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This chapter distinguishes between nulliparous and multiparous women. Multiparous women have more compliant cervix and faster progress in labour. In primiparous women, the cervix usually becomes completely effaced before dilating, whereas in multiparous women the cervix may begin to dilate before effacement is complete. The chapter explains the three stages of labour, the onset and mechanism of labour, the duration of a normal labour and characteristics of a dysfunctional labour. During normal labour the fetal head flexes and rotates to an occipito-anterior (OA) position as it descends through the pelvis. Obstruction can occur if a fetal head is deflexed, or fails to rotate in the usual way. When managing women in labour important interventions appear to be appropriate: one-to-one support during labour, accurate diagnosis, use of a partogram to identify slow progress, which in turn permits appropriate interventions including the use of amniotomy and oxytocin.
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