Latent Phase Of Labor Research Articles

Hospital Admission in the Latent versus the Active Phase of Labor: Comparison of Perinatal Outcomes.

Background: Admission in the latent phase of labor has been associated with increased risk of obstetric interventions compared to admission in the active phase. We aimed to investigate the relationship between labor phase at admission and obstetric and neonatal outcomes. Methods: A retrospective cohort study was conducted on 1005 women with uncomplicated singleton pregnancy admitted for spontaneous labor. Cesarean section rate and other perinatal outcomes were compared between women admitted in the latent phase and those admitted in the active phase. Results: Admission occurred in the active phase of labor for 331 women (32.9%) and in the latent phase for 674 (67.1%). Admission in the latent phase was more frequent in nulliparous than in multiparous (p < 0.01) and for Italian patients compared to foreigners. The incidence of caesarean section was similar between groups. Admission in the latent phase increased the likelihood of epidural analgesia (OR 3.47, 95% CI 1.96–6.14, in nulliparous, and OR 2.58, 95% CI 1.37–4.84, in multiparous) and increased the rate of augmentation of labor with oxytocin in multiparous (OR 2.87, 95% CI 1.05–7.85), without difference in neonatal outcomes. Conclusions: Admission in the latent phase is associated with more frequent use of epidural analgesia, without an increase in cesarean section or adverse neonatal outcomes.

Dynamic changes in maternal immune biomarkers during labor in nulliparous vs multiparous women

Immunomodulation is observed in human parturition. However, data from longitudinal studies for the prelabor phase and the active phase of labor are lacking, and no study had compared the immune responses during labor between nulliparous and multiparous women. This study aimed to investigate the temporal changes of immune biomarkers in maternal blood from the prelabor phase to the latent and active phases of labor and to compare the dynamic changes between nulliparous and multiparous women. A prospective case-control study was conducted on women who had induction of labor at term followed by vaginal delivery. Maternal blood was serially collected at 3 consecutive time points: (1) before the onset of labor, (2) during the latent phase of labor, and (3) during the active phase of labor. Peripheral immune cells were measured by 4-color flow cytometry, and the plasma concentrations of cytokines and chemokines were measured by cytometric bead arrays. A longitudinal comparison was made to assess the dynamic changes in inflammatory parameters over 3 time points in nulliparous and multiparous women, respectively, and a cross-sectional comparison was made between nulliparous and multiparous women. A total of 40 women, including 20 nulliparous and 20 multiparous, were included in the study. Prelabor circulating levels of macrophage inflammatory protein-1β, monokine induced by gamma interferon, and interferon gamma-induced protein-10 were higher in multiparous women than in nulliparous women. In the latent phase of labor, the innate immune system in both groups responded with increases in neutrophils and interleukin 6, and the nulliparous women showed a more pronounced response. During the active phase of labor, such innate immune response continued with both groups, with additional increases in natural killer cells, monocyte chemoattractant protein-1, interleukin 8, and interleukin 10. Conversely, the adaptive immune system in nulliparous women showed a reduction in both cytotoxic and helper T cells, whereas the adaptive immune system in multiparous women only had a reduction in helper T cells, showing a smaller reduction. Innate and adaptive immune responses partake in immunomodulation during human parturition. Nulliparous and multiparous women showed different responses in their blood levels of immune cells and biomarkers during the different phases of labor.

Comparison of delivery outcomes in low-dose and high-dose oxytocin regimens for induction of labor following cervical ripening with a balloon catheter: A retrospective observational cohort study.

A variety of oxytocin regimens are used for labor induction and augmentation. Considering the increasing rates of labor induction, it is important to assess the most optimal oxytocin regimen without compromising maternal and fetal safety. The aim of this study was to compare delivery outcomes of low-dose and high-dose oxytocin induction protocols. This retrospective cohort study of 487 women comparing low-dose oxytocin protocol (n = 280) and high-dose oxytocin protocol (n = 207) in labor induction following cervical ripening by balloon catheter was performed in Helsinki University Hospital after implementation of a new oxytocin induction protocol. The study included two six-month cohorts from 2016 and 2019. Women with vital singleton pregnancies ≥37 gestational weeks, cephalic presentation, and intact amniotic membranes were included. The primary outcome was the rate of vaginal delivery. The secondary outcomes were the rates of maternal and neonatal infections, postpartum hemorrhage, umbilical artery blood pH-value, admission to neonatal intensive care, and induction-to-delivery interval. Statistical analyses were performed by using IBM SPSS Statistics for Windows (Armonk, NY, USA). The rate of vaginal delivery was higher [69.9% (n = 144) vs. 47.9% (n = 134); p<0.004] and the rates of maternal and neonatal infection were lower during the new high-dose oxytocin protocol [maternal infections 13.6% (n = 28) vs. 22.1% (n = 62); p = 0.02 and neonatal infection 2.9% (n = 6) vs. 14.6% (n = 41); p<0.001, respectively]. The rates of post-partum hemorrhage, umbilical artery blood pH-value <7.05 or neonatal intensive care admissions did not differ between the cohorts. The median induction-to-delivery interval was shorter in the new protocol [32.0 h (IQR 18.5-42.7) vs. 37.9 h (IQR 27.8-52.8); p<0.001]. In conclusion, implementation of the new continuous high-dose oxytocin protocol resulted in higher rate of vaginal delivery and lower rate of maternal and neonatal infections. Our experience supports the use of high-dose continuous oxytocin induction regimen with a practice of stopping oxytocin once active labor is achieved, and a 15-18-hour maximum duration for oxytocin induction in the latent phase of labor following cervical ripening with a balloon catheter.

Exploring pain characteristics in nulliparous women; A precursor to developing support for women in the latent phase of labour

BackgroundAdmission to hospital in the latent phase of labour is associated with a cascade of unnecessary intervention. Women who seek early hospital admission may have heightened fear and anxiety in relation to pain routed in their pre-pregnancy experiences. ObjectiveTo determine the prevalence of pain catastrophising in a healthy non-pregnant population and explore previous pain experiences and fear of childbirth as characteristics that might predict pain catastrophising. DesignProspective observational study across two higher education institutions in Scotland and England using a semi-structured survey administered through Bristol Online Surveys. Four validated questionnaires were used to identify the prevalence of pain catastrophising and fear of childbirth in nulliparous women of reproductive age. ResultsThe survey was completed by 122 women undertaking an undergraduate degree and aged between 18 and 23 years. A high prevalence of pain catastrophising was found: a cut-off score of 20 and above = 47.5% (58/122 participants), a cut-off score of 30 and above = 21.3% (26/122). Fear of pain (β = 0.14, t = 4.21, p <0 .001) and pain-related anxiety (β = 0.40, t = 11.39, p <0 .001) were significant predictors of pain catastrophisation. However, there was no correlation between fear of childbirth and pain catastrophisation. Conclusions and implications for practiceIt is reasonable to hypothesise that the pain catastrophising scale may be a good tool to predict those women likely to require additional support in the latent phase of labour; however further work is needed to explore this with a group of pregnant women.

Comparison of Pregnancy Outcomes of Women with and Without Hypertension at the Latent Phase of Labor Who Were Under Medical Care for Preeclampsia

OBJECTIVE: We explored the association between hypertension (&gt;140/90) at the latent phase of labor (resistant hypertension) and the subsequent development of major maternal complications or adverse infant outcomes in women with preeclampsia under medical care. STUDY DESIGN: We drew data from 824 women who were under follow-up at the Department of Perinatology of Health Sciences University Zeynep Kamil Women and Children’s Health Training and Research Hospital with a diagnosis of preeclampsia. Women with and without resistant hypertension were compared in terms of major maternal complications and adverse infant outcomes. RESULTS: Mean age and body mass index were similar between the two groups (p&gt;0.05). The rate of preeclamptic complaints was significantly higher in groups with resistant hypertension (90.1% vs. 67.2%, p&lt;0.05). Proteinuria was more frequent in the resistant hypertension group (78.7% vs. 66.8%, p&lt;0.001). The newborn intensive care unit admission rate was significantly higher in the group with resistant hypertension (65.6% vs. 45.9%, p&lt;0.001). Gestational age at delivery was significantly lower in the group with resistant hypertension compared to the normotensive group (34.6 vs. 32.9 weeks, p&lt;0.001). There was a significant difference between the two groups in terms of the rate of preterm delivery (78.5% vs. 66.7%, p=0.04). CONCLUSION: Resistant hypertension is associated with a higher rate of preeclamptic symptoms during labor and newborn intensive care unit admission.

Association between genital tract infection and premature rupture of membranes: A retrospective case control study in Tunisia, North Africa.

Premature Rupture of Membranes is responsible for most cases of neonatal death. In most of these cases, the causes of PROM have not been established in Tunisia, although several risk factors have been described. Therefore, we set out to determine the presence of an association between genital infections and PROM among Tunisian women. A case-control study was conducted among 251 womens to detect the presence of association between genital tract infection and Premature Rupture of Membranes.Cases had a premature membranes rupture and the controls had intact membranes or suffering from premature membrane rupture during the latent phase of labour. Data were collected from the medical register including socio-demographic characteristics, obstetrics, and medical history. Association between genital infections and premature rupture of membranes was estimated using the Odds Ratio and 95% CI. One risk factor was identified, including age. There is no association between the presence of Group B streptococcus (OR= 1.08; 95% CI 0.50-2.34), presence of Trichomonasvaginalis (OR= 2.45; 95% CI 0.15-39.83) and presence of Candidiasis (OR= 1.11; 95% CI 0.58-2.14) and premature rupture of membranes. Co-infection was not associated with premature rupture of membranes (OR= 0.43; 95% CI 0.45-6.07). There is no association between genital infections and PROM among pregnant Tunisian women.

Efektifitas Tehnik Kneading dan Pelvic Rocking untuk Menurunkan Nyeri pada Persalinan Kala I Fase Laten Di Kecamatan Gondang

Childbirth is a process of releasing the conception of the fetus and placenta at term. 90% of deliveries are always accompanied by pain. Data in Central Java that maternal mortality was 116.01 per 100,000 live births, 49.52% of which occurred due to childbirth. The Maternal Mortality Rate in Gondang District in 2018 was 3/652 live births. Labor pain is a very worrying problem for inpartum mothers, so to relieve labor pain can be overcome by using kneading and pelvic rocking techniques. The aim of this study was to describe the management of kneading and pelvic rocking techniques with acute pain problems during the latent phase of labor. Qualitative research method with a case study approach. Population: post partum mothers. Sample 3 people. Subject taking technique with non-probability sampling with purposive sampling approach. The assessment data showed labor pain with PQRST, the subject was restless, grimaced, clenched his teeth, closed his eyes, and held the pain site, the frequency of uterine contractions in 10 minutes, 1 time the duration of the contraction was 10-20 seconds. TTV: TD: 120 / 80-130 / 90 mmHg, RR: 20-22 times / minute, N: 70-80 times / minute S: 36.2 - 36.5°C. The nursing diagnosis of acute pain relates to a biological injury agent (uterine contractions). Kneading and pelvic rocking technique nursing actions were performed for 4 times. Evaluation of kneading and pelvic rocking techniques can reduce the pain level from 5-6 to 3-5 pain scale. Conclusion: kneading and pelvic rocking techniques can reduce the pain scale in the latent phase of labor.

Hematocervix as an Uncommon Complication of Cesarean Delivery: A Case Report

Hematometra is a condition of retained blood or clot in the uterus. If just the cervix is affected by collection, the condition is described as hematocervix. The hematocervix should be suspected in a women with amenorrhea and recurrent lower abdominal pain. The objective of this case report was to report a rare case of isolated hematocervix following cesarean delivery.A 27-years-old primigravidae woman was admitted with the complaints of severe pelvic pain and amenorrhea. She had the history of full term delivery via cesarean section because of prolonged latent phase of labor almost 3 months ago. Pelvic examination, transvaginal sonography and MRI findings were confirmed the diagnosis of hematocervix cervical dilatation and curettage following vaginal misoprostol was done and the women was discharged with good health status.The increased rates of cesarean delivery in all over the world caused increase in rare complication such as isolated hematocervix. Dilatation and drainage of cervical collection is safe and effective treatment in such cases.

Oxycodone for Pain Management in the Latent Phase of Labour: A Pragmatic Trial

(Acta Anaesthesiol Scand. 2020;64:685–690) While systemic opioids are effective for labor analgesia, there are concerns for adverse fetal and maternal effects, particularly at higher doses. However, there are limited data on the use of oxycodone during labor and on the use of any opioid during the latent phase of labor. This study aimed to evaluate the efficacy, fetal exposure, and safety of subcutaneous (SC) oxycodone used for labor analgesia during the latent phase.

VP54.02: Prelabour short‐term variability in fetal heart rate by computerised cardiotocogram and maternal fetal Doppler indices for the prediction of labour outcomes

A prospective study in 218 women with term singleton pregnancy in latent phase of labour or due to undergo induction of labour. Data on maternal characteristics, maternal-fetal Dopplers indices and computerised cardiotocography (CTG) findings of FHR STV and Dawes-Redman criteria were collected. Pearson correlation analysis was used to determine the relationship between maternal-fetal Dopplers and FHR STV and arterial cord blood pH. Logistic regression analysis was used to determine which factors amongst maternal characteristics, labour onset, indication of labour induction, estimated fetal weight (EFW), maternal-fetal Dopplers, FHR STV and Dawes-Redman criteria were significant predictors of composite neonatal morbidity and arterial cord blood pH less than 7.2. Of the 218 cases, 12 (5.5%) women were delivered by emergency operative delivery for pathological CTG and 42 babies (19.3%) had composite neonatal morbidities. Arterial cord blood pH was not associated with maternal-fetal Doppler indices and FHR STV, but rather it was associated with maternal age and body mass index. The composite neonatal morbidity and arterial cord blood pH less than 7.2 were not significantly associated with maternal characteristics, labour onset, indication of labour induction, pre-labour assessment of EFW, maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria by computerised CTG. In unselected women in latent phase of labour or undergoing induction of labour at term, admission maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria are not predictive of composite neonatal morbidity.

Nursing Support During Latent Phase Labor: A Scoping Review.

Nursing Support During Latent Phase Labor: A Scoping Review.

Nursing Support During Latent Phase Labor: A Scoping Review.

The purpose of this scoping review was to synthesize the literature on nursing support during the latent phase of the first stage of labor. In 2014, the definition of the beginning of active labor changed from 4 centimeters (cm) to 6 cm cervical dilation. More women may have an induction of labor based on results of recent research showing no causal increase in risk of cesarean birth with elective induction of labor for low-risk nulliparous women. Therefore, in-hospital latent phase labor may be longer, increasing the need for nursing support. Scoping review of the literature from 2009 to present. We conducted the review using key words in PubMed, CINAHL, and Scopus. Search terms included different combinations of "latent or early labor," "birth," "support," "nursing support," "obstetrics," and "onset of labor." Peer-reviewed research and quality improvement articles from 2009 to present were included if they had specific implications for nursing care during the latent phase of labor. Articles were excluded if they were not specific to nursing, focused exclusively on tool development, or were from the perspective of pregnant women or providers only. Ten articles were included. Results were synthesized into six categories; support of physiologic labor and birth, the nurse's own personal view of labor, birth environment, techniques and tools, decision-making, and importance of latent labor discussion during the prenatal period. Support for physiologic labor and birth is an important consideration for use of nonpharmacological methods during latent labor. The nurse's own personal view on labor support can influence the support that laboring women receive. Nurses may need additional education on labor support methods.

Proactive versus standard support of labour in nulliparous women; study protocol for a randomized, controlled trial

BackgroundProlonged latent phase of labour often results in a traumatic birth experience. Prolonged labour is associated with more operative deliveries, haemorrhage, fetal asphyxia and poor birth experience. Women with prolonged labour in a former pregnancy more often demand caesarean section in the next, due to their negative birth experience. “Proactive support of labour” is an alternative method, developed to counteract prolonged labour. There are little research and no randomized controlled study that compare proactive to standard labour support.Methods/DesignA prospective, non-blinded, randomized, single-centre, clinical trial where we compare proactive support to standard support of labour in a university hospital setting.Inclusion criteria: latent phase of labour, non-pathologic pregnancy. Robson group 1, with painful contractions, and fully effaced cervix, with 1–3 cm dilatation. Exclusion criteria: induction of labour, breech presentation, twin pregnancy, multi-parity, conditions that require extended surveillance before and/or during labour.Primary outcome: spontaneous, uncomplicated vaginal delivery. After inclusion, women randomized to proactive support of labour will stay at the hospital and have one-to-one midwife support. If no progression during the next 1–2 hours, amniotomy and/or oxytocin stimulation will be started. The control group will adhere to the standard procedures for labour support: expectance until established regular contractions and 4–5 cm cervical dilatation, and then one-to-one midwife support.DiscussionThe idea of proactive support of labour is to initiate early intervention when there are signs of slow progress in order to avoid protracted labour with exhaustion of the mother, the uterus and prolonged stress of the foetus. Proactive support of labour may represent a useful method to improve labour support in nulliparous women. However, evidence based on randomized controlled trials are needed in order to know whether proactive support of labour is comparable or superior to standard care. A randomized, controlled trial is described; challenges and possible clinical implications are discussed.Trial registrationThe Proactive Support of Labor Study (PAF) ClinicalTrials, NCT03056313. Registered on February 17, 2017.

Medication used in Denmark in the latent phase of labor – Do we know what we are doing?

ObjectiveTo describe the various combinations of medication used in Denmark in the latent phase of labor (i.e. for therapeutic rest) and to estimate the frequency of use. MethodsAn informal e-mail survey based on personal information from Danish midwives or staff obstetricians. The main outcome measures were type and dosage of medications used individually or in combination (“cocktail”) for therapeutic rest in Danish delivery wards during the latent phase of labor and also the frequency of their use. ResultsAll twenty-one delivery wards in Denmark participated in the survey. The types and dosages of medication varied substantially. Two delivery wards used prescriptions on morphine with no other medication for therapeutic rest. The remaining 19/21 delivery wards (90%) used a standard “cocktail” with two to four different types of medications; 19/21 wards (90%) used a mild analgesic (paracetamol), 17/21 (81%) used anxiolytics/hypnotics, and 14/21 (64%) wards used a strong analgesic (opioid) in their basic cocktail. Ten delivery wards (48%) combined an opioid, a sedative, and paracetamol in their basic cocktail. Between 7% and 21% of all pregnant women were given a cocktail. ConclusionIn a small country, we found considerable national variation in the medication or combinations of medication used in the latent phase of labor, and polypharmacy was standard in the majority of the delivery wards.

Prelabor short-term variability in fetal heart rate by computerized cardiotocogram and maternal fetal doppler indices for the prediction of labor outcomes

Objectives To investigate (i) the association between pre-labor maternal-fetal Dopplers and fetal heart rate short-term variability (FHR STV) with arterial cord blood pH and (ii) the potential value of pre-labor maternal-fetal Dopplers, FHR STV and Dawes-Redman criteria in predicting composite neonatal morbidity at term in a cohort of unselected women. Method A prospective study in 218 women with term singleton pregnancy in latent phase of labor or due to undergo induction of labor. Data on maternal characteristics, maternal-fetal Dopplers indices and computerized cardiotocography (CTG) findings of FHR STV and Dawes-Redman criteria were collected. Pearson correlation analysis was used to determine the relationship between maternal-fetal Dopplers and FHR STV and arterial cord blood pH. Logistic regression analysis was used to determine which factors amongst maternal characteristics, labor onset, indication of labor induction, estimated fetal weight (EFW), maternal-fetal Dopplers, FHR STV and Dawes-Redman criteria were significant predictors of composite neonatal morbidity and arterial cord blood pH less than 7.2. Result Of the 218 cases, 12 (5.5%) women were delivered by emergency operative delivery for pathological CTG, and 42 babies (19.3%) had composite neonatal morbidities. Arterial cord blood pH was not associated with maternal-fetal Doppler indices and FHR STV, but rather it was associated with maternal age and body mass index. The composite neonatal morbidity and arterial cord blood pH less than 7.2 were not significantly associated with maternal characteristics, labor onset, indication of labor induction, pre-labor assessment of EFW, maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria by computerized CTG. Conclusion In unselected women in latent phase of labor or undergoing induction of labor at term, admission maternal-fetal Doppler indices, FHR STV and Dawes-Redman criteria are not predictive of composite neonatal morbidity.

Effects of the time of pregnant women’s admission to the labor ward on the labor process and interventions

Our aim to conduct the study was to investigate the effects of the time of pregnant women’s admission to the labor ward on the labor process and interventions. This study is a two-group, prospective, analytical study. Groups were determined according to their cervical dilation levels. The data were collected using the Labor Process Form, and analyzed using the Statistical Package for the Social Sciences version. Within this context, the rates of amniotomy, induction with oxytocin, episiotomy, and cesarean section in the participants who presented to the hospital in the latent phase of labor were higher.

Oxycodone for pain management in the latent phase of labour - A pragmatic trial.

Parenteral opioids are used for pain relief in labour but there are little data for oxycodone in this context. The aim of this study was to evaluate the efficacy, foetal exposure and safety of subcutaneous oxycodone in the latent phase of labour. This pragmatic trial included 76 parturients, who received subcutaneous oxycodone for pain relief in the latent phase of labour according to the hospital protocol: an initial dose 0.1mg/kg, and a second dose, 0.05mg/kg, could be administered four hours later. Pain intensity and pain relief were assessed using a numerical rating scale of 0-10. After delivery, blood samples from the maternal and umbilical veins were collected, and plasma concentrations of oxycodone and its main metabolites were quantified using UPLC-MS/MS. The Apgar scores and maternal and neonatal adverse effects were recorded. The foetal exposure at birth was low, the median oxycodone and oxymorphone umbilical vein plasma concentrations were 1.2ng/mL (range 0.21-7.8) and 0.14ng/mL (0-0.26), respectively. Pain scores decreased substantially, from a median pain score of 7/10 before oxycodone to median scores of 5/10 at 30minutes after administration, 5/10 at 60minutes and 6/10 at 120minutes. The median Apgar score was 9 (range 2-10) at 1minute and 9 (6-10) at 5minutes. Maternal adverse effects were mild, and there were no oxycodone-related neonatal adverse effects. Subcutaneous oxycodone provided effective analgesia during the latent phase of labour. Newborn exposure at birth was low, and oxycodone was well-tolerated.

The Effectiveness of Coping Strategies in the Latent First Stage of Labour: A Systematic Review

The latent phase of labour is defined as a period of time marked by painful uterine contractions and variable changes of the cervix, including some degree of cervical effacement and a slow dilatation up to 5 cm [1]...

Effectiveness of back massage on pain relief during first stage of labor in primi mothers admitted at a Tertiary care center.

Background:Labor pain is one of the most severe pains a woman experiences in her life, causing an increase in the anxiety and stress levels. Massage therapy has proven beneficial for relaxation purposes.Aim:To evaluate the effectiveness of back massage in relieving pain during the first stage of labor in primi mothers.Methodology:The study included 40 primipara mothers belonging to the age group 22–25 years, equally divided into 2 groups: Experimental (massage therapy) and control (routine care). The socio-demographic data, labor assessment parameters (cervical dilation, status of fetal membranes, frequency and duration of uterine contractions during the latent and active phase of labor, and the total duration of the first stage of labor), and the level of labor pain (numerical rating pain scale) were recorded. Data analysis was performed by one-way ANOVA and two independent samples t-test (P ≤ 0.05 as significant).Results:During the latent and active phase of labor, majority of the mothers experienced 4–5 contractions in a span of 10 min. During the latent phase of labor, uterine contractions for 20–40 s were exhibited by 90% and 75% mothers in the experimental and control group, respectively; and during active phase, contractions of >40 s were exhibited by 85% mothers in both groups. A significant difference in the post-test pain scores was noted between the 2 groups (P < 0.0001).Conclusion:Our study proved that back massage was effective in reducing pain during the first stage of labor in primipara mothers in comparison to those who were subjected to routine care.

Epidural analgesia for a vaginal birth after caesarean section: Acase report

The use of epidural for vagina birth after caesarean section is contentious even in established Labour and Delivery Units because of concerns regarding maternal and fetal wellbeing following the occurrence of a uterine rupture as epidural analgesia may obscure the pain following such. Epidural analgesia has remained the major option for the management of pain in labour. Recently, there has been anecdotal evidence of increase in the use of epidural in labour and consequently brought to the fore a wide variety of case-mix on the floor. We report a case of labour epidural analgesia for vaginal birth after caesarean section (VBAC). The Parturient was a 28 year old booked G2P1+0, gestational age 37weeks in latent phase of labour. She had a previous caesarean section done for fetal distress and a lower uterine incision was used for the delivery of the fetus.Epidural analgesia was requested by the parturient and this was established in the sitting position using a size 18g Tuohy needle observing unit protocol. It was then activated with 8ml of 0.125% plain bupivacaine and then 5ml after 2 minutes. We ensured safety by ensuring close monitoring of the fetus using a cardiotocography and also of the parturient using a multiparameter monitor. At 4hours 40 minutes after admission, she had an unassisted vaginal delivery of a live 2.75kg male neonate with an Apgar score of 8 in 1 minute and 9 in 5. Baby was healthy and normal and the third stage of labour was managed using 10 international units of intravenous oxytocin and 20IU oxytocin in intravenous fluid 5% dextrose water.Conclusion: Women for VBAC should not be denied epidural labour analgesia. Monitoring gadgets and recruiting more manpower should be advocated especially in emerging Labour and Delivery Units and engender resource-constrained environment.