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Labor:

Labor is defined as the onset of rhythmic contractions and the relaxation


of the uterine smooth muscles, which results in effacement or progressive
thinning of the cervix, and dilation or widening of the cervix. This
process culminates with the expulsion of the fetus and expulsion of the
other products of conception (placenta and membranes) from the uterus.
WHO defines normal birth as: "spontaneous in onset, low-risk at the start
of labor and remaining so throughout labor and delivery. The infant is
born spontaneously in the vertex presentation between 37 and 42
completed weeks of pregnancy. After birth mother and infant are in good
condition"

Normal Labor:
Normal labor or eutocia is a physiological

process by which fetus,

placenta and membrane are expelled through the birth canal between 38
to 42 weeks. Labor 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 aid.
Without having any complications affecting the health of the mother
and /or the baby.

Abnormal Labor:
Any deviation from the definition of normal labor is called abnormal
labor. Dystocia of labor is defined as difficult labor or abnormally slow
progress of labor. Other terms that are often used interchangeably with
dystocia are dysfunctional labor, failure to progress (lack of progressive
cervical dilatation or lack of descent), and cephalopelvic disproportion
(CPD). It is the consequence of four distinct abnormalities that may exist
singly or in combination.
Uterine forces that is not sufficiently strong or appropriately coordinated

to efface and dilate the cervix.


Forces generated by voluntary muscles during the second stage of labor

that are inadequate to overcome the normal resistance of the bony birth
canal and maternal soft parts.

Faulty presentation or abnormal development of the fetus of such


character that the fetus cannot be extruded through the birth canal.
Abnormalities of the birth canal that form an obstacle to the descent
of the fetus
Delivery:
Delivery is the expulsion or extraction of viable fetus out of the
womb. It is not synonymous with labor. It can be take place without
labor as in elective caesarean section. Delivery may be vaginal, either
spontaneous or aided and or may be abdominal.
Premature labor:
Premature labor is defined as labor occurring before the 37 th week of
gestation.

Stage of labour
Labour has four distinct stages. The first starts with
regular contractions that open up your cervix and
lasts until the cervix is fully opened (dilated) to
about 10cm diameter. The second stage of your
labour begins when the cervix is fully dilated and
concludes with the birth of your baby. The third
stage is from the birth of your baby to the delivery of
the placenta and membranes.

First stage of labour

The first stage of labour is the period from the onset of labour (when
you begin to get regular painful uterine contractions) to complete
dilatation of the cervix. It is called cervical dilating stage. It is
concerned with the thinning of the cervix. This initial stage is usually
the longest but every birth is different and the timescale varies. It can
often take 6-12 hours or sometimes more for a first baby and is
usually quicker in subsequent labours. During the first stage of labour
you may experience a range of emotions. Many women experience
nausea or actually vomit near the end of the first stage of labour.

Cont.

Additionally, you may have a strong urge to push (known as bearing


down) with each contraction as your baby's head is pushed against
the cervix.
This is when your breathing exercises come in useful as you will be
advised not to push until the cervix is fully dilated. At this stage you
may experience some loss of bladder or bowel controls due to the
pressure of the babys head so dont feel embarrassed or concerned
because this is normal. Once the cervix is fully dilated your baby is
ready to be born and the second stage of labour begins. The first
stage can be divided functionally into three phases: the latent phase
and the active phase.

The Latent Phase


Latent phase labor (also known as prodromal labor) precedes the
active phase of labor. It is period of effacement, which begins with
the onset of labour and ends with the cervix is 3-4cm dilated. The
latent phase begins with mild, irregular uterine contractions that
soften and shorten the cervix. It is often long about 8hours, in which
average dilatation of cervix is only 0.35cm/hrs in primigravida. In
multipara, the latent phase is short about 4 hrs and effacement and
dilatation occur simultaneously. In this phase contractions are short
and mild in strength. Contractions usually occurs in every 15-20
minutes,lasting 20-25sec.

Shows the thin cervix now opening (or dilating) to about


3 to 4 cm.

The active phase


Active phase labor is a time of rapid change in cervical dilatation,
effacement, and station. Active phase labor lasts until the cervix is
completely dilated. In this phase acceleration of cervical dilation
proceeds at a rate of 1cm/hrs in primigravida and 1.5cm/hrs in
multipara.
Women in active phase labor:
Are at least 4 cm dilated?
Have regular, frequent contractions that are usually moderately
painful?
Demonstrate progressive cervical dilatation of at least 1.2-1.5
cm per hour.
Usually are not comfortable with talking or laughing during
their contractions.

Shows the cervix now open to about 7 to 8 cm

The transition phase


Towards the end of the 1st stage - known as transition, the
contractions generally become very strong and close together
(or for some women back to back, with little to no rest in
between). Many women experience vague urges to push, or
feelings of pressure in their bottom, as their baby's head moves
lower down the birth canal. It is stage of labour when the
cervix is from around 8 centimeters dilated until it is fully
dilated with strong contractions 2-3 minutes apart lasting 4560 seconds. Women often experience feelings of being 'out of
control' or not wanting to 'do it anymore' during transition.

Shows the cervix almost fully open, with the bag of waters bulging down in front of the baby's head

Sign and symptoms of first stage of labor


Painful and progressive uterine contraction with

progressive dilatation of cervix.


Bulging of membranes during contractions.
Complete effacement and dilatation of cervix.
There might/might not be rupture of membrane.
Presentation of show.

Second Stage of Labor

The second stage of labor begins when cervix is fully dilated


and is complete with the birth of the baby. This stage lasts on
average between 1 and 2 hours for a first baby and is usually
shorter in a subsequent pregnancy (2 hrs in primi and 30 min. in
multi). As your baby's head descends onto the perineum your
back passage may bulge because the baby's head is just behind it
and you may feel the need to defecate. Contractions may
become less frequent but more intense. It has got two phases.

The propulsive phase- starts from full dilatation up


to the descent of the presenting part to the pelvic
floor. In this phase descent and rotation of head occur.
The soft tissues of the vagina and pelvic floor
gradually stretched and thinned under the pressure of
the advancing fetal head.
The expulsive phase- it is distinguished by maternal
bearing down efforts and ends with delivery of the
baby.

Sign and symptoms of second stage of labor


Progressive and expulsive uterine contraction.
Bulging of perineum.
Anus gaping with escape of fecal matter.
Complete taking up of the cervix.
Rupture of membrane.
Urge to defecate with descent of the presenting part.

Woman has the urge to push.


Presenting part visible at the perineum.
It is complete with delivery of the baby.

Third Stage of Labor


The third stage of labor is referred to as the "placental"
stage. This is the period from birth of the baby until
delivery of the placenta. Its average duration is about 530 minutes in both primigravida and multiparae. The
duration is however, reduced to 5 minutes in active
management.An 'active' third stage usually speeds up
the delivery of the placenta and helps to reduce the
chance of a postpartum hemorrhage.

Fourth Stage of Labor.

The fourth stage of labor is referred to as the "recovery


or stabilization" stage. It is stage of observation for at
least one hour after expulsion of the placenta. The
forces involved are uterine contractions. During this
period general condition of the women and behaviour
of the uterus are to be carefully watched.