Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

General Management of First Stage of Labour

Management of the first stage supports normal labour while monitoring maternal and fetal wellbeing, cervical progress, contractions, comfort, hydration, elimination, and emotional needs. Abnormal progress or compromise requires timely review.

Purpose

  • Promote safe physiological labour
  • Monitor progress and detect complications
  • Provide comfort, information, and respectful support

Indications

  • Confirmed or suspected first-stage labour
  • Regular painful contractions with cervical change
  • Assessment of labour progress or abnormal symptoms

Equipment

  • Labour room and clean birth equipment
  • Maternal and fetal monitoring equipment
  • Partograph or labour record
  • Comfort, hydration, and pain-relief resources
  • Emergency and referral equipment

Preparation

  • Review risk and birth preferences and ensure emergency services are available.
  • Prepare clean equipment and a calm environment.

Procedure steps

  • Confirm labour, gestation, presentation, risk status, preferences, support person, and immediate concerns.
  • Assess maternal vital signs, contractions, pain, hydration, bladder, bleeding, membranes, and emotional wellbeing.
  • Assess fetal heart and presentation and perform vaginal examination only when indicated and with consent.
  • Record findings on the partograph or approved labour record and identify trends.
  • Encourage mobility and comfortable positions, hydration, bladder emptying, breathing, massage, and chosen pain-relief options.
  • Provide information, privacy, companionship, and shared decisions.
  • Use prescribed analgesia or other interventions and monitor response.
  • Recognize prolonged or obstructed labour, abnormal fetal heart, fever, bleeding, malpresentation, or maternal exhaustion.
  • Escalate promptly and prepare for birth, operative care, or transfer when indicated.
  • Document assessments, support, examinations, treatments, response, communication, and plan.

Precautions

  • Do not label labour normal without ongoing assessment.
  • Avoid unnecessary vaginal examinations and preserve membranes when safe.
  • Escalate abnormal fetal heart, severe pain, bleeding, fever, meconium with concern, or poor progress.
  • Respect the woman’s informed choices.

Aftercare

  • Continue monitoring and update the woman as labour changes.
  • Prepare for second stage and newborn care.

Nursing considerations

  • Provide continuous supportive care where possible.
  • Use trends and the whole clinical picture to recognize delay.

Patient education

  • Explain labour progress, comfort options, hydration, bladder care, examinations, and warning signs.
  • Encourage the woman to communicate pain, pressure, bleeding, fluid, or concerns.

Documentation

  • Record labour onset, contractions, cervical findings, fetal heart, maternal observations, pain relief, fluids, membranes, and plan.
  • Update the partograph and handover.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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