnosis where many things happen including:
Labor is divided into three stages:
Stage 1 (Cervical stage): This occurs from onset of uterine contractions until full dilation of the cervix at 10 cms. Stage 1 contains the latent phase where contractions are mild, short and irregular (less than 45 seconds). The uterus contracts but there is little change in cervical dilation or effacement (thinning of the cervix). The next phase of stage 1 labor is called the active phase which begins around the time of cervical dilation of 3-4 cm and contractions are strong, regular (every 2-3 minutes) and last longer than 45 seconds.
Stage 2: This is from onset of complete cervical dilation (at 10 cms) to the time the Infant is delivered. This stage is influenced by the 3 P’s: Passenger (Infant size and presentation), Passageway (size of pelvis and soft tissues), Power (uterine contraction strength).
Stage 3: This stage occurs from when the Infant is delivered until delivery of the placenta. This stage can be as quick as 10 minutes but can sometimes take up to 30 minutes.
The length of time it takes for these three stages to be completed varies for each woman. Typically the lengths of the first 2 stages for women who have never given birth to a live infant before are significantly longer.
Symptoms of Labor:
It should be noted that patients in the third trimester (final three months of pregnancy) who have abdominal pain or vaginal bleeding should contact their Obstetrician or Midwife as vaginal bleeding is not associated with labor and could be an indication of abnormal labor complications such as placental abruption or placenta previa.
Physical Examination and Workup:
Once you have been seen by a Midwife or Obstetrician they will perform some examinations and tests to confirm you are in labor and what stage you are at:
The patient is assessed to correctly determine they are in labor and rule out other possible diagnoses which could explain their symptoms including:
Pain Control during Labor:
Various methods can be employed during labor to relieve pain and your Obstetrician or Midwife would have discussed these with you in your birth plan prior to being admitted in labor.
Some common methods are:
Labor and delivery is an amazing and exciting process which, after nine months of nurturing and protecting your growing baby – you finally get to meet them.
Mandy has worked for Isabel Healthcare since 2000. Prior to this, she was a Senior Staff Nurse on the Pediatric Infectious disease ward and high dependency unit at one of London's top hospitals, St Mary’s in Paddington which is part of Imperial College Healthcare NHS Trust. Her experience in the healthcare industry for the past 28 years in both the UK and USA means she's a vital resource for our organization. Mandy currently lives and works in Scottsdale, Arizona.