LABOR PROCESS

REPORTED BY: GUENEVERE R. MANALO BSN III-B

LABOR
O Labor is a physiologic process by which a

fetus is expelled from the uterus to the outside world. O It involves the sequential integrated changes in the uterine decidua and myometrium. O Changes in the uterine cervix tend to precede uterine contractions.

SIGNS OF LABOR
O LIGHTENING
O Descent of the fetal presenting part into the

pelvis. O Occurs approximately 10 to 14 days before labor begins. O Occurs when the baby drops further down into the pelvis in preparation for birth.

INCREASE IN LEVEL OF ACTIVITY

O This increase in activity is related to an

increase in epinephrine release that is initiated by a decrease in progesterone produced by the placenta.
O Additional epinephrine prepares a woman's

body for the work of labor ahead.

BRAXTON HICKS CONTRACTIONS

O are irregular, intermittent contractions that

have occurred throughout the pregnancy; become uncomfortable, and produce a drawing pain in the abdomen and groin.
O In the last week or days before labor begins,

a woman usually extremely strong Braxton hicks contractions which she may interpret as true labor contractions.

RIPENING OF THE CERVIX

O Throughout the pregnancy, the cervix feels

softer than normal, similar to the consistency of an earlobe (Goodells sign). O At term, the cervix becomes still softer (describes as butter-soft), and it tips forward.

UTERINE CONTRACTIONS
O The surest sign that labor has begun is

productive uterine contractions.

SHOW
O As the cervix softens and ripens, the mucus plug

that filled the cervical canal during pregnancy is expelled.

O The exposed cervical capillaries seep blood as a

result of pressure exerted by the fetus.

O The blood mixed with mucus, takes on a pink

tinge and is referred to as show or bloody show.

RUPTURE OF THE MEMBRANES

O .

Rupture of amniotic membranes may occur before the onset of labor if the woman suspects that her membranes have ruptured, she should contact her health care provider and go to the labor suite immediately so that she may be examined for prolapsed cord a life-threatening condition for the fetus.

FACTORS AFFECTING LABOR

PASSAGEWAY. This refers to the adequacy of the pelvis and birth canal in allowing fetal descent; factors include:  a. Type of pelvis (for example, gynecoid, android, anthropoid, or platypelloid)  b. Structure of pelvis (for example, true versus false pelvis)  c. Pelvic inlet diameters  d. Pelvic outlet diameters  e. Ability of the uterine segment to distend the cervix to dilate, and the virginal canal and introitus to distend.

 PASSENGER. This refers to the fetus and its ability to move through the passage way, which is based on the following: a. Size of the fetal head and capability of the head to mold the passageway. b. Fetal presentation the part of the fetus enters to maternal pelvis first (for example, cephalic [vertex, face, brow]: breech [frank, single or double footing complete]; or shoulder [transverse, lie]) c. Fetal attitude the relationship of fetal parts to one anther. d. Fetal position the relationship of a particular reference points of the presenting part and the maternal pelvis, described with a series of three letters (side of maternal pelvis [L, left; R, right; T, transverse], presenting [O, occiput; S, sacrum; Sc, scapula; M, mentum], and the part of the maternal pelvis (A, anterior; P, posterior].

3. POWER. This refers to the frequency duration and strength of uterine contraction to cause complete cervical effacement and dilation. 4. PLACENTAL FACTORS refers to the site of placental insertion. 5. PSYCHE refers to the client s psychological state, available support systems, preparation.

TRUE LABOR ANDFALSE LABOR

CHARACTERISTICS OF TRUE LABOR O 1. Contractions occur at regular intervals (Client and Family Teaching 9-1) O 2. Contractions start in the black and sweep around to the abdomen, increase in intensity and durations and gradually have shortened intervals. O 3. Walking intensifies contractions. O 4. Bloody show (pink-tinged mucus released from the cervical canal as labor starts) is usually present. O 5. Cervix becomes effaced and dilated. O 6. Sedation does not stop contractions. CHARACTERISTICS OF FALSE LABOR
O

O O

O O

1. Contractions occur at regular intervals (Client and Family Teaching 9-1) 2. Contractions starts in the back and sweep around to the abdomen, intensify remains the same or is variable, and the intervals remain long. 3. Walking does not intensify contractions and often relief. 4. Blood show usually is not present, if present, it is usually brownish rather than right red and may be due to a recent pelvic examination or intercourse. 5. There are no cervical changes. 6. Sedation tends to decrease the number of contractions.

STAGES OF LABOR
O FIRST STAGE of labor begins with the onset of regular

contractions which cause progressive cervical dilation and effacement. It ends when the cervix is completely effaced and dilated. It is composed of a latent, an active, and a transition phase. O a. Latent phase. This phase begins with the onset of regular contractions and effacement and dilation of the cervix 3 to 4 cm. It lasts an average of 6.4 hours for multiparas. Contractions become increasingly stronger and more frequent. O b. Active phase. Dilation continues from 3 to 4 cm to 7 cm. Contractions become stronger, more frequent, longer, and more painful. O c. Transition phase. The culmination of the first stage is the transition phase during which the cervix dilates from 8 to 10 cm. The intensity, frequency, and durations of contractions peak and there is an irresistible urge to push.

SECOND STAGE (expulsive stage)

a. The second stage begins with complete dilation of the cervix and ends with delivery of the newborn. Durations may differ among primiparas (longer) and multiparas (shorter), but this stage should be completed within 1 hour after complete dilation. b. Contractions are severe at 2 to 3 minute intervals, with a duration of 50 to 90 seconds. c. The newborns exists the birth canal with help from the following cardinal movements or mechanisms of labor i. Descent ii. Flexion iii. Internal Rotation iv. Extension v. External Rotation (restitution) vi. Expulsion d. Crowning occurs when the newborns head or presenting part appears at the vagina; opening e. Episiotomy (surgical incision in perineum) may be done to facilitate delivery and avoid laceration of the perineum.

THIRD STAGE (placental stage) a. This stage begins with delivery of the newborn and ends with delivery of the placenta. It occurs in two phases placental separation and placental expulsion. b. Signs of placental separation include the uterus becoming globular, the fundus rising in the abdomen, lengthening of the cord, and increased bleeding (trickle or gush) c. Contraction of the uterus controls uterine bleeding and aids placental separation and explanation. d. Generally, oxytocic drugs are administered to help the uterus contract.

FOURTH STAGE (recovery and bonding) a. This stage lasts form 1 to 4 hours after birth. b. The mother and newborn recover from the physical process of birth. c. The maternal organs undergo initial readjustment to the non pregnant state. d. The newborn body systems begin in the midline of the abdomen with the fundus midway between the umbilicus and symphysis pubis.