Labor is a process that is subdivided into 3 stages.
•The first stage starts when labor begins and ends with full cervical dilation and effacement.
•The second stage commences with complete cervical dilation and ends with the delivery of the fetus.
•The third stage initiates after the fetus is delivered and ends when the placenta is delivered.
First Stage of Labor
The first stage of labor begins when labor starts and ends with the cervix fully dilated to 10 cm. Labor can be classified as
early labor, active labor and transitional labor.
1. Early labor: The time when contractions begin and your cervix starts to open (dilate) and thin (efface). Your cervix may
be about 5 centimeters dilated at the end of early labor.
2. Active labor: This stage of labor consists of strong contractions that last up to one minute each and happen about
three minutes apart. Some people request an epidural (an epidural is the most common—and most effective—type of
anesthetic for pain relief during labor) during this time because contractions can be painful. Healthcare providers may
also give you oxytocin (Pitocin®) to speed up labor.
An epidural is a numbing medicine given by inserting a needle and a catheter (a small, flexible tube) into the lower part
of a woman's back.)
3. Transitional labor: This is the time just before your cervix is 10 centimeters dilated. It's a short but intense time when
your contractions come very quickly and last longer than one minute. This phase may make you sweat, vomit or feel
shaky. It happens just before you begin to push.
However, distinguishing between true labor and false labor (painful contractions without cervical changes) can be
challenging.
The first stage is divided into two phases:
1. Latent Phase (0 to 6 cm dilation) - The cervix dilates slowly, and the process is less predictable.
2. Active Phase (6 to 10 cm dilation) - This phase involves rapid and predictable cervical dilation at a rate of 1.2 to 1.5 cm
per hour.
Second Stage of Labor
The second stage of labor begins when the cervix is fully dilated to 10 cm and ends with the delivery of the baby. During
this stage, the fetus descends through the birth canal, either with or without maternal pushing efforts. This process
involves seven cardinal movements:
[Link] - The widest part of the baby’s head (measured ear to ear) passes through the pelvic inlet. - This marks
the start of the birthing process, with the baby reaching station 0 in the pelvis.
[Link] - (or "lightening") occurs as the baby’s head moves deeper into the pelvic cavity.
[Link] - the baby’s chin tucks toward the chest, reducing the head’s diameter to fit through the pelvis. [Link]
Rotation - The baby rotates its head and body to align with the changing shape of the pelvis, moving from side-to-side to
front-to-back.
[Link] - After passing the pelvic cavity, the baby’s neck rests under the pubic arch. - Extension occurs as the head,
face, and chin are born.
[Link] Rotation - After the head is delivered, the baby rotates 90 degrees to face one of the thighs, allowing better
alignment for the shoulders.
[Link] - Following external rotation, the shoulders are delivered, first the top and then the bottom, completing the
birth.
Women who have delivered vaginally before often experience a shorter second stage. For first-time mothers (nulliparous
women), the second stage can take up to 3 hours without anesthesia or 4 hours with anesthesia. For multiparous women
(those with prior vaginal deliveries), it usually lasts less than 2 hours without anesthesia or 3 hours with anesthesia.
A prolonged second stage occurs when labor exceeds these time limits. Factors that affect the duration include:
•Fetal factors: size, position, and descent.
•Maternal factors: pelvis shape, strength of pushing efforts, medical conditions (e.g., hypertension or diabetes), age, and
previous delivery history.
Third Stage of Labor
The third stage of labor begins with the birth of the baby and ends with the delivery of the placenta. It is marked by
three key signs indicating placental separation:
1. VULVA SIGN- Gush of blood from the vagina.
2. CORD SIGN- Lengthening of the umbilical cord.
3. UTERINE SIGN- Globular-shaped uterine fundus upon palpation.
What are the risks of having a vaginal delivery?
Vaginal deliveries generally carry the least risk. The most common complications during a vaginal delivery are:
1. Failure to progress: This is when labor slows or stops and your cervix doesn't dilate. Your healthcare provider may give
you oxytocin to stimulate contractions and progress labor.
2. Irregular fetal heart rate: This is when your baby's heart rate slows down because their head or umbilical cord is
compressed.
3. Hemorrhage: This is excessive or life-threatening bleeding during or after birth. Sometimes a person doesn't bleed
until several hours after delivery (postpartum hemorrhage).
4. Vaginal tears: These are tears in the tissue around your vagina and rectum that happen during childbirth.
5. Deep vein thrombosis: These are blood clots that develop in your legs or pelvis shortly after delivery. 6. Postpartum
preeclampsia: This is excessively high blood pressure in a person who has just given birth.