• First stage of labor: subdivided into latent phase and active phase. The latent phase is characterized by cervical dilation from 0-3cm while active phase of labor refers to cervical dilatation from 4cm-10cm. An active phase lasting more than 8 hours is said to be prolonged.
• Second stage of labor: This refers to the stage from full cervical dilatation to delivery of the fetus. Usually lasts for 1 hour in the multiparous women and 2 hours in the primiparous women. The duration may be extended with epidural analgesia by another hour making a total of 2 and 3hours respectively.
• Third stage of labor: from delivery of fetus to delivery of the placenta. This stage usually lasts about 30mins.

This refers to the proactive anticipation of the problems of labor and taking appropriate measures to prevent or correct them, should they occur to deliver a viable baby to a healthy mother.

First stage of labor: A complete history should be obtained including past obstetric, gynecologic, medical and surgical history. A thorough physical examination of mother comprising a general, obstetric and pelvic examination is carried out. The investigations done during the pregnancy are reviewed. This will include antenatal screening investigations and ultrasonography results.

• During the latent phase of labor, she is allowed light meals, given adequate analgesia and allowed to ambulate.
• Once she is in the active phase of labor, a partograph (a graphical representation of the events of labor plotted against time) is used to monitor progress of the labor. Intravenous access is secured and a blood sample for complete blood count and for grouping and cross matching is obtained. Uterine contractions are checked every 30minutes and fetal heart rate checked every 15minutes. A pelvic exam is done every 4hours to check for cervical effacement and dilatation, station of the presenting part and position. The mother’s pulse is checked every 30minutes, her blood pressure every 4 hours and her temperature every 4 hours. Fluid intake and urinary output, check for protein and acetone/ketone as well as the drugs administered during the labor are recorded on the partograph.

 The second stage of labor: There is full cervical dilatation with subsequent descent of fetus. She is urged to bear down once presenting part distends the perineum and she expresses the urge to do so. Episiotomy can be considered if perineum is stretched to an extent that it may result in a tear. With gentle downward traction of the head, the anterior shoulder is delivered followed by upward traction to deliver posterior shoulder. The umbilical cord is then divided between two clamps within a minute of delivery of baby.

The third stage of labor: refers to period from delivery of fetus to delivery of the placenta. The active management of third stage of labor is important in preventing postpartum hemorrhage. The components include

• The administration of oxytocin injection within one minute of delivery of the fetus.
• Delivery of the placenta via controlled cord traction
• Ensure uterus is well contracted after delivery

After delivery, the placenta and membranes should be examined for completeness. The genital tract should also be examined for any perineal tears. Any tears or laceration should be repaired

Normal puerperium:  It is 6-week postpartum period where pregnancy induced changes return to pre-pregnancy state. The uterus undergoes involution to its pre-pregnancy state. For the first 3-4 days a reddish discharge (lochia rubra) is noted per vagina. From the 4-10^th day, it becomes progressively paler and is known as lochia serosa. Beyond the 10^th day the lochia assumes a white or yellowish-white color known as lochia alba. Lochia usually resolves within puerperium. The breasts also start to produce milk for breastfeeding during the puerperium.

Induction of Labor Is the artificial initiation of labor after the age of viability with the aim of achieving vaginal delivery. Indications for induction of labor include prolonged pregnancy, preeclampsia, chorioamnionitis, intra uterine fetal death, diabetes in pregnancy, renal disease in pregnancy and rhesus isoimmunization

Problems of Labour Include failure to progress, cephalopelvic disproportion, prolonged labor, cord prolapse, uterine rupture, prolonged second stage, shoulder dystocia, perineal tear, birth asphyxia and postpartum hemorrhage