Stages of labor antenatal workshop

1Copyright © 2014 Paras Hospitals. All rights reserved.

STAGES OF LABOR

Dr Nupur Gupta, Unit HeadDepartment of Obstetrics & Gynecology

Paras Hospital, Gurgaon

2Copyright © 2014 Paras Hospitals. All rights reserved.

Pain and the brain…

What will labour feel like and can I

cope with it?

3Copyright © 2014 Paras Hospitals. All rights reserved.

WHAT IS LABOR?

Series of events to deliver viable fetus from uterus

into outside world

Term labor- 32-40wks

Preterm labor- < 37 wks

Post term labor- > or = 42wks

4Copyright © 2014 Paras Hospitals. All rights reserved.

ONSET OF LABOR

Initiation of labor

- hormones of mother & fetus

- placental hormones

Hormones

- estrogen, progesterone, oxytocin & prostaglandin

5Copyright © 2014 Paras Hospitals. All rights reserved.

True Vs False Labor

TRUE LABOR

Regular contractions

Increase in frequency and intensity

Cervix dilates

No relief with sedation

Abdomen and back pain

FALSE LABOR

Irregular

Remain the same

Unchanged

Relieved

Lower abdomen pain

6Copyright © 2014 Paras Hospitals. All rights reserved. 6

WOW! I AM IN LABOR?

Waiting for this precious arrival!

Mild pain radiating from back to abdomen

Feeling frequency of urination

7Copyright © 2014 Paras Hospitals. All rights reserved.

STAGES OF LABOUR

Conventionally labour divided into 3 stages

(some 4th stage)

First stage

Second stage

Third stage

Fourth stage

8Copyright © 2014 Paras Hospitals. All rights reserved.

FIRST STAGE (Dilatation stage)

From onset of true labour pains - full

dilatation of cervix

CERVICAL stage

Duration - 12 hrs in primi & 6-7 hrs in

multiparae

9Copyright © 2014 Paras Hospitals. All rights reserved.

SECOND STAGE (Expulsive stage)

From full dilatation of cervix- expulsion of

fetus

Average duration 2hrs in primi

& 30 mins in multipara

10Copyright © 2014 Paras Hospitals. All rights reserved.

THIRD STAGE (Placental stage)

From expulsion of fetus to expulsion of placenta

with membranes

Average duration 10-15 mins

11Copyright © 2014 Paras Hospitals. All rights reserved.

FOURTH STAGE (Observation stage)

Stage of observation

At least 1 hr ( Golden Hour)

observation after expulsion of

afterbirths

12Copyright © 2014 Paras Hospitals. All rights reserved.

First stage

Beginning of contractions -progressing

changes in cervix & ends -cervix fully

dilated

3 phases of labor

- Early Labor Phase

- Active Labor Phase

- Transition phase

13Copyright © 2014 Paras Hospitals. All rights reserved.

Phases of First Stage

Latent (EARLY) : Dilation 0-3 cms. Contractions mild/irregular.

Active: 4-7 cms. Contractions 5-8 min. apart. Lasts 45-60 sec;

moderate - strong intensity.

Transition: Dilatation 8-10 cms. Contractions 1-2 min. apart; 60 –

90 sec.; strong intensity.

Baby’s heart beats monitored

14Copyright © 2014 Paras Hospitals. All rights reserved.

First Stage of labour: Early Labour - How do you know?

Mild, regular contractions, 30-45 sec / 5-30 min

Cervical dilatation starts

Contractions - lower back, menstrual cramps, & pressure on pelvis area

Pink or brownish-red blood tinged vaginal discharge- “bloody show”

Possibility of breaking of water bag

Early labor ends -cervix about 4cm dilated

15Copyright © 2014 Paras Hospitals. All rights reserved.

First stage of labour: Active Labor (4 to 8 hrs)

Contractions frequent, longer, and stronger 1-2 mins duration/

2-3 mins

Cervix dilates from 4 to 10 cm

Baby begins to descend or drop

The last part of active labor, cervix dilates upto 10 cm

16Copyright © 2014 Paras Hospitals. All rights reserved.

WHAT TO DO: Natural Pain Coping techniques?

Take a walk

Be relaxed

Can take a warm bath

Listen to favorite music or watch videos

Take help from husband or close relatives

17Copyright © 2014 Paras Hospitals. All rights reserved.

Best to take rest

Tired, try to doze off between contractions

Be sure to drink plenty of fluids to stay well

hydrated & energetic

Pass urine frequently

WHAT TO DO: Natural Pain Coping techniques?

18Copyright © 2014 Paras Hospitals. All rights reserved.

Try some breathing exercises

Can watch a movie or read a book

Opt for which relaxes you

Different comfortable positions

Pain medication

WHAT TO DO: Natural Pain Coping techniques?

19Copyright © 2014 Paras Hospitals. All rights reserved.

Take a massage

A cool cloth on forehead or a cold pack on back or warm compression

for comfort

Transition stage most painful- try to distract – music or conversation

or loving touch from partner

WHAT TO DO: Natural Pain Coping techniques?

20Copyright © 2014 Paras Hospitals. All rights reserved. 20

Fathers do make a difference to birth……………

21Copyright © 2014 Paras Hospitals. All rights reserved.

Second stage

Cervix fully dilated, and it is time to push

Contractions will last 45-90sec with a 3-5 minute rest period

Baby is very low in pelvis - feel pressure on rectum

Each contraction forces baby down

22Copyright © 2014 Paras Hospitals. All rights reserved.

Second Stage

Delivery of infant

up to 1 hr. or approx 20 contractions – primigravida

20 min. or approx 10 contractions in multipara

Most difficult & uncomfortable part of labor

Strong urge to push & bear down

23Copyright © 2014 Paras Hospitals. All rights reserved.

Pushing stage

Try to follow doctor’s instructions

Use deep breathing techniques to stay controlled

Concentrate on self power

Positions: Sitting, Side Lying, Standing, Squatting, All Fours, Kneeling

WHAT TO DO: Natural Pain Coping techniques?

24Copyright © 2014 Paras Hospitals. All rights reserved.

Third stage

After birth of baby, uterus contracts

First contractions separate the placenta from

uterine wall

25Copyright © 2014 Paras Hospitals. All rights reserved.

Afterwards!

Be patient

Feeling of achievement

All that pain subsides with touch of baby

Try to put baby on breast

Helps to create immediate bonding

26Copyright © 2014 Paras Hospitals. All rights reserved. 26