Normal Labor and Delivery

Asja ĆosićMentor: A. Žmegač Horvat

Labor• labor

– series of rhythmic, progressive contractions of the uterus

– gradually move the fetus through the cervix and birth canal

• main stages of labor– first stage: labor proper – contractions cause the

cervix to dilate and to thin and pull back (efface)• cervix merges with the rest of the uterus

– second stage: delivery of the fetus– third stage: delivery of the placenta

Labor• within 2 weeks before or after the estimated date of delivery• after 36 weeks a cervical examination is performed to estimate

when labor will start• labor lasts - 12 to 18 hours in a woman's first pregnancy - 6 to 8 hours in subsequent pregnancies• main signs of the start of labor are:

– back pain– contractions in the lower abdomen at regular intervals

• at first contractions may be weak, irregular, and far apart• with time, they become longer, stronger, and closer together

– bloody show: a small discharge of blood mixed with mucus from the vagina about 72 hours before contractions start

– rupture of membranes: the amniotic fluid flows out through the vagina

FIRST STAGE

• from the beginning of labor to the full dilation of the cervix to about 4 inches (10 cm)

• initial (latent) phase• active phase

FIRST STAGE - Initial (Latent) Phase

• contractions become progressively stronger and more rhythmic

• discomfort is minimal• the cervix thins and opens to approx. 4 cm• lasts an average of 8½ hours (up to 20 hours) in a

first pregnancy and 5 hours (up to 12 hours) in subsequent pregnancies

FIRST STAGE - Active Phase• cervix opens to the full 10 centimeters• fetal presenting part begins to descend into the

mother's pelvis• mother feels urge to push as the baby descends, but

she should resist it• 5 to 7 hours in a first pregnancy and 2 to 4 hours in

subsequent pregnancies

SECOND STAGE

• from the complete opening of the cervix to delivery of the fetus

• 45 to 60 minutes in first pregnancy• 15 to 30 minutes in subsequent pregnancies• during this stage, the woman pushes

CARDINAL MOVEMENTS IN LABOR

• Engagement • Descent • Flexion • Internal Rotation • Extension • External Rotation • Expulsion

THIRD STAGE• from delivery of the fetus to delivery of the

placenta• usually lasts only a few minutes but may last up

to 30 minutes• maternal blood loss is limited by contraction of

the uterus• can be managed either expectantly or actively

Fourth stage

• can refer to the immediate puerperium, or the hours immediately after delivery of the placenta

Admission to a Hospital or Birthing Center

• strength, duration, and frequency of contractions are noted• weight, blood pressure, heart and breathing rates, and temperature

are measured• urine and blood samples are taken for analysis• abdomen is examined to estimate the size, position and

presentation of the fetus• vaginal examination is done to determine whether the membranes

have ruptured and how dilated and effaced the cervix is• intravenous line – to prevent dehydration and for therapy, if

needed• oxytocin or prostaglandin are used to induce labor• fetal monitoring: electronic monitoring is used to continuously

monitor fetal heartbeats and uterine contractions (CTG)

References:http://www.merck.com/http://en.wikipedia.org/wiki/Childbirth