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Labor:
Labor is defined as the onset of rhythmic contractions and the relaxation
of the uterine smooth muscles, which results in effacement or progressive
thinning of the cervix, and dilation or widening of the cervix. This
process culminates with the expulsion of the fetus and expulsion of the
other products of conception (placenta and membranes) from the uterus.
WH defines normal birth as! "spontaneous in onset, low#ris$ at the start
of labor and remaining so throughout labor and delivery. The infant is
born spontaneously in the vertex presentation between %& and '
completed wee$s of pregnancy. fter birth mother and infant are in good
condition"
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Normal Labor:
*ormal labor or eutocia is a physiological process by which fetus,
placenta and membrane are expelled through the birth canal between %+
to ' wee$s. Labor is called normal if it fulfills the following criteria !#
• pontaneous in onset and at term
• With vertex presentation
• Without undue prolongation
• *atural termination with minimal aid.
• Without having any complications affecting the health of the mother
and -or the baby.
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Abnormal Labor:
ny deviation from the definition of normal labor is called abnormal
labor . ystocia of labor is defined as difficult labor or abnormally slow progress of labor. ther terms that are often used interchangeably with
dystocia are dysfunctional labor, failure to progress (lac$ of progressive
cervical dilatation or lac$ of descent), and cephalopelvic disproportion
(/0). 1t is the conse2uence of four distinct abnormalities that may exist
singly or in combination.
• 3terine forces that is not sufficiently strong or appropriately coordinated
to efface and dilate the cervix.
• 4orces generated by voluntary muscles during the second stage of labor
that are inade2uate to overcome the normal resistance of the bony birth
canal and maternal soft parts.
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• 4aulty presentation or abnormal development of the fetus of such
character that the fetus cannot be extruded through the birth canal.
• bnormalities of the birth canal that form an obstacle to the descent
of the fetus
Delivery:
elivery is the expulsion or extraction of viable fetus out of thewomb. 1t is not synonymous with labor. 1t can be ta$e place without
labor as in elective caesarean section. elivery may be vaginal, either
spontaneous or aided and or may be abdominal.
Premature labor:
0remature labor is defined as labor occurring before the %& th wee$ of
gestation.
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Stage of labour
Labour has four distinct stages. The first starts with
regular contractions that open up your cervix and
lasts until the cervix is fully opened (dilated) to
about 56cm diameter. The second stage of your
labour begins when the cervix is fully dilated and
concludes with the birth of your baby. The third
stage is from the birth of your baby to the delivery of
the placenta and membranes.
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First stage of labour
The first stage of labour is the period from the onset of labour (when
you begin to get regular painful uterine contractions) to complete
dilatation of the cervix. 1t is called cervical dilating stage. 1t is
concerned with the thinning of the cervix. This initial stage is usually
the longest but every birth is different and the timescale varies. 1t can
often ta$e 7#5 hours or sometimes more for a first baby and is
usually 2uic$er in subse2uent labours. uring the first stage of labour
you may experience a range of emotions. 8any women experience
nausea or actually vomit near the end of the first stage of labour.
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Cont……….
dditionally, you may have a strong urge to push ($nown as bearing
down) with each contraction as your baby9s head is pushed against
the cervix.
This is when your breathing exercises come in useful as you will be
advised not to push until the cervix is fully dilated. t this stage you
may experience some loss of bladder or bowel controls due to the
pressure of the baby:s head so don:t feel embarrassed or concerned
because this is normal. nce the cervix is fully dilated your baby is
ready to be born and the second stage of labour begins. The first
stage can be divided functionally into three phases! the latent phase
and the active phase.
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The Latent Phase Latent phase labor (also $nown as prodromal labor) precedes the
active phase of labor. 1t is period of effacement, which begins with
the onset of labour and ends with the cervix is %#'cm dilated. The
latent phase begins with mild, irregular uterine contractions that
soften and shorten the cervix. 1t is often long about +hours, in which
average dilatation of cervix is only 6.%;cm-hrs in primigravida. 1n
multipara, the latent phase is short about ' hrs and effacement and
dilatation occur simultaneously. 1n this phase contractions are short
and mild in strength. /ontractions usually occurs in every 5;#6
minutes,lasting 6#;sec.
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hows the thin cervix now opening (or dilating) to about
% to ' cm.
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The active hase
ctive phase labor is a time of rapid change in cervical dilatation,
effacement, and station. ctive phase labor lasts until the cervix is
completely dilated. 1n this phase acceleration of cervical dilation
proceeds at a rate of 5cm-hrs in primigravida and 5.;cm-hrs in
multipara.
!omen in active hase labor:
• re at least ' cm dilated<
• Have regular, fre2uent contractions that are usually moderately
painful<
• emonstrate progressive cervical dilatation of at least 5.#5.;
cm per hour.
• 3sually are not comfortable with tal$ing or laughing during
their contractions.
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hows the cervix now open to about & to + cm
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The transition hase Towards the end of the 5st stage # $nown as transition, the
contractions generally become very strong and close together(or for some women bac$ to bac$, with little to no rest in
between). 8any women experience vague urges to push, or
feelings of pressure in their bottom, as their baby9s head moves
lower down the birth canal. 1t is stage of labour when the
cervix is from around + centimeters dilated until it is fully
dilated with strong contractions #% minutes apart lasting ';#
76 seconds. Women often experience feelings of being 9out of
control9 or not wanting to 9do it anymore9 during transition.
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hows the cervix almost fully open, with the bag of waters bulging down in front of the baby9s head
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Sign an" symtoms of first stage of labor
• 0ainful and progressive uterine contraction with
progressive dilatation of cervix.
• =ulging of membranes during contractions.
• /omplete effacement and dilatation of cervix.
• There might-might not be rupture of membrane.
• 0resentation of show.
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Secon" Stage of Labor
The second stage of labor begins when cervix is fully dilated
and is complete with the birth of the baby. This stage lasts on
average between 5 and hours for a first baby and is usually
shorter in a subse2uent pregnancy ( hrs in primi and %6 min. in
multi). s your baby9s head descends onto the perineum your
bac$ passage may bulge because the baby9s head is >ust behind it
and you may feel the need to defecate. /ontractions may
become less fre2uent but more intense. 1t has got two phases.
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• The roulsive hase# starts from full dilatation up
to the descent of the presenting part to the pelvic
floor. 1n this phase descent and rotation of head occur.
The soft tissues of the vagina and pelvic floor
gradually stretched and thinned under the pressure of
the advancing fetal head.
• The e#ulsive hase# it is distinguished by maternal
bearing down efforts and ends with delivery of the
baby.
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Sign an" symtoms of secon" stage of labor• 0rogressive and expulsive uterine contraction.
•
=ulging of perineum.
• nus gaping with escape of fecal matter.
• /omplete ta$ing up of the cervix.
• ?upture of membrane.
• 3rge to defecate with descent of the presenting part.
• Woman has the urge to push.
• 0resenting part visible at the perineum.
•
1t is complete with delivery of the baby.
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Thir" Stage of Labor
The third stage of labor is referred to as the "placental"
stage. This is the period from birth of the baby until
delivery of the placenta. 1ts average duration is about ;#
%6 minutes in both primigravida and multiparae. The
duration is however, reduced to ; minutes in active
management.n 9active9 third stage usually speeds up
the delivery of the placenta and helps to reduce the
chance of a postpartum hemorrhage.
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Fourth Stage of Labor.
The fourth stage of labor is referred to as the "recovery
or stabili@ation" stage. 1t is stage of observation for at
least one hour after expulsion of the placenta. The
forces involved are uterine contractions. uring this period general condition of the women and behaviour
of the uterus are to be carefully watched.