Labour is described as the process by which the fetus, placenta and membrane are expelled through the birth canal after 37 completed weeks of gestation.

Labour is said to be normal labour (systocia) when;-

It starts spontaneously (without any intervention).
The whole process takes not more than 18 hours.
It is vaginal delivery and occurs at term.
The fetus presented by vertex.
The fetus is alive and requires no or minimal resuscitation.
A mother can deliver with her effort.
No complication arise on both fetus and mother.

Any labour without these characters is said to be abnormal labour (dystocia) and therefore require referral to the health centre or hospital.

Signs of onset of True Labour

Suspect or anticipate labour if the woman has:
- Intermittent lower abdominal pain.
- Pain watery vaginal discharge or a sudden gush of water.
- Cervical dilatation (surest sign).

Types of uterine contraction:

Mild contraction which lasts < 20 seconds shade dots in the box.
Moderate contraction 20 - 40 seconds shade diagonal in the box.
Severe contraction 40 - 60 seconds full shade to the box.

Diagrammatically is shown as follows:

Often associated with blood-stained mucus discharge (show).
Blood-stained mucus discharge (show) can be seen a few hours before or after labour has started denoting that the cervix is softening, and opening.

Confirm the onset of labour if:

The frequency of the contraction (how many contractions per ten minute ): at least last two contractions in 10 minutes.
The intensity of contraction (how painful her contraction is): the mother has regular painful contractions which are not relieved by anti-pain medications and ambulation.
Duration (How long each contraction of uterus lasts/onset to peak): contraction lasts stronger, i.e., which lasts more than 40 seconds
There is cervical effacement (the progressive shortening and thinning of the cervix during labour) which is expressed regarding percentage .(see figure 2.1).
There is cervical dilatation: the increase in diameter of the cervical opening measured in centimetres.

Fig. 2.1. Effacement and dilatation of the cervix.

Remember:

Sometimes, the membrane ruptures and the amniotic fluid may pass as a gush or may leak slowly for several days. Some women think that labour is not progressing if the membrane is not ruptured, but that is not true as labour can start with or without rupture of membrane.
As the membrane ruptures, the labour should start within 6 hours if not you should urgently refer as this cause infection since the door of the uterus is open and cord prolapsed may occur which might later be compressed by the presenting part of the fetus against pelvic bone. This cause cessation of oxygen to the fetus and as the consequence of this the fetus will die. Also, care should be taken during vaginal examination as there is increased the risk of introduction of infection to sterile uterus since the uterus is open (standard hygiene precaution should be applied) and avoid infrequent application of vaginal examination.