INTRODUCTION

Pregnancy is the state of carrying a developing embryo or fetus within the female body.
This condition can be indicated by positive results on an over-the-counter urine test, and confirmed
through a blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about
nine months, measured from the date of the woman's last menstrual period (LMP). It is
conventionally divided into three trimesters, each roughly three months long.
When gestation has completed, it goes through a process called delivery, where the
developed fetus is expelled from the mother’s womb. There are two options of delivery: Cesarean
section and NSVD or normal spontaneous vaginal delivery. A cesarean section is a surgical
incision through the mother’s abdomen and uterus to deliver one or more fetuses. NSVD or normal
spontaneous vaginal delivery is the delivery of the baby through vaginal route. It can also be called
NSD or normal spontaneous delivery, or SVD or spontaneous vaginal delivery, where the mother
delivers the baby with effort and force exertion.
Vaginal delivery is the method of childbirth most health experts recommend for women
whose babies have reached full term. Compared to other methods of childbirth, such as a cesarean
delivery and induced labor, it’s the simplest kind of delivery process.
Most experts also recommend vaginal births for women with low-risk pregnancies. And
indeed research shows that vaginal births may have a positive impact on a child’s health and
particularly in developing the child’s immune system. In cases of high-risk pregnancies, however,
cesarean sections can have life-saving results.
A normal spontaneous vaginal delivery (NSVD) occurs when a pregnant female goes into
labor without the use of drugs or techniques to induce labor, and delivers her baby in the normal
manner, without forceps, vacuum extraction, or a cesarean section. This occurs after a pregnant
woman goes through labor. Labor opens, or dilates, her cervix to at least 10 centimeters. Labor
usually begins with the passing of a woman’s mucous plug. This is a clot of mucous that protects
the uterus from bacteria during pregnancy. Soon after, a woman’s water may break. This is also
called a rupture of membranes. The water might not break until well after labor is established, even
right before delivery. As labor progresses, strong contractions help push the baby into the birth
canal.
ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM

EXTERNAL FEMALE GENITALIA

The overview of the female reproductive system begins at the external genital area or also
knows as the Vulva which runs from the pubic area downward to the rectum. A rounded mound
of fatty tissue that covers the pubic bone in the external genitalia of women is called the “Mons
Pubis”. During puberty, it becomes covered with hair. The mons pubis contains oil-secreting
(sebaceous) glands that release substances that are involved in sexual attraction (pheromones).
The labia majora are relatively large, fleshy folds of tissue that enclose and protect the other
external genital organs. The labia majora is comparable to the scrotum in males. ---The labia
majora also contain sweat and sebaceous glands, which produce lubricating secretions
The labia minora can be very small or up to 2 inches wide which lie just inside the labia
majora and surround the openings to the vagina and urethra. A rich supply of blood vessels gives
the labia minora a pink color. During sexual stimulation, these blood vessels become engorged
with blood, causing the labia minora to swell and become more sensitive to stimulation. The area
between the opening of the vagina and the anus, below the labia majora, is called the perineum.
The perineum varies in length from almost 1 to more than 2 inches (2 to 5 centimeters). The labia
majora and the perineum are covered with skin similar to that on the rest of the body. In contrast,
the labia minora are lined with a mucous membrane, whose surface is kept moist by fluid secreted
by specialized cells. The opening to the vagina is called the introitus. The vaginal opening is the
entryway for the penis during sexual intercourse and the exit for blood during menstruation and
for the baby during birth.
When stimulated, the Bartholin glands located beside the vaginal opening, secretes a thick
fluid that supplies lubrication for intercourse. The opening to the urethra, which carries urine from
the bladder to the outside, is located above and in front of the vaginal opening. The clitoris, located
between the labia minora at their upper end, is a small protrusion that corresponds to the penis in
the male. The clitoris, like the penis, is very sensitive to sexual stimulation and can become erect.
Stimulating the clitoris can result in an orgasm.

INTERNAL FEMALE GENITALIA

The Vagina
The vagina is the female organ of copulation and receives the penis during intercourse. It
is a muscular, ridged sheath connecting the external genitals to the uterus, where the embryo grows
into a fetus during pregnancy.
The Cervix
The cervix is the narrower, inferior part of the uterus. After intercourse, sperm ejaculated
in the vagina pass through the cervix, and then proceed through the uterus to the fallopian tubes
where, if a sperm encounters an ovum (egg), conception occurs. The cervix is lined with mucus,
the quality and quantity of which is governed by monthly fluctuations in the levels of the two
principle sex hormones, estrogen and progesterone.
When estrogen levels are low, the mucus tends to be thick and sparse, which makes it
difficult for sperm to reach the fallopian tubes. But when an egg is ready for fertilization and
estrogen levels are high the mucus then becomes thin and slippery, offering a much friendlier
environment to sperm as they struggle towards their goal.
The Uterus
The uterus or womb is the major female reproductive organ of humans. One end, the cervix,
opens into the vagina; the other is connected on both sides to the fallopian tubes.
The uterine wall is composed of three layers: the Perimetrium, Myometrium, and Endometrium.
The Perimetrium is the outer serosa layer of the uterus, equivalent to peritoneum. The Myometrium
is the middle layer and is consists of a thick layer of smooth muscle. This part accounts for the
bulk of the uterine wall and is the thickest layer of the smooth muscle in the body. Its major
function is to accept a fertilized ovum which becomes implanted into the endometrium, and derives
nourishment from blood vessels which develop exclusively for this purpose. The fertilized ovum
becomes an embryo, develops into a fetus and gestates until childbirth. The Endometrium is the
mucous membrane or the innermost lining layer of the uterus which functions to prevent adhesions
between the opposed walls of the myometrium.
The Fallopian Tubes
The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female
mammals into the uterus. On maturity of an ovum, the follicle and the ovary's wall rupture,
allowing the ovum to escape and enter the Fallopian tube. There it travels toward the uterus, pushed
along by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If the
ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium when
it reaches the uterus, which signals the beginning of pregnancy.
The Ovaries
The ovaries are the place inside the female body where ova or eggs are produced. The
process by which the ovum is released is called ovulation. The speed of ovulation is periodic and
impacts directly to the length of a menstrual cycle. After ovulation, the ovum is captured by the
oviduct, where it travelled down the oviduct to the uterus, occasionally being fertilized on its way
by an incoming sperm, leading to pregnancy and the eventual birth of a new human being. The
Fallopian tubes or also known as oviducts have small hairs (cilia) to help the egg cell travel.
MECHANISMS (CARDINAL MOVEMENTS) OF LABOR
Effective passage of a fetus through the birth canal involves not only position and
presentation but also a number of different position changes in order to keep the smallest
diameter of the fetal head (in cephalic presentations) always presenting to the smallest diameter.
These position changes are termed the cardinal movements of labor: engagement, descent,
flexion, internal rotation, extension, external rotation, and expulsion.

1. Engagement

Refers to the settling of the presenting part of a fetus far enough into the pelvis that it rests at the
level of the ischial spines, the midpoint of the pelvis.
2. Descent

The downward movement of the biparietal diameter of the fetal head within the pelvic inlet. Full
descent occurs when the fetal head protrudes beyond the dilated cervix and touches the posterior
vaginal floor.
3. Flexion

As descent is completed and the fetal head touches the pelvic floor, the head bends forward onto
the chest, causing the smallest anteroposterior diameter (the suboccipitobregmatic diameter) to
present to the birth canal.
4. Internal Rotation

During descent, the biparietal diameter of the fetal skull was aligned to fit through the
anteroposterior diameter of the mother’s pelvis. As the head flexes at the end of descent, the
occiput rotates so the head is brought into the best relationship to the outlet of the pelvis, or the
anteroposterior diameter is now in the anteroposterior plane of the pelvis. This movement brings
the shoulders, coming next, into the optimal position to enter the inlet, or puts the widest
diameter of the shoulders (a transverse one) in line with the wide transverse diameter of the inlet.
5. Extension

As the occiput of the fetal head is born, the back of the neck stops beneath the pubic arch and
acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head, the
face and chin, are born.
6. External Rotation

In external rotation, almost immediately after the head of the infant is born, the head rotates a
final time (from the anteroposterior position it assumed to enter the outlet) back to the diagonal
or transverse position of the early part of labor. This brings the after coming shoulders into an
anteroposterior, which is best for entering the outlet. The anterior shoulder is born first, assisted
perhaps by downward flexion of the infant’s head.
7. Expulsion

Once the shoulders are born, the rest of the baby is born easily and smoothly because of its
smaller size. This movement, called expulsion, is the end of the pelvic division of labor.

FETAL PRESENTATION AND POSITION

Other factors that play a part in whether a fetus is properly aligned in the pelvis and is in the
best position to be born are fetal attitude, fetal lie, fetal presentation, and fetal position.

1. Attitude. Describe the degree of flexion a fetus assumes during labor or the relation of
the fetal parts to each other.

2. Lie. Relationship between the long (cephalocaudal) axis of the fetal body and the long
(cephalocaudal) axis of a woman’s body.

3. Presentation. Denotes the body part that will first contact the cervix or be born first and
is determined by the combination of fetal lie and the degree of fetal flexion.

 Cephalic Presentation is the most frequent type of presentation, occurring as often as 96%
of the time. With this type of presentation, the fetal head is the body part that first contacts
the cervix.

 Breech Presentation means either the buttocks or the feet are the first body parts that will
contact the cervix. Breech presentations occur in approximately 4% of births and we are
affected by fetal attitude the same as vertex

 Shoulder Presentation. In a transverse, a fetus lies horizontally in the pelvis so the longest
fetal axis is perpendicular to that of the mother. The presenting part is usually one of the
shoulders, an iliac crest, a hand, or an elbow.

4. Position. Relationship of the presenting part to a specific quadrant and side of a

woman’s pelvis.

5. Engagement. Refers to the settling of the presenting part of a fetus far enough into the
pelvis that it rests at the level of the ischial spines, the midpoint of the pelvis.

6. Station. Refers to the relationship of the presenting part of the fetus to the level of the
ischial spines.

 When the presenting fetal part is at the level of the ischial spines, it is at a 0 station
 If the presenting part is above the spines, the distance is measured and described as minus
stations, which range from -1 to -4 cm.
SIGNS OF LABOR
 Effacement: Thinning of the cervix

Before labor, the lower part of your uterus called the cervix is typically 3.5 cm to 4 cm long. As
labor begins, your cervix softens, shortens and thins (effacement). You might feel
uncomfortable, but irregular, not very painful contractions or nothing at all.

 Dilation: Opening of the cervix

Another sign of labor is your cervix beginning to open (dilate). Your health care provider will
measure the dilation in centimeters from zero (no dilation) to 10 (fully dilated).

At first, these cervical changes can be very slow. Once you're in active labor, expect to dilate
more quickly.

 Increase in vaginal discharge

During pregnancy, a thick plug of mucus blocks the cervical opening to prevent bacteria from
entering the uterus. During the late third trimester, this plug might be pushed into your vagina.
You might notice an increase in vaginal discharge that's clear, pink or slightly bloody. This
might happen several days before labor begins or at the start of labor.

If vaginal bleeding is as heavy as a normal menstrual period, however, contact your health care
provider immediately. Heavy vaginal bleeding could be a sign of a problem.

 Nesting: Spurt of energy

You might wake up one morning feeling energetic, eager to fill the freezer with prepared meals,
set up the crib and arrange your baby's outfits according to color. This urge is commonly known
as the nesting instinct.

Nesting can begin at any time during pregnancy but for some women it's a sign that labor is
approaching.

 Feeling the baby has dropped lower

Lightening is the term used to describe when the baby's head settles deep into your pelvis. This
might cause a change in the shape of your abdomen. This change can happen anywhere from a
few weeks to a few hours before labor begins.

 Rupture of membranes: Your water breaks

The amniotic sac is a fluid-filled membrane that cushions your baby in the uterus. At the
beginning of or during labor, your membranes will rupture — also known as your water
breaking.
When your water breaks you might experience an irregular or continuous trickle of small
amounts of watery fluid from your vagina or a more obvious gush of fluid. If your water breaks
— or if you're uncertain whether the fluid is amniotic fluid, urine or something else — consult
your health care provider or head to your delivery facility right away. You and your baby will be
evaluated to determine the next steps.

Once your amniotic sac is no longer intact, timing becomes important. The longer it takes for
labor to start after your water breaks — if it hasn't started already — the greater you or your
baby's risk of developing an infection. Your health care provider might stimulate uterine
contractions before labor begins on its own (labor induction).