STAGES OF LABOR
Comparison of Length of Labor in Primigravida & Multigravida
Stages of labor Primigravida Multigravida
First stage 12.5 hours 7hours,& 20 minutes
Second stage 80 minutes 30 minutes
Third stage 10 minutes 10 minutes
Total 14 hours 8 hours
First stage of labor- FROM TRUE LABOR PAINS TO COMPLETE DILATATION OF CERVIX
• >UTERINE CONTRACTION-
• Phases of uterine contraction
– INCREMENT/CRESCENDO- increase intensity of the contraction, longest phase than the two
– Acme /apex- height or peak of contraction
– Decrement /decrescendo – decrease intensity of contraction
– > Bloody show – appear 24-48 hours before labor begins
Dilatation- process by which external cervical enlarges from few millimeter to full
dilatation ( 10 cm )
• Effacement- shortening and thinning of the cervix by retraction.
• > primigravida – effacement occurs before dilatation
• > multigravida – dilatation may precede before effacement
• In general multigravida deliver 6 hours earlier than primigravida
• Precipitate labor- labor completed in less than 3 hours.
Prolonged labor
primigravida- labor completed more than 18 hours
Multigravida- more than 12 hours
• Position of fetus can be assessed through:
• 1. Leopold maneuver
• 2. Vaginal examination
• 3. Auscultation of FHB
Fetal assessment during labor
• FHR- 120 – 160 bpm
• FH Pattern
– Early deceleration- monitor
– Late deceleration – O2 left side
– Variable deceleration- O2 left side
– Signs of fetal distress – unstable FHB , meconium stained, prolapsed cord
Second stage of labor – from full dilatation of cervix
up to delivery of the baby
• 1. Latent or early phase- start of regular contraction , mild
and short lasting 20-40 seconds, dilatation and
effacement occurs , 0-3 cm
• 2. Active phase-cervical dilation occurs rapidly from 4 to 7
cm, ( 1 cm in primi per hour and 2 cm in multi per hour )
contraction grow stronger 40-60 second every 3-5 mins.
• This phase last 3 hours in nullipara and 2 hours in
multipara
• 3. Transition phase –
• >contraction is at peak in intensity,
• > duration 60-70 seconds very 2-3 minutes
• > cervical dilation 7-10 cm.
• > mother experience intense pain
Mechanisms ( cardinal movements of labor )
• 1. Descent- downward movement of the biparietal diameter of fetal head within the
pelvic inlet.
• 2. Flexion – as descent occurs, head bends forward onto the chest making the
smallest anteroposterior diameter (suboccipitobregmatic diameter) is presented to
the brim canal.
• 3. Internal rotation- head enters the pelvis with the anteroposterior diameter in
diagonal/transverse position.
• 4. Extension – as occiput is born, the back of the neck stops
beneath the pubic arch and acts as a pivot for the rest of the
head. Fetal head passes under the symphysis pubis and is
delivered occiput first , followed by chest and chin
• 5. External rotation – after the head, it rotates anteroposterior
position, assumes to enter the outlet back to the diagonal or
transverse position of the early part of [Link] rotates to
full alignment with neck and shoulder for shoulder delivery. To
accommodate shoulder the head goes back to its position.
• 6. Expulsion- once the shoulders are out, the rest of the body are spontaneously
born because of smaller size. When the body of the baby emerged from mother/s
body birth is complete. This time is recorded as the time of birth.
Third stage of labor- placental stage
• > from birth of baby to expulsion of placenta
• Signs of placental separation:
• 1. Cullen’s sign- earliest sign, uterus change in shape from discoid to globular
• 2. sudden gush of vaginal blood
• 3. lengthening of umbilical cord
Types of placental delivery
• 1. Shultz method- placenta separates from the center to the edge, placenta is
delivered with the fetal surface first like an inverted umbrella. 80 % of placenta are
delivered
• 2. Duncan method – placenta separates from the edge to the center. Maternal
surface of placenta is seen first.
Rooming In
• Hospital that offers rooming –in -is “baby friendly”- keeping the newborn and
mother together will form a sound mother-child relationship.
– Complete rooming-in the mother and child are together 24 hours.
– Partial rooming-in the baby remains in the room of the mother during day time then
placed in the nursery near the mother’s room.