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Stages of Labor

Stages of Labor

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Published by MASII
notes on normal labor process
notes on normal labor process

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Published by: MASII on Jul 29, 2010
Copyright:Attribution Non-commercial


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Labor is considered “normal” when the woman is at or near term, nocomplications exist, as single fetus presents by vertex and labor is completed within24 hrs. The course of labor has 4 stages:
First Stage of Labor 
The first stage of labor is the longest. There are three phases within the firststage: Early or latent phase, Active phase and Transition phase. At the end of thefirst stage, the cervix is dilated to 10 centimeters. In mothers having their first child,this stage usually lasts 12 to 16 hours. For women having second or subsequentchildren, the first stage lasts around 6-7 hours.
During the early or latent phase, the cervix dilates to 4 centimeters.The duration of the first phase is the longest, averaging around 8 hours. Your contractions may be irregular, progressing to rhythmic and methodical. Thepain felt at this early stage may be similar to menstrual pain: aching, fullness,cramping and backache. You will still be able to walk. Walking is usually morecomfortable than sitting. Most women spend these hours at home, or theymay be checked at the hospital and sent home until labor becomes moreactive. You may feel eager, excited and social. It is important that youconserve your energy for the work of labor.
Active labor is marked by regular contractions that become longer,stronger and closer together over time. Most providers recommend that yougo to the hospital when your contractions are five minutes apart, lasting more
then 60 seconds for at least an hour.If you have had previous deliveries, the active phase of labor can proceedmore quickly. When you are in active labor, you will be concentrating on thetask at hand, and will not feel like doing anything else. Contractions aregrowing stronger, longer and closer together. Contractions will be about 3-4minutes apart, lasting 40 to 60 seconds. You may have a tightening feeling inyour pubic area and increasing pressure in your back. If you have learnedbreathing techniques, begin using them now. Pain medication is often givenat this stage. If you have chosen to have anepidural anesthetic, it is usuallygiven at this stage.
Transition is the most difficult phase of labor, and fortunately, theshortest, lasting from 30 minutes to two hours. The cervix is opening the lastfew centimeters, from 7 to 10 centimeters. The pain may be intense, as thecervix stretches and the baby descends into the birth canal. All of your energyis concentrated on doing the work of labor. At the end of transition, you mayfeel a strong urge to push the baby out. The baby is ready to be born.
Second Stage of Labor 
The second stage begins from the time the cervix is fully dilated(10 cm) untilthe baby is born. This stage of labor lasts anywhere from one contraction up to twohours. The baby's head stretches your vagina and perineum (the skin between thevagina and rectum). This may cause a burning sensation. Some women may feel asif they are having a bowel movement, and feel the urge to push, or bear down. Thelabor nurse or physician will tell you when it is time to push. It is important that younot push until instructed. Pushing too early will cause the cervix to becomeedematous, or swollen. "Crowning" occurs as the widest part of the head appears at
the vaginal opening. In the next few pushes, the baby is born. Mucous and amnioticfluid will be removed from the baby's mouth and nose with a bulb syringe. The babywill take its first breath, and may begin to cry. Immediately after birth, the baby is stillconnected to the placenta by theumbilical cord. The cord is clamped and cut.
Third Stage of Labor 
The third stage of labor, or the placental site, begins with the birth of the infantand ends with the delivery of the placenta. Two separate phases are involved:placental separation and placental separation and placental expulsion. Signs of placental separation includes: calkin’s sign, uterus becomes mobile, sudden gushingof blood and lengthening of umbilical cord. The types of placental delivery or presentation includes: schultze’s mechanism, which is the shiny “clean” side firstbluish side and duncan’s mechanism, appears to be rough, ”dirty”, reddish maternalside out first.After birth of the infant, the uterus can be palpated as a firm, round mass justinferior to the level of the umbilicus. After few minutes of rest, uterine contractionsbegin again, and the organ assumes a discoid shape. It retains this new shape untilthe placenta has separated, approximately 5 minutes after the birth of the infant.
Fourth Stage of Labor 
This stage is really more about getting back to normal than anything else --the hour or two after delivery when the tone of the uterus is established and theuterus contracts down again expelling any remaining contents. These contractionsare hastened by breast-feeding, which stimulates production of the hormoneoxytocin. Your blood pressure, temperature and heart rate will stabilize in much thesame way a marathon runners does: a little at a time during the hour after theplacenta is delivered. Contractions will cease. Your uterus will harden, doing its job

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