Normal labor

Presented by,
Ms. Pallavi Bokade
Msc nursing 1st year
 introduction
Labor is a physiologic process
during which the fetus ,membranes,
umbilical cord, and placenta are
expelled from the uterus. The main
aim of antenatal care is to help the
mother to have a full term , normal
and spontaneous labor.
 DEFINITION
“It is a series of events that takes
place in the genital organs in an
efforts to expel the viable product of
conception (fetus , placenta, and the
membranes) out of the womb
through the vagina into the outer
world is called normal labor”.
 NORMAL LABOUR (EUTOCIA):

Labor is called normal if it fulfill

the following criteria:-

o Spontaneous in onset and at term

o With vertex presentation
o Without undue prolongation
 Natural termination with minimal
aids .
 Without having any complication
affecting the health of mother and the
baby .
Abnormal labor (Dystocia):
 Any deviation from the definition
of normal labor is called as
abnormal labor.
 Causes:
 The precise mechanism of human
labor is still obscure. Endocrine
biochemical and mechanical stretch
pathway as obtain from animal
experiments .However,there are
four hypotheses.
 Uterine distension:
Stretching effect on the myomertrum by
the growing fetus and liquor amnii can
explain the onset of labor at least in twins
or polyhydramnios .uterine stretch
increases gap junction protein receptors
for oxytocin and specific contraction
associated proteins.

 Fetoplacental contribution :
 At term hypothalamic pituitary
axis of fetus activate and release
corticotrophin releasing harmone .
The CRH acts on pituitary and
stimulate pituitary to release adreno
corticotrophin realeasing harmone .
 This ACRH acts act on adrenal
gland cortex and initiate release of
cortisol and DHEAS(Dihydro
epiandosterone sulfate ).
 This cortisol act on placenta which
release in increased estrogen,
prostaglandins and oxytocine level
DHEAS this inhibit activation of
progesterone .Hence decrease
progesterone level this leads to
termination of pregnancy.
 Fetal hypothalamus

Corticotrophin releasing harmone

Pituitary

Adenocoticotropine harmone

Adrenal gland

Cortisole
DHEAS (Dihydroepiandisterone sulfate)
Cortisole & DHEAS act on placenta and Increase
oxytocine,estrogen prostaglandin & decrease progesteron
These AreDifferentiated From True
Labor Pain As Follow:
STAGES OF
NORMAL
LABOR
 FIRST STAGE:

It start from the onset of true labor

pain and end with full dilation of
cervix.
It is also called as cervical stage.
Its average duration is 12 hours in the
primigravidae and 6hour in
multiparae.
 In the first stage ,there
are 3 phases:

Latent phase
Active phase
Transition phase
 SECOND STAGE :

It starts from the full dilatation of the

cervix ( not from the rupture of the
membranes) and ends with expulsion of
the fetus from the birth canal.
It has got two phases:
The propulsive or passive phase
The expulsive or active phase
 Propulsive phase
Startfrom full dilatation up to the
descent of the presenting part to the
pelvic floor.
  The expulsive or active
phase:
 Itis distinguished by maternal bearing down
efforts and ends with delivery of the baby.
 Its average duration is 2 hours in
primigravidae, and 30 minutes in multiparae.
 This stage is also known as pelvic stage.
 THIRD STAGE:
 It begins after expulsion of the fetus and
ends with expulsion placenta and
membranes(afterbirths).
 Its average duration is about 15 minute as
in both primigravida and multiparae.
 The duration is, however, reduced to 5min
in active management
 FOURTH STAGE:
It is the stage of observation for at
least 1 hour after expulsion of the
placenta and the membrane.
During this period maternal vitals,
uterine retraction and any vaginal
bleeding are monitored.
Baby is examined.
 PHYSIOLOGY
OF
FIRST STAGE OF
LABOR
 PHYSIOLOGY OF THE FIRST
STAGE OF LABOR
1. UTERINE CONTRACTION IN
LABOR
2. DILATATION AND
EFFACEMENT OF CERVIX
CONTI…
Progressive anatomical changes in
the cervix, such as dilatation and
effacement, are recorded following
each vaginal examination.
CONTI..

 Cervical dilatation is expressed

either in terms of fingers—1, 2, 3
or fully dilated or better in terms of
centimeters (10 cm when fully
dilated).
 EFFACEMENT OR TAKING UP OF
CERVIX:

Effacement is the process by which the

muscular fibers of the cervix are pulled
upward and merges with the fibers of
the lower uterine segment.
The cervix becomes thin during first
stage of labor or even before that in
primigravidae.
 Conti….
In primigravidae, effacement
precedes dilatation of the cervix,
whereas in multiparae, both occur
simultaneously.
 Expulsion of mucus plug is caused
by effacement.
3. FULL FORMATION OF
LOWER UTERINE SEGMENT
 Managemen
t of the first
stage of
labor
 PRINCIPLES:
 To prepare the patient for natural
birth.
To monitor carefully the progress
of labor, maternal conditions and
fetal behavior so as to detect any
intrapartum complication early.
 PRELIMINARIES:

This consists of basic evaluation of

the current clinical condition.
Enquiry is to be made about the
onset of labor pains or leakage of
liquor, if any.
Conti…
Thorough general and obstetrical
examinations including vaginal
examination are to be carried out
and recorded. Records of antenatal
visits, investigation reports and any
specific treatment given, if
available, are to be reviewed.
 physiology of second
stage of labor
1. uterine action and
bearing down efforts:
2. Descend
3. Rupture of the
membrane
 Clinical features of 2nd
stage of labor
Pain
Bearing down efforts
Membrane status
Descent of the fetus
Conti….
Vaginal sign –
 Perineum progressively bulge
during pain .
 There may be desire to pass stool
when the head comes on the pelvic
floor.
 Crowning
 Maternal vital sign

Blood pressure can be rise of 15 to

20 mmhg during the contraction.
Temperature can increase upto 1
degree Celsius at the time of
delivery.
Respiration is slow during the pain.
Conti..
Complete dilatation of the cervix
as evidenced on vaginal
examination
Urge to push or defecate with
descent of the presenting part.
 Management of 2nd
stage of labor.
The transition from the first stage to
the second stage is evidenced by the
following features:
Increasing intensity of uterine
contractions.
 Bearing-down efforts
  PRINCIPLES:

1) To assist in the natural expulsion
(

of the fetus slowly and steadily,

 (2) To prevent perineal injuries.
 GENERAL MEASURES:
—The patient should be in bed.
— Constant supervision is mandatory
and the FHR is recorded at every 5
minutes.
— To administer inhalation analgesics,
if available, in the form of gas N2O and
O2 to relieve pain during contractions.
Conti..

— Vaginal examination is done at the
beginning of the second stage not only
to confirm its onset but to detect any
accidental cord prolapse. The position
and the station of the head are once
more to be reviewed and the
progressive descent of the head is
ensured.
 PREPARATION FOR DELIVERY
Position: Positions of the woman
during delivery may be lateral,
squatting or partial sitting (45°).
Dorsal position with 15° left lateral
tilt is commonly favored as it avoids
aortocaval compression and facilitates
pushing effort.
Conti…
The accoucheur scrubs up and puts
on sterile gown, mask and gloves and
stands on the right side of the table.
Toileting the external genitalia and
inner side of the thighs is done with
cotton swabs soaked in Savlon or
Dettol solution.
Conti..

One sterile sheet is placed beneath

the buttocks of the patient and one
over the abdomen. Sterilized
leggings are to be used.
conti….

Essential aseptic procedures are

remembered as three Cs: (a) Clean
hands, (b) Clean surface and (c)
Clean cutting and ligaturing of
the cord.
To catheterize the bladder, if it is
full.
Conti..
CONDUCTION OF DELIVERY:
The assistance required in spontaneous
delivery is divided into three phases :
 Delivery of the head  Delivery of
the shoulders  Delivery of the
trunk
 IMMEDIATE CARE OF
THE NEWBORN
Soon after the delivery of the baby,
it should be placed on a tray
covered with clean dry linen with
the head slightly downward (15°).
Conti…
Air passage (oropharynx) should be
cleared of mucus and liquor by gentle
suction.
Apgar rating at 1 minute and at 5
minutes is to be recorded.
 Clamping and ligature of the cord.
 Physiology of 3rd
stage of labor.
1. Seperation of placenta
and membrane
 2. Expulsion of placenta:
 Clinical feature of 3rd
stage of labor
Pain
Uterus become discoid in shape.
Fundal height reaches slightly
below the umbilicus.
Conti..
Slight gush of vaginal bleeding .
Slight bulging in the suprapubic
region due to distension of the
lower segment by the separated
placenta.
 Management of 3rd
stage of labor
Third stage is the most crucial
stage of labor. Previously
uneventful first and second stage
can become abnormal within a
minute with disastrous
consequences.
 Expectant management
(traditional):
In this management, the placental
separation and its descent into the
vagina are allowed to occur
spontaneously. Minimal assistance
may be given for the placental
expulsion if it needed.
 Assisted expulsion
 Active Management of Third
Stage of Labor (AMTSL)
The underlying principle in active
management is to excite powerful
uterine contractions within 1 minute of
delivery of the baby (WHO) by giving
parenteral oxytocic.
Conti…

This facilitates not only early

separation of the placenta but also
produces effective uterine
contractions following its
separation.
Examination of placenta
membrane and cord
Fourth stage of labor
Conti…

Itis the stage of observation for at least

1 hour after the delivery of the baby,
placenta and the membranes to ensure
that both the mother and the baby are
well.
 CONCLUSION :

Normal labour is also called as eutocia.It

is series of events that takes place in the
genital organ in an efforts to viable
production of conceptus expel through
the vagina out of the womb. Causes of
onset of labor is hormonal factor,
neurological factors,and physiology of
the first stages are dilatation and
effacement of cervix.
 ASSIGNMENT –

What are the stages of normal

labor? And explain physiology and
management of first stage of labor.
 BIBLIOGRAPHY
 DC Dutta’s, Testbook of gynecology, hiralal konar, 7th edition,
Jaypee publication.

 Annamma Jacob, A comprehensive, Textbook of midwifery

and gynecological nursing, fourth edition, Jaypee publication.

 Kamini Rao, Textbook of midwifery and obstetric for nurses,

 A.V. Raman, maternity nursing, family newborn and women’s

health care, 19th edition.

 Shirish S. sheth, essential of gynecology 2nd edition, Jaypee

publication.
 http://bettercare.ca.z