NORMAL SPONTANEOUS DELIVERY

Reyes, Janyn Marione A.

DEFINITION

Labor is defined as the onset of regular painful contractions with progressive cervical effacement and dilatation of the cervix accompanied by descent of the presenting part.

The following criteria should be present to call it normal labor

Spontaneous expulsion, of a single,mature fetus (37 completed weeks 42 weeks), presented by vertex, through the birth canal (i.e. vaginal delivery), within a reasonable time (not less than 3 hours or more than 18 hours), without complications to the mother, or the fetus

Signs and symptoms of labor

Before labor begins, women usually notice one or more premonitory, or warnings, signs that labor is about to begin. They are: Painful regular uterine contractions as evidence by contraction at least one in ten minutes Show as evidence by mucus mixed with blood Rupture of membranes as evidence by leaking liquor Progressive shortening and dilatation of the

Pathophysiology of normal spontaneous delivery

FERTILIZATIO N
Zygote Unicellular ( Intermingling of haploid paternal 23 X or Y and maternal 23 X chromosomes ) Series of Mitotic Cell division Cleavage ( In 24 hours become two cell organism ) In 72 hours become 16 cell organism called Morula

The The inner layer gave outer rise to the embryo layer (embryoblast) gave rise to the Embryonic development placenta begins during second week continues through ( the 8th week trophobla st ) Separate into two parts by fluid from the uterus on the 4th day 3 Stages
1st stage increase in cell number and with elaboration of cell products 2ndstage morphogenesis / includes mass cell movement 3rdstage differentiation or maturation of physiologic processes

blastocytes ataches to endometrium on the 6th day

Implantation Fetal Developmen t is from ninth week to birth Newborn baby via Vaginal Delivery

Morula enters the uterus on the 3rd day through peristaltic movement

Three stages of labor

Labor can be divided into three stages, which are unequal in length.
FIRST STAGE
It begins with the onset of true labor contractions and ends when the cervix is fully dilated (10 cm). Cervical effacement and dilatation occur in the first stage

SECOND STAGE
The second stage of labor begins with complete dilatation of the cervix and ends with the birth of the baby. The duration is about 1 to 1 hours in nulliparas and about 30 to 45 minutes in parous women.

THIRD STAGE
The third stage is that of separation and expulsion of placenta and membranes and also involves the control of bleeding. It begins after the birth of the baby and ends with the expulsion of the placenta and membranes. This is the shortest stage, lasting up to 30 minutes, with an average length of 5 to 10 minutes. There is no difference in duration for nulliparous and parous.

First stage of labor consists of two phases:- latent and active. The first stage of labor is the longest for both nulliparous and parous women.

FIRST STAGE OF LABOR

Phases of the first stage of labor

Latent phase begins with onset of contracts and ends when cervix is 3 cm dilated and effaced Active phase begins after the cervix is 3 cm dilated

LATENT Phase
1. 2.

ACTIVE Phase
1. 2.

3.
4. 5. 6.

Begins with onset of contractions Slow progress Little cervical dilatation Progressive cervical effacement Ends once the cervix reaches 3 cm dilatation Durations ~ 8 hours for nulliparae ~ 6 hours for multiparae

3.
4. 5.

Active process Begins after 3 cm of cervical dilatation Period of active cervical dilatation (average rate 1 cm/hr) S-shaped curve which is used to define progress of labour It has 3 component a) acceleration - slow b) maximum - fast c) deceleration - slow

A. EARLY LABOR

Cervical dilation of 0-3cm Contractions in the range of 5-20 minutes and lasting for about 30-45 seconds

S/S of early labor: Back ache and nesting urges Contractions progress over time by getting longer, stronger and closer together Mild-moderate intensity during contractions

NURSING RESPONSIBILITIES
-

Encourage mothers to rest Conserve patient energy Assist with relaxing activities such as deep breathing exercises

B. ACTIVE LABOR

Active labor is defined by cervical dilation of 48cm, contractions 3 5 minutes apart and lasting about 60 seconds S/S: Beginning of intense contractions Trembling Nausea Vomiting Mild discomfort in between contractions

NURSING RESPONSIBILITIES

Encourage position changes Relaxing and slow breathing during contractions Hot/cold packs for pain Massage

C. TRANSITION

Cervical dilation of 8-10cm Contractions are about 2-3minutes apart Last for approximately 60-90 seconds S/S Extremely intense contractions that occur with little rest in between Contractions may be accompanied by rectal pressure if the babys head is low Mothers will often have the most difficulty coping Shaking or trembling, N/V and intense emotions

NURSING RESPONSIBILITIES

Encourage position changes Verbal encouragement Reassure mother that she is close to the end and that all of the intense sensations are indeed normal

NORMAL LABOUR AND DELIVERY

WHAT HAPPENS DURING THE FIRST STAGE OF LABOUR

NORMAL LABOUR AND DELIVERY

1. Contractions:

CONTRACTIONS 1: Regular 2: Increasing in frequency 3: Stronger

NORMAL LABOUR AND DELIVERY

2. Cervical dilatation and effacement:
Causes of cervical dilatation:
Contraction and retraction of uterine musculature Mechanical pressure by the bulging membrane (fore water) The descend of the presenting part

Phases of cervical dilatation

Latent phase the first 3 cm of dilatation; a slow process (8 hours in nulliparous and 3 hours in multiparous

Active phase this is active process of cervical dilatation; the normal rate is 1 cm/hour

NORMAL LABOUR AND DELIVERY

3. Engagement of the presenting part:

Second stage of labor

SECOND STAGE OF LABOR

begins when the cervix is completely effaced and dilated and ends when the infant is born.

Has three phases: A. Resting phase B. Descent phase C. Crowning

A. RESTING PHASE

Occur for some women after 10cm of dilation A period of about 10-20 minutes without contraction or without an urge to bear down is often seen S/S Few noticeable contractions without an urge to bear down

NURSING RESPONSIBILITIES

Encourage rest Review pushing positions Remind mother to empty bladder if unmedicated (diaper)

B. DESCENT PHASE

Occurs with contractions 3-5minutes apart Lasting about 60 seconds S/S Contractions are accompanied by a strong urge to bear down several times with each contraction The babys head descends with each contraction and then recedes.

NURSING RESPONSIBILITIES

Encourage position changes as mother prefers or if no noticeable progress Rest in between contractions

C. CROWNING

The babys head descends to the opening of the vagina and does not recede with contractions. Extremely intense for the mother with a sense of stretching followed by burning. Ask if mother can have cool compress to perineum for comfort Remind her to slow her pushing to ease babys head out.

Third stage of labor

1.

Begins after DELIVERY of the baby and ends with DELIVERY OF THE PLACENTA / MEMBRANES. It have TWO Phases a) Separation phase b) Expulsion phase Duration usually 15 minutes or less (if actively managed). Average blood loss 150 to 250 ml.

2.

3.

4.

NURSING RESPONSIBILITIES

Offer encouragement, congratulate mother on her effort and enjoy the baby. Initiate breastfeeding promotes bonding.

WHAT FACTORS INFLUENCE PROGRESS OF labor ?

Factors that influence the progress of labor

Power

Passenger

Passage

The end!