Stages of Labor

1st Stage: Cervical Stage

> Period from the onset of true labor contraction until full dilatation & effacement is achieved

3 Phases

1. Latent phase

> cervical dilatation: 0-3cm

2. Active phase

> cervical dilatation: 4-7 cm

> lasts approximately 6 hrs

> uterine contraction are moderate, 3-5

min apart, & last 40-60 sec

3. Transition phase

> cervical dilatation: 8-10 cm

> lasts 1-2 hrs

> uterine contractions are strong, 2-3 min apart and last 60-70 sec

2nd Stage: Expulsive Stage

> occurs from full cervical dilatation until the birth of the baby

3rd Stage: Placental Stage

> period from delivery of the baby to the expulsion of the placenta

4th Stage: Immediate Postpartum Period

> period from delivery of placenta until the condition of the woman has stabilized
DURATION OF LABOR

Stage of

Labor

1st Stage

2nd Stage

3rd Stage
hrs

5-20 mins

4th Stage

2-4 hours

Primis

Multi

10-12 hours

30 mins-2

5-20 mins

2-4 hours

6-8 hours

20-90 mins

Essential Factors of Labor

1. Passages

hard passages: bony pelvis

soft passages: lower uterine segment, cervix, vagina, pelvic floor &
perineum

Functions of the pelvis:

1. Provides protection to the in the pelvic cavity. organs found

2. Provides attachment to muscle, fascia & ligaments.

3. Supports the uterus during pregnancy.

4. Serves as birth canal.

Types of Pelvis

1. Gynecoid

>female type of pelvis

> inlet is round shaped, straight side walls, with transverse diameter larger than anteroposterior
diameter, has a wide pubic arch.

2. Android

> male type of pelvis

>AP diameter is wider than its transverse diameter

3. Anthropoid

> deepest type of pelvis

> inlet is oval shaped with AP diameter wider than transverse diameter

4. Platypelloid

> flat pelvis

> transverse diameter is wider than AP diameter

• Head of the fetus is the most important part of its body because:

1. Being the largest part of the fetal body, it is the part that would most like encounter difficulty during
delivery.

2. It is always the presenting part so its measurements, position & presentation are important factors
that affect labor outcome.

3. It is the least compressible of all fetal parts.

Cranial Bones of the fetal skull

1 frontal bone,one occipital bone 2 parietal bones, one sphenoid bone 2 temporal bones, one ethmoid
bone
Suture Lines

1) Sagittal > located between 2 parietal bones

2) Frontal > located between 2 frontal

bones

3) Coronal > located between frontal and parietal bones

4) Lambdoidal > lacated between parietal

& occipital bones

Fontanels

>Are membrane covered spaces located between the intersections of suture lines

1. Anterior fontanel

> formed by the intersection of the sagittal, frontal & coronal sutures

2. Posterior fontanel

> formed by the intersection of sagittal

& lambdoidal sutures

Fetal Lie

>Refers to the relationship of the long axis of the fetus to the long axis of the mother

a) Longitudinal Lie

> long axis of the fetus is parallel to the long axis of the mother

b) Transverse Lie

> long axis of the fetus is at right angle to the long axis of the mother

c) Oblique Lie

> fetus assuming this lie usually rotates to transverse or longitudinal lie in the course of labor

Presentation
Determined by fetal lie and attitude

Attitude

> Describe the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each
other

Good attitude> in complete flexion

• Moderate flexion > chin is not touching the chest

Partial extension > poor flexion, the back is arched, the neck is extended

Complete extension > presents occipitomental diameter of the head to the birth canal

Types of Fetal Presentation

1. Cephalic Presentation

a) Vertex presentation

> occurs when the head is completely flexed that the chin touches the chest

> most ideal type of presentation

> occipitobregmatic part is presented

> presenting part is posterior fontanel

b) Sinciput presentation

> occurs when the head is partially flexed & the anterior fontanel is the presenting part

c)Brow presentation

> occurs when the head is extended or bent backward causing the occipitomental diameter to be
presented for delivery

d) Face presentation

> occur when the head is sharply extended causing the occiput to come in contact with the back of the
fetus

e) Chin presentation

> occur when the head is hyperextended with the chin as the presenting part
2. Breech

> feet or buttocks come out first during delivery

a) Complete breech

b) Frank breech

c) Footling

3. Shoulder presentation

> fetus is lying perpendicular to the long axis of the mother & the shoulder is the presenting part

Causes

1. Relaxed abdominal walls due to grand multiparity

2. Pelvic contraction

3. Placenta previa

4. Compound presentation

> occurs when there is prolapse of the fetal hand along side the vertex, breech or shoulder

Attitude

>Refers to the degree of flexion of the fetal body, head & extremities or the relationship of fetal parts to
each other

Station

>Relationship of the presenting part of the fetus to an imaginary line drawn at the level of the ischial
spines of the mother

Mechanisms of Labor

1. Engagement, descent with flexion

2. Internal rotation
3. Extension

4. External rotation

5. Expulsion

Person in Labor

Maternal attitude and behavior

during labor depend on:

1. Perception and meaning of childbirth

2. Readiness & preparation for childbirth

3. Past experiences

4. Coping skills

5. Cultural & social background

6. Presence of significant others & support system

Powers of Labor

Primary power: Uterine Contractions

Characteristics:

1. Involuntary

2 Intermittent

3. Involve discomfort

a) compression of nerve ganglia in the cervix

b) stretching of the cervix during dilatation

c) stretching of the peritoneum overlying

the uterus

d) hypoxia of the contracted myometrium

e) stretching of ligaments

Phases of Uterine Contractions

> the time when contraction is starting and intensity is building up

2. Acme

> peak of contraction

3. Decrement

> the time when muscle start to relax

Intensity

>Refers to the strength of uterine contractions

Classifications:

1. Mild> slightly tense fundus that is easy to indent with fingertips

2. Moderate > firm fundus that is difficult to indent with fingertips

3. Strong> rigid boardlike fundus

Frequency

>Measured from the beginning of a contraction to the beginning of the next

Duration

>Measured from the beginning of contraction to the end of the same contraction

Interval

Measured from the end of a contraction to the beginning of the next contraction

Secondary Forces

>The force created by increased intra- abdominal pressure which is achieved when the mother “bears
down” or “pushes”

Position
• Lithotomy

Indication:used when surgical

Procedures are to be performed

Advantage:control of delivery because

Perineum can be seen

Disadvantage: muscle’strain when legs are improperly placed on the stirrups

Dorsal recumbent

Indication: home delivery Advantage:good control of delivery because perineum can be seen

Disadvantages: may be uncomfortable

Side-Lying

Indication: heart disease

Advantages: increase comfort to mother

Disadvantages:

1. less control of delivery

2. an assistant is needed

Responsibilities of Nurses

During Labor

First Stage of Labor is divided into 3 Phases

1. Latent phase

2. Active phase

3. Transitional phase
1. Latent phase

a) establish rapport

b) encourage verbalization of feelings

c) promote comfort & relief measures

2. Active phase

a) coach woman on breathing & relaxation

techniques

b) inform the patient of the progress of labor

& wellbeing of the fetus

c) discourage the woman from bearing down

d) let woman stay in bed if BOW has ruptured

e) provide relief measures

3. Transition Phase

a) reassure woman that although this the most difficult period of labor, this is

also the shortest.

b) do not give narcotics

c) discourage bearing down

d) do not let woman fall asleep

Internal examination

Purpose:

To assess status of amniotic fluid, consistency of cervix, effacement, dilatation, presentation, station, &
obtain

Pelvic measurement.

Guidelines when doing I.E.

1. It is performed in between contractions when the uterus is relaxed.

Ruptured.

3. IE is not done in the presence of vaginal bleeding & cord prolapse.

4. IE is a sterile procedure, wash hands and

Wear sterile gloves.

5. Place patient in dorsal recumbent

Position.

6. During IE

a) for escaping fluid & cord

prolapse before inserting fingers

b) insert middle and index finger

c) assess cervical consistency

d) assess effacement

e) assess dilatation

Danger Signs during Labor

1. Water breaks but labor does not

Start

>Most women will start labor within 24 hours after their waters break. If labor has not started after I day
and I night, the woman and her baby could get a serious infection.

What to do?

a) Mother must not put anything in the vagina

If she has a fever or there is a bad smell in the vagina, an infection is starting. She needs intravenous (IV)
antibiotics. Even if labor starts, the woman and her baby could die. Go to a health center or hospital.

Try to get labor started. The woman should swallow 2 tablespoons of castor oil, roll her nipples, or have
someone suck them for a while every few hours until labor starts.
2. Baby Lying Sideways

>A baby lying sideways cannot be born without an operation.

>What to do?

Take the mother to the hospital

2. Too Long Labor

EXERCISE DURING PREGNANCY

Prenatal Yoga

Perineal and Abdominal Exercises

Tailor Sitting

Squatting

Kegel Exercises

Pelvic Rocking