After an endocrine signal from the baby, the maternal labor process is triggered.

This is what the wikipedia has to say: The stages of normal human birth Latent phase The latent phase of labor causes confusion with many. Latent phase may last many days and the contractions are an intensification of the Braxton-Hicks contractions that start around 26 weeks gestation. Cervical effacement occurs during the closing weeks of pregnancy and is usually complete or near complete, by the end of latent phase. Cervical effacement is the incorporation of the cervix to form the lower segment of the cervix. The muscular portion of the uterus is the upper segment, and is made of non-striated muscle. The lower segment of the uterus has no muscles and is comprised of the cervix itself, which becomes massively stretched and thinned out. This cervical effacement will usually be accomplished fully prior to the onset of labor. The degree of cervical effacement may be felt during a vaginal examination. A 'long' cervix implies that not much has been taken into the lower segment, and vice versa for a 'short' cervix. Latent phase ends with the onset of active first stage; when the cervix is about three cm. dilated. First stage: contractions The first stage of labor is an active stage and should not be confused with the latent phase of labor. The first stage of labour starts classically when the effaced cervix is 3 cm dilated. There is variation in this point as some patients may present a little before this point with active contraction, or later, without regular contractions. The onset of actual labor is defined when the cervix begins to progressively dilate. Rupture of the membranes, or a blood stained 'show' may or may not occur at around this stage. Uterine muscles form opposing spirals from the top of the upper segment of the uterus to its junction with

the lower segment. During effacement, the cervix becomes incorporated into the lower segment. During a contraction, these muscles contract causing shortening of the upper segment and drawing upwards of the lower segment, in a gradual expulsive motion. This draws the cervix up over the baby's head. Full dilatation is reached when the cervix is the size of the baby's head; at around 10cm dilation for a term baby. The duration of labour varies widely, but active phase averages some 8 hours for women giving birth to their first child ("primiparae") and 4 hours for women who have already given birth ("multiparae").

Second stage: delivery This stage begins when the cervix is fully dilated, and ends when the baby is finally delivered. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has successfully passed through the pelvic brim. Ideally it has successfully also passed below the interspinous diameter. This is the narrowest part of the pelvis. If these have been accomplished, all that will remain is for the fetal head to pass below the pubic arch and out though the introitus. This is assisted by the additional maternal efforts of "bearing down." The fetal head is seen to 'crown' as the labia part. At this point the woman may feel a burning or stinging sensation. Delivery of the fetal head signals the successful completion of the fourth mechanism of labor (delivery by extension), and is followed by the fifth and sixth mechanisms (restitution and external rotation). The second stage of labor will vary to some extent, depending on how successfully the preceding tasks have been accomplished. Third stage: placenta In this stage, the uterus expels the placenta (afterbirth). Maternal blood loss is limited by the compression of the spiral arteries of the uterus as they pass though the lattice-like uterine muscles of the upper segment. Normal blood loss is less than 600 mL. The placenta is usually delivered within 15 minutes of the baby being born. Source(s): http://en.wikipedia.org/wiki/Childbirth#

I.

Physiology of Normal Labor and Delivery A. Normal labor Emanuel Friedman in his elegant treatise on labor (1978) stated correctly that "the clinical features of uterine contractions namely frequency, intensity, and duration cannot be relied upon as measures of progression in labor nor as indices of normality. Except for cervical dilatation and fetal decent, none of the clinical features of the parturient patient appears to be useful in assessing labor

progression." Friedman sought to select criteria that would limit normal labor and thus be able to identify significant abnormalities of labor. These limits, admittedly arbitrary, appear to be logical and clinically useful. The graphic representation of labor plotting descent and dilatation against time has become known as the Friedman curve. It, or a modification of it, is used extensively to evaluate laboring patients. Figure 2. Graphic portrayal of the relationship between cervical dilatation and elapsed time in labor (heavy line) and between fetal station and time (light line). Labor has been divided functionally into a preparatory division (including latent and acceleration phases of the dilatation curve), a dilatational division comprising only the linear phase of maximum slope of dilatation, and a pelvic division encompassing the linear phase of maximum descent. B. Functional classification of labor

Principal Clinical Features on the Functional Divisions of Labor

Characteristic Functions Preparatory Division Dilatational Division Pelvic Division Pelvis negotiated; mechanisms of labor; fetal descent; delivery Deceleration phase and second stage Linear rate of descent Prolonged deceleration; secondary arrest of dilatation; arrest of descent; failure of descent

Contractions Cervix actively coordinated, polarized, dilated oriented; cervix prepared Latent and acceleration phases Elapsed duration Prolonged latent phase Phase of maximum slope Linear rate of dilatation Protracted dilatation; protracted descent

Interval Measurement Diagnosable disorders

C.

Abnormal labor Dystocia (literally difficult labor) is characterized by abnormally slow progress in labor. It is the consequence of four distinct abnormalities that may exist singly or in combination. 1. Uterine forces that are not sufficiently strong or appropriately coordinated to efface and dilate the cervix. Forces generated by voluntary muscles during the second stage of labor that are inadequate to overcome the normal resistance of the bony birth canal and maternal soft parts. Faulty presentation or abnormal development of the fetus of such character that the fetus cannot be extruded through the birth canal. Abnormalities of the birth canal that form an obstacle to the descent of the fetus.

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Labor Disorders
Pattern Prolonged latent phase Protracted active phase dilatation Protracted descent Prolonged deceleration phase Diagnostic Criterion Nulliparas 20 hr or more Multiparas 14 hr or more Nulliparas 1.2 cm/hr or less Nulliparas 1 cm/hr or less Multiparas 2 cm/hr or less Nulliparas 3 hr or more Multiparas 1 hr or more

Secondary arrest of dilatation Arrest 2 hr or more

Arrest of descent Failure of descent

Arrest 1 hr or more No descent in deceleration phase of second stage

1.

Prolonged latent phase of labor (see Figure) Prolonged Latent Phase Pattern (solid line) Etiologic factors that appear to be responsible for the development of prolonged latent phase disorders in multiparas most often include excessive sedation administered during the course of the latent phase and poor prelabor soft-tissue preparation. In addition, false labor and myometrial dysfunction are found but can be diagnosed only retrospectively. (see Figure)

2.

Arrest disorder (see Figure 3) A. Secondary arrest of dilatation pattern with documented cessation of progression in the active phase Prolonged deceleration phase pattern with deceleration phase duration greater than normal limits Failure of descent in the deceleration phase and second stage

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D.

Arrest of descent characterized by halted advancement of fetal station in the second stage.

These four abnormalities are similar in etiology, response to treatment, and prognosis, being readily differentiated from the normal dilatation and descent curves (broken lines). Etiology of arrest disorders are as follows. The striking association with cephalopelvic disproportion makes these disorders especially ominous; whenever encountered, arrest patterns should signal the likelihood that a bony impediment exists. Other factors very often occur in combination with each other and with disproportion as well. (see Figure 4)

V.

Forceps delivery Forceps Figure 5. Showing line of axis traction perpendicular to the plane of the pelvis at which the head is stationed.

VI.

Cesarean delivery (See Figure) Immediately after incising the uterus and fetal membranes, the operators fingers are insinuated between the symphysis pubis and the fetal head until the posterior surface is reached. The head is carefully lifted anteriorly and, as necessary, superiorly to bring it from beneath the symphysis

forward through the uterine and abdominal incisions.

Take Home Points

The progress of labor is measured by evaluating dilatation of the cervix and descent of the presenting part as a function of time. When an abnormality is diagnosed, the cause is identified and the appropriate treatment initiated.

http://library.med.utah.edu/kw/human_reprod/lectures/physiology_labor/