Normal Labour
• LABOUR: A series of events that take place
in the genital organs in an effort to expel the
viable products of conception out of the womb
through the vagina into the outer world is
called Labour.
.
• DELIVERY:
it is the expulsion or extraction of a
viable fetus out of the womb. It may
be take place without labour as CS
• It may be vaginal, either spontaneous
or aided or it may be abdominal
NORMAL LABOUR : It is also called EUTOCIA
Labour is called normal if it is fulfils the following criteria
• Spontaneous in onset & at term.
• With Vertex presentation.
• without undue prolongation.
• Natural termination with minimal aids
• Without having any complication to mother & baby.
ABNORMAL LABOUR:
• Any deviation from normal
labour is called abnormal labour.
• It is called as DYSTOCIA.
THE FACTORS OF LABOUR
(1) The powers.
(2) The passages.
(3) The passenger
(1) The primary powers are the contractions and
retraction of the uterine muscle.
The secondary powers are the contractions of the
abdominal muscles and diaphragm.
(2) The passages are the pelvis, uterus, vagina and
pelvic floor.
(3) The passenger is mainly the foetus; but placenta,
membranes and liquor amnii are also passengers.
STAGES OF LABOUR
[Link] stage
2. Second stage
3. Third stage
4. Fourth stage
[Link] STAGE
• It is the stage of cervical dilatation.
• Starts with the onset of true labour pain and
ends with full dilatation of the cervix i.e. 10
cm in diameter.
• It takes about 12 hours in primigravida and
about 6 hours in multipara.
2. SECOND STAGE
• It is the stage of expulsion of the fetus.
• Begins with full cervical dilatation & ends with
the delivery of the fetus.
• It has got 2 phases:
a. Propulsive phase: starts from full
dilatation to descent of presenting part
to pelvic floor.
b. Expulsive phase: it’s the phase of
delivery of the baby
• Its duration is about 2 hour in
primigravida & ½ hour in multipara.
3. THIRD STAGE
• It is the stage of expulsion of the placenta and
membranes.
• Begins after delivery of the fetus and ends with
expulsion of the placenta and membranes
(afterbirths).
• Its duration is about 15 mins in both primi and
multipara.
4. FOURTH STAGE
• It is the stage of observation.
• Begins immediately after expulsion of
the placenta & membranes and lasts for
one hour.
• During which careful observation for the
patient, & particularly the uterus is
assessed.
THE DURATION OF LABOUR
There are wide variations in the duration of labour,
depending on whether the woman is a primipara or
multipara
CAUSE OF ONSET OF LABOUR:
1. Mechanical factors:
• Uterine distension theory: Like any hollow
organ in the body, when the uterus is
distended, it starts to contract to evacuate
its contents.
(eg. Preterm labour in multiple pregnancy &
polyhydramnios)
• Stretching of lower uterine segment by the
presenting part.
2. Hormonal factors:
• Oestrogen theory:
it increases the release of oxytocin from maternal
pituitary
Promotes synthesis of oxytocin receptors in
myometrium and decidua.
Increases prostaglandin synthesis from amnion
Excites the myometrium to contract
• Progesterone withdrawal theory:
Before labour, there is a drop in progesterone
synthesis leading to predominance of action of
oestrogens.
• Prostaglandins theory:
it is synthesized at amnion, chorion, decidual cells
& myometrium.
PGE2 & PGF2α are strong stimulators of uterine
muscle activity & ripening of cervix.
• Oxytocin theory:
Strong uterine stimulator
Promotes release of prostaglandins
• Foetal cortisol theory:
Increased cortisol production from foetal adrenal
gland before labour which increases production of
estrogen & PG from placenta.
THE PREMONITORY SIGNS OF LABOUR :
It starts 2-3 wks before true labour in primi & few
days before in multi
(1) Lightening.
(2) Frequency of micturition.
(3) False pains.
(4) Slight taking up of the cervix.
1. Lightening: it is a “welcome sign”, few wks
prior to onset of labour, the presenting part
sinks into the true pelvis & engagement
occurs. this relieves upper abdominal pressure
symptoms as dyspnoea & palpitation.(descent
in the fundal level after engagement)
2. Cervical ripening takes place prior to
onset of labour. Cervix becomes soft &
less than 1.5 cm in length, admits a finger
easily & is dilatable.
3. Appearance of false pain:
• Mostly seen in primigravida
• Onset- 1-2 wks prior to onset of labour in primi
& few days in multi.
• Features:
Dull in nature & confined to lower abdomen
& groin
Continuous & unrelated to hardening of
uterus
Without any effect on dilation of cervix
Relieved by enema & Sedative.
FEATURES OF TRUE LABOUR:
True labour pain- increase in intensity,
duration & intervals
Show:It is an expelled cervical mucus plug
mixed with blood from ruptured small
vessels as a result of separation of the
membranes from the lower uterine segment.
Effacement & Dilatation of cervix
Formation of the “bag of waters”:
o It bulges through the cervix and becomes
tense during uterine contractions.
True labour pains False labour pains
Regular and predictable Irregular
Felt first in lower back & sweeps Remains confined to lower
towards lower abdomen abdomen
Not relieved by rest Often relieved by rest
Increase in duration, intensity and Does not increase in
frequency with time duration, intensity or
frequency
“Show” blood stained mucus “Show” absent
discharge present
Accompanied by cervical changes Not accompanied by
cervical changes
Care during labor and delivery 22