Labor is the physiological process by which a fetus is expelled from the uterus to the outside world. Determining whether a woman is in labor is sometimes difficult as painful uterine contractions alone are not sufficient to establish a diagnosis of labor. Typically, the diagnosis is reserved for uterine contractions which result in cervical dilatation and/or effacement. Bloody show (a small amount of blood with mucus discharge [ie, mucus plug] from the cervix) may precede the onset of labor by as much as 72 hours. Occasionally, fetal membranes rupture with egress of amniotic fluid prior to the onset of labor.
This topic will present a paradigm for intrapartum management of women in labor. Many of the options for evaluating and managing women during labor have not been studied in clinical trials or the data from clinical trials is insufficient for evidence-based decision-making ; thus, many of our recommendations are based upon clinical experience.
Management of complicated deliveries is reviewed elsewhere. (See "Overview of breech presentation" and "Face and brow presentations in labor" and "Operative vaginal delivery".)
The World Health Organization (WHO) defines normal birth as: “spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth, mother and infant are in good condition” .
Preparation — Childbirth education classes help to prepare women, and their partners, for labor and delivery. (See "Preparation for labor and childbirth".)