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The Normal Labor

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The Labor• Labor is the physiological process

in which products of conception (the fetus, membranes, umbilical cord, and placenta) is passed from the uterus to the outside world between 37 and 42 completed weeks of pregnancy.

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• The period begins with the onset of regular uterine contractions (UCs) and lasts until the expulsion of the placenta; we called the Intrapartum.

• Delivery is the birth of baby itself.• Delivery can occur in two ways,

vaginally or by a cesarean delivery.

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Normal Labor Signs1. Pre-labor (1 - 4 weeks before labor):

• Baby’s head drops down and lightening feels

• Increased back pain and cramps• Abdominal pain• Joints feel looser• Diarrhea • Cervix effacement and dilation (opening

and thins out of cervix)

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2. Early labor (Hours before labor):• Bloody show: vaginal discharge

becomes thicker and pink.• Water breaks: rupture and break of

the amniotic sac.• Uterine contractions (UCs): painful,

regular, strong contraction.

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True vs. False LaborFalse True Irregular Regular, become closer and

stronger Contraction

May last 1 – 2 min. Last 30 – 60 sec. Timing

Upper abdomen Lower abdomen and back Contraction position

Go away with changing position, walking, hot bath

Get stronger with changing position Position

No changes Dilation and effacement Cervix

No significant changes Drops into pelvis Fetus

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Factors affecting Labor (5 P’s)In every labor; there are five essential factors affect the

process. These are easily remembered as the five P’s:1. Passenger: the fetus2. Passageway: the pelvis and birth canal3. Powers: the uterine contractions4. Position: maternal postures and physical

positions 5. Psyche: the response of the mother

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1.Passenger (The Fetus):The fetus relationship to the passageway is the major factor in the birthing process. The relationship includes:• Fetal skull and size• Number of fetuses• Position of feus− Fetal lie: relationship of fetal spine to maternal spine;

longitudinal (vertical) or transverse (horizontal)− Fetal presentation: part of fetus that enters pelvis first − Fetal attitude: relationship of fetal body parts to each other;

flexion (normal) or extension (abnormal)− Fetal position: fetal direction in the pelvis− Fetal station: position of the baby's head relative to the lower

bone of pelvis called the ischial spines

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Fetal Lie & Presentation

10Fetal Attitude

Complete extension (abnormal)

Complete flexion(normal)

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Fetal Position

12Fetal Station

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2. Passageway (The pelvis):

• The passage includes the bony pelvis, the soft tissues of the cervix, and the vagina.

• The maternal pelvis is the greatest determinant in the vaginal delivery of the fetus.

• During the first stage of labor, the cervix opens (dilates) and thins out (effaces) to allow the baby to move into the birth canal.

• The cervix must be 100 percent effaced and 10 centimeters dilated before a vaginal delivery.

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3. Powers:• Powers refer to the involuntary Uterine

Contractions (UCs) and voluntary pushing of fetus.

• Contractions are a tightening and relaxing of the muscles in the abdomen and the back.

• Uterine Contractions have two major goals:1. To dilate the cervix2. To push the fetus through the birth canal

• After each contraction there is a uterine relaxation that allows blood flow to the uterus.

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4. Position:Maternal position during labor and birth.

5. Psyche:The psychological state of the mother and her response. We should give her the support and health care, and allow the family to give her the support.

18A. Positions for labor B. Positions for pushing

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Mechanism of LaborIn the normal labor; there are series of changes in position and attitude of the fetus to accommodate himself to the pelvic to pass easily through the birth canal:1. Engagement2. Descent3. Flexion4. Internal rotation5. Extension6. External rotation7. Expulsion

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1. EngagementThe greatest diameter of the fetal head passes through the pelvic inlet.2. DescentMovement of the fetus through the birth canal during the first and second stages of labor3. FlexionThe chin of the fetus moves toward the fetal chest which reduce the fetal head diameter from nearly 12 to 9.5 cm.

21Flex

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4. Internal rotationThe rotation of the fetal head until the longest diameter of the fetal head match the longest diameter of the maternal pelvic.

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5. ExtensionThe fetal head passes beneath the synthesis pubis and passes out of the birth canal making the crowning.

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6. External rotation (Restitution)After the head has delivered, the shoulders rotate internally to fit the pelvis.

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7. ExpulsionThe shoulders and remainder of the body are delivered

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The Stages of Labor1. 1st stage (cervix dilation): begins with onset of

labor and ends with complete cervical dilation.2. 2nd stage (baby delivery): begins with complete

dilation of cervix and ends with delivery of baby.3. 3rd stage (placenta delivery): begins after

delivery of baby and ends with delivery of placenta.

4. 4th stage (postpartum): begins after delivery of the placenta and is completed 4 hours later.

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First stage:• This is the onset of labor to complete

dilation of cervix.• A typical pattern for the latent phase

contractions begins by lasting about 40 seconds and coming every ten minutes. By the time; the contractions will last for more than a minute and come every 30 seconds.

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First stage:• This stage divided into two phases:1. Latent phase: contractions become

frequent, very strong, and painful. Cervix dilates about 4 cm.

2. Active phase: dilatation of the cervix from 6 to 10 centimeters. Contractions become regular, longer, more severe, and more frequent In most cases, the active phase is shorter than the latent phase.

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Second stage:• It starts when the cervix is completely opened

and ends with the delivery of the baby. • The second stage is often referred to as the

"pushing" stage when the mom push the baby outside to the world.

• When the baby's head is visible at the opening of the vagina, it is called "crowning."

• The second stage is shorter than the first stage, and may take between 30 minutes to 3 hours for a woman's first pregnancy.

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Third stage:• Is the delivery of the placenta; which

occurs after the birth of the baby and the umbilical cord is clamped.

• Once the baby has been delivered, it may be left for two to three minutes before cut the umbilical cord.

• The mother may experience some bleeding.• This stage usually lasts just a few minutes

up to a half-hour.

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34clamp and cut of the umbilical cord

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Fourth stage:• The hour to four hours after delivery, and

sometimes for about six weeks, or with the stabilization of the mother.

• The baby should be assessed and the mother should have regular assessments for uterine contraction, vaginal bleeding, heart rate and blood pressure, and temperature, for the first 24 hours after birth.