Pregnancy is a unique, exciting and often joyous time in a woman's life, as it highlights the

woman's amazing creative and nurturing powers while providing a bridge to the future. The
processes usually involve labor, it is the process of giving birth. In the normal child birth that is
through the cervix the labor is divided into four stages; the dilation of the cervix, birth of the
baby and the birth of the placenta and the recovery stage. However, these stages are
eliminated if child birth is through caesarean section. The duration of labor differs from a
primipara to a multipara. Primipara takes 14 hours but not more than 20 hours while Multipara
takes 8 hours but not more than 14 hours.

The first stage of labor refers to the onset of contractions to full dilatation and effacement of
the cervix. It is divided into three phases: Latent, Active, Transitional. During the Latent mild
contractions are expected that last 20-40 seconds every 5-10 minutes. During this first phase,
the cervix dilates to about 0- 3 cm in diameter. The mother’s behaviour during this phase is
apprehensive, excited but can communicate. Active labor (phase two) begins when the
cervix reaches 4 to 8 cm in diameter. Contractions are usually moderate in intensity that last
30 – 60 seconds every 3-5 minutes. Mother feels fear of losing control of herself. The third
phase is the "transition". During transition, the cervix dilates to between 8 and 10 centimetres.
Contractions during this phase will last about 45-90 seconds every 2 -3 minutes. This is often
the most difficult phase, but it is also the shortest in duration. There’s a sudden behavioural
change of the mother usually accompanied by hyperesthesia of the skin (hypersensitivity of
the mother to touch). The second stage of labor refers to the complete dilatation and
effacement to birth of the baby also known as the Fetal stage. During this phase, mothers
are encouraged to push or bear down with their pelvic muscles when they feel contractions.
Bulging of perineum is the surest sign that the baby is about to be delivered. It is important to
advice mother to do panting, breathing exercise much like blowing a feather. Modified
Ritgen’s Maneuver is done to properly deliver the baby and prevent perineal lacerations and
extension of episiotomy into rectum. Occasionally, completions occurring during this second
stage of labor may require a procedure called an Episiotomy, which is an incision that is cut
between the vagina and the anus to enlarge the vaginal opening so that the infant can
more easily exit the vagina. Episiotomies are repaired with stitches following the birth.

The third stage of labor refers to the birth of the baby up to expulsion of placenta also known
as the Placental stage. Placenta is delivered usually 3-10 minutes after the delivery of the
baby. Signs of placental separation includes fundus becomes globular and firm, rising high to
the umbilicus, Lengthening of the cord and lastly sudden gush of blood from the vagina. Do
not hurry the expulsion of placenta as this can cause uterine inversion just watch for the signs
of placental separation. Brandt Andrews maneuver is done so that no membranes are left
inside the uterus. Oxytocin is also administered following the birth of the baby as this maintain
uterine contraction post delivery to prevent haemorrhage. Lastly, the fourth stage of labor
occurs during the first 1-2 hours after placental delivery also known as the recovery stage.
Immediately after delivery, it is palpable between umbilicus and symphysis pubis; two hours
after delivery, the fundus is at the same height with umbilicus. Always check for bladder
distention, determine voiding pattern because a full bladder can lead to uterine atony
leading to haemorrhage. Monitor for the presence of lochia, post-partum vaginal discharge
it should be moderate in amount as well as the perineum observe for redness, edema,
ecchymosis, discharges and approximation. Then mostly importantly during this stage,
promote maternal- infant bonding. Savor this special time with your baby. Your preparation,
pain and effort have paid off. Revel in the miracle of birth.