Introduction to labor

PRESENTED BY
Bidhya Gupta
Lecturer.,
Chitwan Medical
College
College 0f Nursing

Labour
Definition
Series of events that takes place in the genital organ
in an effort to expel the viable products of conception out
of the womb through the vagina into the outer world is
called labour.

Normal labour (Eutocia)

Labour is called normal if it fulfills the

following criteria:
Spontaneous in onset and at term.
With vertex presentation
Without undue prolongation
Natural termination with minimal aids
Without having any complications affecting the

health of mother and/or baby.

Abnormal labour
(Dystocia)
Any deviation from the definition of normal

labour is called abnormal labour.

False
labour
pain
Features
1. Dull in nature and usually confined to

the lower abdomen and groin.

2. Continuous and unrelated with
hardening of the uterus
3. Without any effect on dilatation of the
cervix.
4. Usually relieved by medications

True labour pain

Features of true labour pain:
Painful uterine contractions (labour pain) at

regular intervals
Contraction with increasing intensity and
duration Show Progressive effacement and
dilatation of the cervix
Formation of the bag of water.

fference between True labor and False la

Niggling / Spurious labor / False labor

True labor

Uterine contraction :
Not always present
Lasts for 3 to 4 minutes
Irregular
Felt in lower back radiates to lower
Portion of abdomen
May or may not be painful
Can stop with comfort measures
No back ache
Intensity stop with position changes,
Walking
Cervix :
No shortness , Soft
No dilatation
No tensed membrane
Posterior position
No show

Uterine contraction :
Always present
Not exceed > 90 seconds
Regular and rhythmic
Felt in back or abdomen above navel

Fetus :
No head engagement

Fetus :
Head engagement

Abdominal tightening ,discomfort and

Pain will not stop with comfort measures
May have back ache
Increase intensity with walking
Cervix :
Shortening
Dilatation
Tensed membrane
Anterior position
Show presents

STAGES OF LABOR

First stage (or) Dilating stage

Second stage (or) Pushing stage (or) pelvic

stage

Third stage (or) Placental stage

Fourth stage (or) Recovery stage

FIRST STAGE OF LABOUR

DEFINITION

It starts with regular and rhythmic uterine contractions till

completion of full cervical dilatation (10cm).
DURATION :
For

primi gravida 16hrs to 18hrs.

For multi gravida 6hsrs to 10hrs.
There are two phases of first stage of labour:
Latent phase
Active phase
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SECOND STAGE OF
LABOUR / PUSHING
STAGE / PELVIC STAGE

12

DEFINITION
It starts from the full dilation of the cervix and ends with

expulsion of fetus from the birth canal.

DURATION :

Primi gravida
Multi gravida

- 2 hours.
30 minutes.

Third stage/PLACENTAL STAGE

DEFINITION
It starts with separation of placenta till
expulsion of placenta .

DURATION :

Primi gravida :15 minutes

Multi gravida : 5 15 minutes

15

FOURTH STAGE / RECOVERY

STAGE

DEFINITION
The fourth stage begins with the delivery of
the placenta and ends two hours later.
DURATION
1 to 2hours after the expulsion of placenta .

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Factors affecting labor process:

4 Ps [Powers of Labor]
Passenger
Passageway
Powers
psyche

Passenger: [infant]
Fetal head: widest part of body; most difficult to
pass
thru vaginal canal; passage depends on bones,
sutures,
fontanelles.
Cranium - 8 bones meet @ suture lines
Cranial bones move & overlap, allows skull to pass
thru birth canal.
Fontanelles: soft spaces created by junctures of
suture lines - covered by membranes; compress
during delivery to aid in passage of fetus.
Molding of infant head.

Passenger cont.

Skull widest @ antero-posterior diameter

[front to back] than @ transverse diameter
[across].
Antero-posterior diameter measures
differently @ different locations.
Occipitomental diameter- widest - measured from
chin to posterior fontanelle = 13.5 cm
Smallest diameter - lower occiput to anterior
fontanelle (suboccipitobregmatic) = 9.5 cm
Complete flexion allows smallest diameter of
fetal skull to enter pelvis most easily.

B. Fetal Attitude: degree of flexion of fetal

head; chin touches sternum.
Complete flexion: allows smallest diameter
of skull
to pass thru pelvic cavity. Best position!
Moderate flexion: head less flexed making
diameter wider
Poor flexion: brow or face presentation;
presents
skull diameter too wide making delivery
difficult.

C. Fetal lie: [position of fetus in utero] relationship of long

axis of fetus [spine] to long axis of mother:
1. Longitudinal vertex/breech; vertical in
relation to mom; ~ 99%.
2. Transverse horizontal in relation to mom; < 1 %.
C/S; ^ in grand multip stretched uterine muscles; try
version.
3. Oblique - diagonal
D. Fetal presentation: part of fetal head enters pelvis;
1. Cephalic 95.5%
2. Breech 3.5%
3. Face 0.3%
4. Shoulder 0.4% [transverse lie]

E. Fetal position: occiput is landmark

Described in 3 letters:
1st : presenting part in relation to mothers R or L.
Middle: presenting part [occiput, mentum, sacrum]
Last: landmark is anterior, posterior, transverse in
relation to mothers spine. Anterior (A) back of
head against symphysis pubis & face towards
spine. Posterior (P) Back of head = mothers
spine; painful contxs. Transverse (T) = fetus
sideways.
Common positions in vertex presentations: *LOA,
ROT, ROP, ROA, LOT, LOP.

Passageway:
Refers to fetus passing thru uterus, cervix,
vaginal
canal. Single most important determinant to
mechanism
of labor.

A. 4 Types of pelvis:

1. Gynecoid 50% of women; rounded, oval

shape; easy vaginal delivery; considered
normal female pelvis

2. Android 20 % of women; vaginal delivery

difficult; prob. C/S; true male pelvis

3. Anthropoid oval; assisted vaginal birth

usually with forceps; 20-25%

Platypelloid < 5 % of women;

flattened pelvis; vag. del. difficult

4.

B. Structure of Pelvis: bones held together

by ligaments. Supports/protects organs

inside.

False Pelvis: Outer - broader. Hip bones.

True Pelvis: Internal narrower. Holds bladder,
rectum, & reprod. Organs.
True pelvis - 3 parts - inlet, midpelvis, outlet.
[Most important in childbirth]

If pelvis too small, home birth not done.

CPD - cephalopelvic disproportion > C/S.

PELVIC INLET:
Antero-posterior diameter - front to back ~
12.5
cm. (diagonal conjugate)
True conjugate - actual opening of outlet.
Subtract width of symphysis pubis [1.5 cm]
from
diagonal conjugate. 12.5 1.5 = 11.0 cm.
(complete flexion = 9.5cm diameter)

Transverse diameter [across] ~ 13.5 cm

MIDPELVIS: narrowest part of pelvis that

fetus must pass through - ischial spines
PELVIC OUTLET: Trouble passing through
pelvic opening, pelvis too small or poor
fetal attitude.

Soft Tissue: Ligaments, Uterus, cervix,

vaginal canal

Powers:
Uterine contxs: primary force moving
fetus thru maternal pelvis during 1st
stage of labor.
Maternal Efforts: woman adds voluntary
pushing force to force of contx.s during
2nd stage of labor to propel fetus thru
pelvis.

Psyche:
Psychologic Response to birth process:

Prepared for childbirth - Childbirth classesPrenatal care.

Previous childbirth experience - Complicated?
Support from significant other - Separated?
Marital strain? Abuse?
Emotional status - anxious/depressed, drug use,
psych history
Culture - background may influence response to
pain. Some moan, some stoic, some verbally
expressive.
Fear/anxiety exacerbate pain uterine
dysfunction & ineffectual labor & posttraumatic
stress disorder