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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Diagnosis and stages of labour

Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending

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Symptoms that require urgent assessment

Heavy vaginal bleeding, persistent pain between contractions, collapse, abnormal fetal heart rate or a visible or palpable cord are not explained by uncomplicated labour. Do not wait for a cervical dilatation threshold before escalating.

Action: Call for obstetric and midwifery assistance, assess maternal airway, breathing and circulation, and evaluate the fetal heart promptly. Manage the suspected emergency, arrange transfer when necessary and avoid routine vaginal examination in unexplained bleeding until placental location and the clinical situation have been assessed.

Synopsis

Distinguish early labour from established progress, assess maternal and fetal wellbeing, and recognise when the stage or course requires a different management plan.

  • Labour is diagnosed from the pattern of contractions and cervical change, alongside the maternal and fetal assessment.
  • NICE defines established first-stage labour as regular contractions with progressive cervical dilatation from 4 cm.
  • The latent phase may be intermittent and includes cervical softening, effacement and early dilatation; its duration varies widely.
  • The second stage begins at full dilatation and has passive and active components that should be recorded separately.
  • The third stage runs from birth of the baby to delivery of the placenta and membranes.
  • Pain intensity alone does not measure dilatation, progress or the need for obstetric intervention.
  • Consent, privacy, explanation and the person's wishes apply to every vaginal examination, including repeat assessments.

Key red flags

Fresh bleeding greater than an ordinary blood-stained show requires prompt obstetric assessment.

Reduced fetal movements, a persistent fetal heart abnormality or thick meconium requires reassessment of fetal risk.

Constant severe abdominal pain, uterine tenderness or maternal instability requires urgent evaluation for an obstetric complication.

Fever, offensive fluid or worsening maternal tachycardia raises concern for infection.

Symptoms of labour before 37 weeks require the preterm labour pathway rather than routine term reassurance.

Investigation priorities

01
Maternal observations and abdominal assessmentFirst step

Assess current wellbeing and establish the obstetric context.

Management branches

Early presentationSupport the latent phase

Contractions are present but established first-stage labour has not been demonstrated.

  1. Undertake a maternal and fetal assessment, review risk factors and provide a clear explanation of the findings and uncertainty.
  2. Offer emotional support, appropriate analgesia and practical advice on rest, comfortable movement and drinking to thirst.
  3. Discuss home or planned birth-setting care according to clinical suitability, coping, travel, support and the person's preference; do not send someone away solely because dilatation is below 4 cm.
  4. Give explicit contact instructions for increasing pain, inability to cope, bleeding, reduced movements, membrane rupture or other new concerns.

Key medicines

Oxytocin for active third-stage managementFollowing vaginal birth, NICE includes oxytocin 10 units intramuscularly or 5 units intravenously as prophylactic options. Where intravenous oxytocin is used after oxytocin in labour, give it slowly over 3–5 minutes according to the obstetric plan.This prophylactic dose is distinct from a titrated augmentation infusion. Consider the complete haemorrhage-risk and cardiac assessment; intravenous administration can cause cardiovascular effects, and oxytocin with ergometrine is unsuitable in some hypertensive or cardiac conditions.
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Sources and review status3 sources · checked 7 Sept 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.

  • NICE NG235 intrapartum care recommendations
  • NICE NG229 fetal monitoring in labour
  • NHS stages of labour and birth

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom