Do not allow a woman to remain for a long time in the first or second stages of labour without making an efficient referral.

When should you refer a multiparous or primiparous woman whose labour is prolonged? (Think back to Study Session 9.)

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Referral for prolonged labour should happen for all women if:

The latent first stage of labour lasts more than 8 hours before entering into the active first stage
The active first stage lasts more than 12 hours before entering into the second stage
The second stage of labour lasts more than one hour in a multiparous woman, or more than two hours in a primiparous woman, unless the birth of the baby seems to be imminent.

Your major role is primary prevention – in this case, making sure that if there is obstructed labour, you can get the woman to a health facility for emergency care in time to prevent uterine rupture. However, there are many reasons why you may have to give emergency care yourself to a woman with a ruptured uterus, where your role will be secondary prevention of the complications associated with uterine rupture.